CPD Unscheduled Bleeding with HRT

Unscheduled bleeding with hormone replacement therapy

Regarding menopause,

1. it is defined by the World Health Organization 1996 declaration as the permanent cessation of menstruation resulting from the loss of ovarian follicular activity. T ⬜ F⬜
2. it is the last menstrual bleed diagnosed retrospectively after 1 year of amenorrhoea in the absence of any pathologic disorder that could be responsible for the amenorrhoea. T ⬜ F ⬜
3. in the UK, the median age is 50.8 years. T ⬜ F ⬜
4. follicle‐stimulating hormone (FSH) is the first gonadotrophin to rise in the biological ageing process. T ⬜ F ⬜
5. the findings of plasma estradiol below 20 pg/ml (range 5–25 pg/ml) as well as an elevated FSH >100mU/ml are consistent with cessation of ovarian function. T ⬜ F ⬜

Regarding vasomotor symptoms and menopause,

6. the ‘domino effect' of hormone replacement therapy (HRT) refers to the reduction in anxiety, depression and cognitive disorders by its positive impact on vasomotor symptoms. T ⬜ F ⬜
7. hot flushes occur in about 70–80% of women who go through physiological menopause. T ⬜ F ⬜

Regarding osteoporosis and menopause,

8. menopause predisposes to type 2 osteoporosis. T ⬜ F ⬜
9. postmenopausal osteoporosis is responsible for fractures in one of every two postmenopausal women. T ⬜ F ⬜

Regarding postmenopausal HRT,

10. it increases muscle mass and maintains strength. T ⬜ F ⬜
11. it is indicated as first‐line in women with premature menopause. T ⬜ F ⬜
12. the National Institute for Health and Care Excellence (NICE) says the lowest effective dose should be used for the shortest possible period. T ⬜ F ⬜
13. combined continuous therapy is recommended in perimenopausal women. T ⬜ F ⬜
14. combined continuous therapy has a lower risk of endometrial cancer. T ⬜ F ⬜

Regarding bleeding and HRT,

15. up to 80% of women on combined continuous HRT will experience unscheduled bleeding or spotting in the first 6 months of treatment. T ⬜ F ⬜
16. NICE recommends reporting any unscheduled bleeding if it occurs after the first 6 months of therapy. T ⬜ F ⬜
17. unscheduled or abnormal bleeding is responsible for 25–50% of women stopping HRT. T ⬜ F ⬜

Regarding investigations and treatment for unscheduled bleeding during HRT,

18. hysteroscopy with endometrial sampling remains the gold standard for uterine cavity evaluation in the UK. T ⬜ F ⬜
19. using a cut‐off reference of 5 mm endometrial thickness on transvaginal ultrasound, the risk of endometrial cancer in postmenopausal women decreases by 90% for those with thickness < 5 mm, regardless of hormone use. T ⬜ F ⬜
20. endometrial biopsy has been shown to miss up to 20% of focal lesions like endometrial polyps. T ⬜ F ⬜

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