Q] Hormone replacement therapy ( HRT) in a post menopausal women is not indicated for……[AIIMS MAY 2013]
[B] Cardiovascular manifestation
[C] Urogenital atrophy
H0RMONE REPLACEMENT THERAPY IN POSTMENOPAUSAL STAGE
Perimenopausal and menopausal women present with wide spectrum and variable intensity of symptoms resulting from decreased circulating levels of estrogens.
The most common presentation of menopause is vasomotor instability leading to hot flashes (hot flushes), sweating, and palpitations.
Presenting symptoms include the following :-
 Vasomotor system: Vasomotor instability hot flashes (hot flushes), sweating, and palpitations.
 Urogenital system: Atrophy and thinning of the mucosal lining of the urogenital system( loss of vaginal elasticity and distensibility)
 Bone : progressive osteoporosis
 Cardiovascular system : Increased susceptibility to heart disease
 Neurologic symptoms: Mood changes, insomnia, depression, anxiety
How is HRT given?
HRT CONSISTS OF :-
Combined estrogen and progestogen
Selective estrogen receptor modulator (SERM)
Gonadomimetics, such as tibolone
Schedules of HRT :-
Cyclic or sequential regimens: Progestogen is added for 10-14 days every 4 weeks
Continuous combined regimens: Estrogen + progestogen (taken daily)
INDICATIONS OF HRT
 To relieve vasomotor symptoms
 To improve urogenital symptoms
 To prevent osteoporosis
NOTE : Current clinical guidelines do not recommend routine hormone therapy for cvs problems in postmenopausal women.
So the ans to the asked mcq is [B] Cardiovascular manisfestation.
CONTRAINDICATIONS TO HRT : Relative contraindications are as a history of breast cancer/endometrial cancer , Porphyria, Severe active liver disease, Hypertriglyceridemia, Thromboembolic disorders, Undiagnosed vaginal bleeding, Endometriosis, Fibroids.
POTENTIAL RISKS OF HRT :
Breast cancer (slightly increased risk after at least 5 years of continuous use )
Endometrial cancerand uterine hyperplasia