A 49 year old woman is referred to the gynaecology clinic complaining of low libido which is now adversely affecting her marriage. She has been on sequential combined hormone replacement therapy for 3 years to manage menopausal symptoms.
Why is the correct answer implant rather than topical use?
BMS suggests use of gels; the implants are not easily available.
Posted by
Katarzyna K.
Options for Questions 11-11
A
Reassure and discharge
B
Explain that risks of HRT outweigh benefits
C
Oral oestrogen + progestogen replacement
D
Oral oestrogen + progestogen replacement for up to 6 months
E
Oral oestrogen + progestogen replacement for up to 12 months
F
Trans-dermal oestrogen + progestogen replacement
G
Oral or trans-dermal oestrogen + progestogen replacement
Instructions: For each scenario described below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.
Explanation
Question 11
A healthy 51 year old woman attends the gynaecology clinic because of severe hot flushes. Her last menstrual period was 3 months ago and she has been having irregular periods every 1-6 months for the last 2 years. She has no significant personal or family history
Could you please advice Why is the answer transdermal, rather than oral or transdermal?
Thank you!
Contraception interactions
Posted by
Katarzyna K.
Options for Questions 10-10
A
30 mcg combined contraceptive pill (COCP)
B
COCP or progestogen-only pill
C
COCP or progestogen implant
D
COCP, progestogen-only pill or progestogen implant
E
COCP or depo-medroxyprogesterone acetate
F
Progestogen implant only
G
Depo-medroxyprogesterone acetate only
H
Cu IUCD only
I
Cu IUCD, progestogen-only pill or progestogen implant
J
COCP or Cu IUCD
K
COCP, Cu IUCD or progestogen implant
Instructions: For the scenario below, choose the single most appropriate management from the above list of options. Each option may be used once, more than once, or not at all.
Explanation
Question 10
A 23 year old woman with epilepsy has a spontaneous vaginal birth at 38 weeks gestation. She has a history of epilepsy treated with lamotrigine. She is not breast-feeding and wishes to discuss contraception. Which option(s) would you recommend?
Why is the correct answer I?
The FSRH guideline on interactions suggests that It is possible that contraceptive effectiveness of combined hormonal contraception, all progestogenonly pills and the etonogestrel implant could be reduced during use of lamotrigine. Should the answer not be H?
Vasomotor symptoms (VMS), hot flushes and night sweats are the hallmarks of menopause, occurring in approximately 75% of postmenopausal women, with 25% of these being severely affected.
The percentage of women reporting hot flushes varies across countries and ethnic backgrounds.
Symptoms may resolve in 2–5 years but the median duration is 7 years and sometimes longer.
Offer HRT to people with vasomotor symptoms associated with menopause
Consider menopause-specific cognitive behavioural therapy (CBT) as an option for vasomotor symptoms associated with menopause:
in addition to HRT or
for people for whom HRT is contraindicated or
for those who prefer not to take HRT
Do not routinely offer SSRIs, SNRIs or clonidine as first-line treatment for vasomotor symptoms alone
All options should be offered but transdermal HRT preferable because of better side-effect profile and lower VTE risk compared to oral HRT.
