KEY INFORMATION, EXTRA’S
KEY INFORMATION
- HRT is not a contraceptive
- Fertility continues:
2 years post-last period if <50 years, 1 year post-last period if >50 years
- All women can stop contraception by age 55
- Progesterone-only contraception is safe with cyclical HRT – can help with dysfunctional bleeds.
- HRT can interact with Levothyroxine – the dose may need to be increased & TSH monitoring is needed regularly
EXTRA’S
Adverse effects of HRT:
- VTE: Greater risk in Oral HRT (therefore use transdermal)
- Breast cancer: associated with combined HRT & linked to duration of treatment (risk decreases when HRT is stopped
- Ovarian cancer
- CVD risk: use transdermal form – Oestrogen-related:
- Fluid retention
- Breast tenderness
- Bloating
- Leg cramps
- Progesterone-related:
- Fluid retention
- Breast tenderness
- Acne
- Migraines Mood swings
- Vaginal bleeding:
- Common in the first 4-6 months
- If it persists beyond 6 months, consider transvaginal USS and if abnormal, consider a
2-week cancer referral to rule out endometrial pathology
- If sinister pathology is excluded, you can alter the Progesterone part of the regimen:
o Increase the dose/duration of the progesterone part
o Or switch to a different formulation: Mirena coil + Oral/Patch Oestrogen Benefits of HRT:
- Reduced fragility fractures (osteoporosis) – both HRT & CHC provide good bone protection