Please note this information is for educational purposes only and prescriptions should not be based on this. OSCEstop takes no responsibility for use of this information.
Antihypertensives
Oral hypoglycaemics
NB: aim HbA1c 48-58mmol/mol; only metformin and insulin are known to be safe in pregnancy; all drugs should be temporarily discontinued in ketoacidosis; metformin should be temporarily discontinued in lactic acidosis, perioperatively, and if using iodinated contrast agents.
Systemic (for systemic symptoms, e.g. vasomotor): usually transdermal oestorgen (e.g. gel or patch) β women with a uterus on transdermal oestrogen preparations must still take progesterone separately as discussed below
Vaginal oestrogen (for local symptoms, e.g. urogenital atrophy, vaginal dryness): tablet, cream, pessary or vaginal ring
Types of systemic therapy
No uterus β oestrogen-only HRT (usually transdermal, i.e. gels or patches)
Uterus present (oestrogen as above but also need progesterone, usually as oral micronised progesterone, e.g. utrogestan)
Perimenopausal β cyclical HRT (oestrogen given every day, and progesterone given for 12 days of each 28 day cycle β to induce bleed)
Post-menopausal (i.e. no periods for >1 year or been on cyclical HRT for >1 year) β continuous combined HRT(continuous oestrogen and progesterone β no bleed)
NB: the Mirena coil can also suffice as the progesterone component.
Contraindications: undiagnosed PV bleeding, pregnancy/breastfeeding, oestrogen-dependent cancer, active liver disease, uncontrolled hypertension, history of breast cancer, history of venous thromboembolism, recent stroke/MI/angina
Side effects: vaginal bleeding, premenstrual syndrome, breast tenderness, leg cramps, nausea/bloating
Long-term risks: increased VTE risk (except transdermal preparations), increased stroke risk, increased breast cancer risk with time, increased ovarian cancer risk if used >5 years, increased endometrial cancer risk (but only with unopposed oestrogen), coronary artery disease (if started >10 years after menopause)
Control specific causes/associated conditions (e.g. hypertension, AF, obesity, diabetes, myocardial ischaemia) for heart failure with preserved ejection function
Non-pharmacological treatments
Cardiac resynchronisation therapy device: considered if QRS significantly prolonged
Implantable cardioverter defibrillator: considered if risk of ventricular arrhythmias