07 meno

Question 1

when to consider menopause?

average age?

if measure FSH, what is the level?

Answer 1

after 12 months of amenorrhea (ovarian failure)

51

> 40IU/L

Question 2

5 absolute contraindication for hormone replacement

Answer 2

active liver disease
active Br CA
active vascular thomrbosis
history of unexplained vaginal bleeding
pregnancy

Question 3

indication for estrogen replacement? 2

for progestin?

Answer 3

E - manage symptoms primarily, prevent osteo, should be both, no to prevent osteo alone

P- added to ERT to reduce risk of estrogen induced endometrial hyperplasia and endom CA

Question 4

dosage compared to contraception?

Answer 4

Doses are 1/3 to 1/6 that of oral contraceptives

Question 5

eg of non hormonal therapy for meno s/s - 7

se?

Answer 5

1.) Clonidine- 0.2 mg bid
no effect to modest
SE: drowsiness, dry mouth, orthostatic hypotension

2.) SSRIs – Paroxetine 20 mg daily,Fluoxetine 20 mg daily,citalopram 10-20mg & SNRI -Venlafaxine 37.5 -75 mg/day
40 – 60% effective
SE: headache,nausea,vomiting

3.) Gabapentin 300 mg/day and titrate to 300 mg tid
SE: somnolence, dizziness, periperal edema

7. Vaginal lubricants – GyneMoistrin, Replens
   For atrophic vaginal symptoms

4.) Bellergal Spacetabs (Belladonna, ergotamine and phenobarbital) “autonomic stabilizer”
small benefit & many SE dry mouth, constipation, dizziness, drowsiness

5. Phytoestrogens (e.g. isoflavones, soy)
   mild effect, mixed results (Cochrane 2010-no benefit)
6. Black Cohosh –(Herb)
   limited efficacy and safety in short-term use (<6 months) (liver toxic)

Question 6

3 antidepressants that can help with vasomotor symptoms

which one is better for irritability?

other drugs for menopause?

Answer 6

Fluoxetine 20 mg - prozac

paroxetine 7.5mg - paxil

Venlafaxine - 37.5 seretonin and noradrenaline reuptake inhibitor - better for irritability?

Clonidine and Gabapentin

Question 7

if have dyslipidemia, what route of estrogen prep is good?

what is better if high TG or hypertriglyceridemia?

which route has less risk for VTE or clots?

Answer 7

oral - will reduce LDL

cream or patch

patch

Question 8

3 progesterone types? which two use more?

which one better to take a night cuz sedating?

which one has peanut allergy?

Answer 8

medroxyprogesterone - provera

micronized progesterone - prometrium - better at night to help sleep cuz sedating - helps with lots of s/s with sleep - first choice? - but has peanut oil,, caution

norethindrone - micronor - not used much

Question 9

SE of HR?

SE - estrogen, progesterone, patch?

Answer 9

break through bleeding

E - breast tenderness, nausea, headache, bloating

P - sedating, mood alteration, breast tenderness, sedating

patch - skin rash, irritation

Question 10

when is it better to be cardio protective to start HR?

Answer 10

perimenopausal, early, less than 5 years into menopause

under 60 years old

not good to start HRT over 60 for primary CAD prevention

Question 11

other non hormone to help menopausal symptoms

Answer 11

phytoestrogens

black cohost - herb

vag lubricants - gynemoistrin, replens, astroglide

Question 12

2 indications for estrogen and progestrin

Answer 12

Indications for Estrogen Replacement Therapy (ET)
• Management of symptoms (e.g. vasomotor- hot flushes, night sweats, urogenital atrophy, mood changes)
• Prevention of osteoporosis (not recommended unless being used primarily for symptom management)

Indications for Progestin therapy
• Added to ERT to reduce risk of estrogen - induced endometrial hyperplasia and endometrial carcinoma
• Management of vasomotor symptoms where estrogen is contraindicated