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Menopause (Clinical presentation (Night sweats, Sexual dysfunction Loss…

- - - - SEs
        
        Oestrogen
        Weight gain, fluid retention, bloating, tender/enlarged breasts,
        nausea, headaches, leg cramps, dyspepsia
        
        Progesterone
        Fluid retention, breast tenderness, headaches/migraine,
        mood swing, depression, acne, abdo pain, backache
        
        Combined
        Irregular breakthrough bleeds
      - Benefits
        and risks
        
        Benefits
        Reduced vasomotor symptoms (4w, max 3m)
        Reduced urogenital symptoms (months)
        Improved sexuality
        Reduced osteoporosis (fractures, strength)
        Reduced CRC
        
        Risks
        Vascular: VTE (oral>transdermal)
        Cancers: breast (endometrial if unapposed oestrogen)
        Metabolic: Gallbladder disease
      - Types
        
        Oestrogen alone
        Indication: hysterectomy
        Route: PO, transdermal
        
        Oestrogen plus progestrogen
        Indication: no hysterectomy
        MOA: oestrogen and cyclical progesterone (peri-menopausal),
        continous oestrogen/progestrone (no bleeds; post-menopausal)
        Routes: PO, transdermal, vaginal (oestrogen only),
        intrauterine (progesterone only)
      - MOA
        Replaces ovarian hormones to reduce symptoms
        Does NOT act as a contraceptive; potentially fertile women
        will need a non-hormonal contraceptive alongside
        Considered potentially fertile until 2y after LMP if <50, 1y if >50y
      - CIs
        Oestrogen-dependent BC
        Prev VTE
        Undiagnosed PV bleeding
        Pregnancy/breastfeeding
        Abnormal LFTs
      - Monitoring (annual)
        Breasts, vaginal bleeding
        BP, weight
    - - Vasomotor symptoms
        Indication: HRT CI or not wanted
        E.g. SSRI (fluoxetine), SNRI (venlafaxine), clonidine (a-agonist)
      - Osteoporosis prophylaxis
        Indication: osteoporosis risk
        E.g. Ca and vit D, bisphosphonates,
        selective oestrogen reuptake modulators (SERMs)
        MOA: inhibit bone resporption or stimulate formation
      - Urogenital symptoms
        Indication: dryness/atrophy
        E.g. vaginal lubricants or moisturisers,
        oestrogen cream, oestradiol ring, oestadiol vaginal tablets