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HRT- Explaining the risks to patients

HRT- Explaining the risks to patients . Tasneem Siddiqui. Introduction. Brief summary of HRT History of HRT use HRT risks How I would explain risks Summary. What is HRT . Hormone preparations combined or oestrogen only Patches, topical, oral Relief of menopausal symptoms

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HRT- Explaining the risks to patients

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  1. HRT- Explaining the risks to patients Tasneem Siddiqui

  2. Introduction • Brief summary of HRT • History of HRT use • HRT risks • How I would explain risks • Summary

  3. What is HRT • Hormone preparations • combined or oestrogen only • Patches, topical, oral • Relief of menopausal symptoms • 80% women experience menopausal symptoms and 45% find these distressing • Flushes, night sweats, loss of libido • Also used in prevention of osteoporosis in high risk patients • HRT can be very effective in relieving these symptoms

  4. Risk of HRT • Women's Health Initiative (WHI) study and Million Women Study (MWS) • Doubles the risk of Breast cancer and VTE • ’29% increased risk of heart attack’ • Small numbers • Breast cancer risk double but only goes up from 10 in 1000 to 16/1000 • Average patient in 60’s • Use over 5 yrs

  5. How to explain risk? • Facts and figures • Relative risk=Compare risk in 2 groups of people i.e. HRT vs non HRT • Absolute risk=Risk of an individual developing a disease over a period of time • Describing risks with words • Standardised vocabularly= Common, v. common

  6. Do not take into account risk increasing with age or duration Different risks (vte, breast ca, strokes..) and type of hrt etc. Difficult to visualise when confronted by lots of statistics Percentages

  7. Risks of HRT- per 1000 women More than 1 in 1000 extra cases on HRT= DVT/ PE Breast cancer 1 extra case per 1000- stroke An increased risk of less than 1 case per 1000 Lung cancer deaths, ovarian cancer and endometrial cancer

  8. HRT and risk • Increases with duration • over 5 years and even more over 10 yr • Increases with age • over 60y • In general risk is higher with combined HRT than oestrogen only • Combined HRT reduces risk of endometrial ca and is given to women with an intact uterus • Risk reduces back to baseline 5 years after stopping HRT

  9. Patient aids • What type HRT- combined or oestrogen only? • Age of patient • Use appropriate patient decision aid • http://www.npc.nhs.uk/therapeutics/other/hormone/resources/pda_hrt_combined.pdf

  10. Combined HRT- cancer risk in 50-59 y

  11. Combined HRT-VTE, heart disease 50-59 y

  12. Conclusion • Actually fairly safe for short term use in woman with no risk factors • Risk increases with use over 5 years and age over 60y • Different patients will accept different levels of risks- emotional element to this • Balance with benefits • HRT does not increase risk in women under 50y (without risk factors) • Remember to regularly review and safety net!

  13. http://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/Disadvantages.aspxhttp://www.nhs.uk/Conditions/Hormone-replacement-therapy/Pages/Disadvantages.aspx • http://www.patient.co.uk/doctor/hormone-replacement-therapy • http://www.npc.nhs.uk/therapeutics/other/hormone/resources/pda_hrt_combined.pdf • http://www.bmj.com/content/327/7417/745?sso=

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