p.3
Impact of Surgical Menopause and Benefits of Hormone Replacement Therapy (HRT)
What is the relationship between RRSO and bone health?
RRSO is associated with elevated bone turnover markers and increased risk of osteopenia and osteoporosis.
p.3
Types and Administration of HRT
What should be considered when continuing HRT after the age of natural menopause?
Informed discussion regarding the risks and benefits based on individual circumstances and medical history.
p.7
Impact of Surgical Menopause and Benefits of Hormone Replacement Therapy (HRT)
What is essential for women following premenopausal oophorectomy?
HRT should be offered until the age of natural menopause if not contraindicated.
p.1
Indications and Timing for RRSO
Why is oophorectomy alone considered inadequate for prevention?
It is clinically inappropriate; both tubes and ovaries must be removed.
p.7
Types and Administration of HRT
Which medications have shown to be the most effective for menopausal symptoms?
Venlafaxine, paroxetine, and citalopram.
p.4
Types and Administration of HRT
What is tibolone and its uses?
A synthetic steroid with estrogenic, progestogenic, and androgenic activity used for continuous combined HRT to treat symptoms following surgical menopause.
p.4
Types and Administration of HRT
What are the reported effects of transdermal testosterone?
Improves sexual activity, orgasms, desire, and positively impacts Personal Distress Scale scores in women with hypoactive sexual dysfunction.
p.5
Alternatives to HRT for Managing Menopausal Symptoms
What are the first-line options for breast cancer patients with vaginal/urogenital symptoms?
Non-hormonal approaches, such as lubricants and moisturizers.
p.3
Adverse Effects and Contraindications of HRT
What are some potential negative consequences of early surgical menopause in low-risk women?
Increased incidence of neurocognitive impairment, dementia, and parkinsonism.
p.1
Screening Tools and Their Limitations
What was the outcome of the UKCTOCS study regarding screening?
Did not show a delayed mortality benefit.
p.6
Adverse Effects and Contraindications of HRT
What are the main contraindications to HRT after RRSO?
History of breast cancer and personal history of VTE/thrombophilia.
p.2
Indications and Timing for RRSO
What factors should be considered in the decision-making process for RRSO?
Clinical factors and personal preference.
p.6
Alternatives to HRT for Managing Menopausal Symptoms
How effective is cognitive behavioural therapy (CBT) for menopausal symptoms?
CBT has been shown to be helpful in reducing vasomotor symptoms and improving mood.
Is routine monitoring of endometrial thickness necessary while using HRT?
No, it is not necessary for topical or systemic HRT.
p.7
Types and Administration of HRT
What are some pharmacological options for treating menopausal symptoms?
SSRIs, SNRIs, clonidine, gabapentin, and beta-blockers.
p.5
Adverse Effects and Contraindications of HRT
In which type of breast cancer can HRT be considered for short-term use?
Triple-negative breast cancer.
p.5
Types and Administration of HRT
What should be considered if non-hormonal options are ineffective for debilitating symptoms?
Short-term topical estrogen at the lowest effective vaginal dose, following specialist advice.
p.4
Indications and Timing for RRSO
What is the recommendation for continuing HRT beyond 51 years in high-risk women?
Safety data are lacking, and its use is not routinely recommended; decisions should involve clinical discussion.
p.5
Adverse Effects and Contraindications of HRT
What is the risk of stroke in low-risk women with premature ovarian insufficiency?
The absolute risk of stroke is low.
p.4
Types and Administration of HRT
What are the delivery methods for progestogens?
Orally, transdermally, or via a progestogen-releasing intrauterine system.
p.4
Impact of Surgical Menopause and Benefits of Hormone Replacement Therapy (HRT)
How does premenopausal oophorectomy affect androgen levels?
It reduces free androgen index levels by 50%.
p.7
Multidisciplinary Approach to Care and Patient Education
What is the importance of multidisciplinary input for women post-RRSO?
To provide evidence-based information, advice on HRT, symptom management, and sustained support.
When should HRT therapy be reviewed after starting treatment?
After 3 months and annually thereafter.
p.7
Types and Administration of HRT
What is the recommended dosage for venlafaxine for menopausal symptoms?
37.5 mg titrated up to 150 mg/day.
p.1
Risk-Reducing Salpingo-Oophorectomy (RRSO) and Its Effectiveness
What is the most effective method of prevention for women at increased risk of ovarian cancer?
Risk-reducing salpingo-oophorectomy (RRSO).
p.4
Adverse Effects and Contraindications of HRT
What should be done if persistent irregular vaginal bleeding occurs after HRT?
It requires investigation.
p.2
Impact of Surgical Menopause and Benefits of Hormone Replacement Therapy (HRT)
What is a potential consequence of undergoing RRSO?
Premature iatrogenic menopause.
p.6
Alternatives to HRT for Managing Menopausal Symptoms
What alternatives to HRT can women consider for menopausal symptoms?
Pharmacological, non-pharmacological, and complementary treatments.
p.2
Benefits of Hormone Replacement Therapy (HRT)
What is the role of HRT after RRSO?
To ameliorate symptoms associated with iatrogenic menopause.
p.3
Types and Administration of HRT
When should HRT be initiated for women undergoing RRSO?
Immediately postoperatively and recommended until the mean age of natural menopause (around 51 years).
p.2
Indications and Timing for RRSO
When should RRSO ideally be carried out?
Preferably near or after menopause.
p.7
Lifestyle Recommendations for Women Post-RRSO
What lifestyle advice can help manage menopausal symptoms?
Regular aerobic exercise, weight management, adequate sleep, and avoiding symptom triggers.
What should prompt investigations after starting HRT?
Specific symptoms or concerns, such as unexpected bleeding.
How does E + P-HRT compare to E-HRT in terms of breast cancer risk in low-risk women?
E + P-HRT is associated with increased breast cancer risk, while E-HRT has a better risk profile.
p.1
Indications and Timing for RRSO
In which women is RRSO traditionally offered?
BRCA1/BRCA2 carriers and women with Lynch syndrome.
p.3
Types and Administration of HRT
What type of HRT should be used in women who have undergone hysterectomy?
Estrogen-only HRT (E-HRT).
p.7
Lifestyle Recommendations for Women Post-RRSO
What is the recommended total intake of calcium and vitamin D3?
1200 mg/day of calcium and 600 – 1000 IU/day of vitamin D3.
p.5
Multidisciplinary Approach to Care and Patient Education
What should be involved in the decision-making process for HRT use in breast cancer patients?
A multidisciplinary team including the woman, a breast oncologist, and a menopause specialist.
p.2
Indications and Timing for RRSO
Who should be consulted for complex ovarian cancer risk assessments?
A specialist such as a clinical geneticist or gynaecologist with expertise in genetic risk assessment.
What is the compliance rate of HRT after RRSO in BRCA carriers?
Reported rates vary from 25% to 60%, with higher rates of approximately 74% in specialist centres.
p.6
Alternatives to HRT for Managing Menopausal Symptoms
What improvements were noted in a small study of women following RRSO using psychosexual interventions?
Significant improvements in sexual desire, arousal, and satisfaction.
p.3
Types and Administration of HRT
What is the benefit of transdermal estrogens compared to oral preparations?
Lower risk of venous thromboembolism (VTE), stroke, and myocardial infarction.
p.4
Adverse Effects and Contraindications of HRT
What are the concerns regarding testosterone therapy in women?
Lack of data specific to high-risk women and unknown impact on breast cancer risk.
p.5
Alternatives to HRT for Managing Menopausal Symptoms
What is Ospemifene and its potential use?
A selective estrogen receptor modulator that may benefit symptomatic vulvar and vaginal atrophy.
p.5
Adverse Effects and Contraindications of HRT
What is the recommendation for women at increased risk of VTE regarding HRT?
Transdermal HRT should be considered instead of oral preparations.
p.4
Adverse Effects and Contraindications of HRT
Which form of progestogen is associated with fewer adverse effects?
Progestogen-releasing intrauterine system.
p.7
Risk-Reducing Salpingo-Oophorectomy (RRSO) and Its Effectiveness
What is the role of RRSO in women with a 5-10% lifetime risk of ovarian cancer?
It is emerging as a preventive measure for ovarian cancer.
p.1
Adverse Effects and Contraindications of HRT
What is the impact of oophorectomy on long-term health in low-risk women under 50 who do not use HRT?
Potentially lower survival.
p.2
Impact of Surgical Menopause and Benefits of Hormone Replacement Therapy (HRT)
What symptoms can iatrogenic menopause due to RRSO cause?
Vasomotor symptoms, mood changes, sleep disturbance, reduced libido, vaginal dryness, dyspareunia, and poorer sexual functioning.
p.3
Adverse Effects and Contraindications of HRT
What is the reported risk of heart disease associated with premenopausal oophorectomy?
Increased risk and up to 3% absolute increase in mortality from heart disease in low-risk women.
p.5
Adverse Effects and Contraindications of HRT
Why is HRT usually contraindicated for women with a personal history of breast cancer?
Because of estrogen receptor-positive status.
p.4
Types and Administration of HRT
What benefits does testosterone replacement provide?
It may benefit women experiencing low energy levels and reduced libido despite adequate estrogen replacement.
What does research say about HRT use in BRCA1/BRCA2 carriers after premenopausal RRSO?
Short-term HRT has not been shown to increase breast cancer risk or negate protective effects.
What is the role of DEXA scanning in women post-RRSO?
To assess bone mineral density (BMD) and osteoporosis risk.
p.5
Adverse Effects and Contraindications of HRT
What is the risk associated with oral HRT?
Increased risk of venous thromboembolism (VTE), especially during the first year of treatment.
p.1
Types and Administration of HRT
What is indicated to relieve menopausal symptoms and prevent complications post-RRSO?
Hormone Replacement Therapy (HRT).
p.2
Indications and Timing for RRSO
In which syndrome is routine concomitant hysterectomy justified?
Lynch syndrome, due to increased risk of endometrial cancer.
p.7
Lifestyle Recommendations for Women Post-RRSO
What lifestyle changes are recommended to improve bone health after RRSO?
Maintain a healthy lifestyle, undertake weight-bearing exercise, avoid smoking and excessive alcohol intake, and maintain normal body weight.
p.1
Screening Tools and Their Limitations
What screening tool has been developed for early diagnosis of ovarian cancer?
Risk of Ovarian Cancer Algorithm (ROCA).
p.5
Adverse Effects and Contraindications of HRT
What is the recommendation regarding intravaginal DHEA for women with a history of breast cancer?
Its use is not yet recommended due to insufficient safety data.
p.1
Adverse Effects and Contraindications of HRT
What menopausal symptoms are associated with premenopausal oophorectomy?
Vasomotor symptoms and poorer sexual function.
