HRT

• Clinical Indications of HRT:

  Induce puberty

  Prevent long term symptoms in POI

  Menopause relief

  Prevent osteoporosis

  IVF
• Regime for no uterus: oestrogen only
• Regime for a uterus with less than a year since last period: sequential or continuous progesterone and continuous oestrogen
• Regime for women with a uterus and longer than a year since LMP: continuous oestrogen and progesterone
• Tibolone?

  MOA: regulates enzymes in bone, uterus and breast

  Indications: >1yr from LMP

  Without added progesterone
• SE of systemic HRT?

  Vaginal bleeding

  Stroke

  VTE

  Increased breast cancer risk

  Inducers of liver enzymes lower hormone amount circulating