Course Content
Management of Ischaemic Heart Disease
0/5
Pathophysiology & Clinical Presentation
13:40
Pharmacological Management
14:35
Non-Pharmacological Interventions
05:25
Patient Education & Adherence Strategies
05:17
End of Topic Quiz
00:20:00
Anticoagulants & Antiplatelet Therapy
0/4
Mechanisms of Action of Anticoagulants & Antiplatelets
05:30
Indications, Dosing, & Monitoring of Anticoagulation Therapy
06:27
Management of Bleeding Risks & Reversal Strategies
03:49
End of Topic Quiz
00:20:00
Management of Diabetes Mellitus
0/5
Overview of Type 1 & Type 2 Diabetes Management
03:45
Pharmacological Treatments
08:05
Monitoring of Blood Glucose & HbA1c
05:22
Managing Complications
09:20
End of Topic Quiz
00:20:00
Hormone Replacement Therapy
0/4
Indications for Hormone Replacement
09:47
Risks & Benefits of Hormone Therapy
08:15
Monitoring & Adjusting Hormone Therapy
End of Topic Quiz
Asthma & COPD Management
0/5
Pathophysiology of Asthma & COPD
07:26
Pharmacological Treatments
Inhaler Technique & Patient Education
05:03
Acute Management
06:56
End of Topic Quiz
00:20:00
Immunotherapy in Respiratory Diseases
0/4
Role of Immunotherapy in Allergic Asthma
01:00
Mechanisms & Types of Immunotherapy
13:50
Monitoring Response and Adverse Effects to Immunotherapy
End of Topic Quiz
00:20:00
Heart & Respiratory Disease Management
About Lesson

What is HRT?

  • Hormone Replacement Therapy (HRT), also known as Hormone Therapy (HT), is used to relieve menopausal symptoms by replacing hormones that the body reduces production of during menopause.

Menopause Overview

  • Definition: Permanent end of ovarian function.
  • Average Age: 51 years.
  • Symptoms: Hot flashes, night sweats, vaginal dryness, painful intercourse, mood swings, depression, irritability, insomnia, and urinary incontinence.

Types of HRT

  1. Estrogen Therapy:

    • Only oestrogen; typically starts with a low dose.
    • Forms: Pills, patches, gels, rings, creams, tablets, sprays.
    • Recommended post-hysterectomy due to reduced long-term risks.

  2. Combination Therapy (Estrogen-Progesterone):

    • Oestrogen + progesterone, for women with a uterus to lower uterine cancer risk.
    • Forms: Pills, patches, IUDs.

Administration Methods

  • Systemic HRT: Hormones enter the bloodstream, treating general menopausal symptoms like hot flashes and night sweats. Forms include pills, patches, sprays, and gels.

  • Local HRT: Direct application to treat vaginal dryness with lower hormone doses. Forms include creams, rings, and tablets.

Indications for HRT

  1. Moderate-to-Severe Vasomotor Symptoms: For perimenopausal and early postmenopausal women with symptoms like hot flashes.

  2. Vaginal Symptoms Only: Preferable to use local oestrogen.

  3. Premature Ovarian Insufficiency (POI): HRT or hormonal contraceptives help manage early menopause symptoms in women under 40.

  4. Osteoporosis Prevention: FDA-approved HRT regimens are available, though not recommended solely for osteoporosis by USPSTF.

  5. Female Sexual Interest and Arousal Disorder (FSAID): Testosterone supplementation may be added to HRT after excluding other causes.

Age Considerations

  • Under 50: Benefits of HRT generally outweigh risks.
  • 50-60: HRT benefits typically outweigh risks.
  • Over 60: Risks and benefits balance, so treatment should be individualised.
  • Over 70: Risks often outweigh benefits.

Important Notes on HRT

  • Not for Disease Prevention: HRT is not indicated for preventing cardiovascular disease, cancer, stroke, dementia, or other chronic conditions.
  • Inclusion of Progesterone: Women with an intact uterus should include progesterone with estrogen to prevent endometrial cancer.
  • Avoid Compounded Formulations: Compounded HRT lacks standardisation in safety, efficacy, and consistency.
  • Shared Decision-Making: Patient values and preferences are central to HRT decisions, requiring thorough provider consultation.

References

  1. Martin, K. A., & Barbieri, R. L. (2020). Hormone Therapy for the Management of Menopausal Symptoms. In StatPearls. StatPearls Publishing.

  2. GP Notebook. Clinical Indications for Hormone Replacement Therapy (HRT).

  3. Cleveland Clinic. Hormone Therapy for Menopause Symptoms.

  4. Mayo Clinic. Hormone Therapy: Is it Right for You?.

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