MMED 11
HORMONAL REPLACEMENT
THERAPY
IN GYNAECOLOGY
Introduction
No absolute contraindications of
hormone therapy have been
established. However, HT is relatively
contraindicated in certain clinical
situations, such as patients with the
following findings:
A history of breast cancer
A history of endometrial cancer (see Uterine Cancer and
Endometrial Carcinoma)
Porphyria
Severe active liver disease
Hypertriglyceridemia
Thromboembolic disorders (see
Deep Venous Thrombosis and Pulmonary Embolism)
Undiagnosed vaginal bleeding (see
Dysfunctional Uterine Bleeding )
Endometriosis
Fibroids
Pretreatment Evaluation
Personal history
Social history
Obstetric history
Gynecologic history
Menstrual and sexual history
Previous medical history (eg, of diabetes, hypertension,
jaundice, gallstones, hepatic disease, thrombosis)
Previous surgical interventions
Menopausal symptoms
Psychiatric problems
Skeletal symptoms
Psychomotor symptoms
Components of the physical examination
Height measurement
Weight measurement
Determination of an obesity index (see
Obesity)
Blood pressure measurement (see
Hypertension)
Breast examination
Abdominal examination
Pelvic examination
Rectal examination
Required baseline investigations
Hemography
Urinalysis
Evaluation of the fasting lipid profile
Measurement of blood sugar levels
Electrocardiography
Papanicolaou test
Ultrasonography to measure endometrial thickness and ovarian
volume
Mammography, which is performed once every 2-3 years and
annually after the age of 50 years (see
Mammography - Computer-Aided Detection)
Determination of serum estradiol levels in women who will be
prescribed an implant and in women whose symptoms persist
despite use of an adequate dose of a patch or gel
Determination of serum follicle-stimulating hormone
(FSH) levels: FSH values may be used to monitor
women who are taking oral preparations for
symptomatic control, especially those with premature
menopause.
Endometrial sampling: This test is not required in
routine practice. If abnormal bleeding is present before
or during HT, ultrasonography is recommended to
check endometrial thickness (cutoff, <4 mm), followed
by outpatient Pipelle sampling and hysteroscopy. In
patients with a tight cervix, formal hysteroscopy and
dilation and curettage under general anesthesia are
advised
Adverse Effects and Risks of Hormone Therapy