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Practice bulletins > #141 Management of Menopausal Symptoms > Flashcards

#141 Management of Menopausal Symptoms Flashcards

1
Q

What are the prevalence of vasomotor symptoms among women experiencing natural menopause?

A

50-82%

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2
Q

When does occurence of vasomotor symptoms peak during menopausal transition?

A

Approximately 1 year after the final menstrual period

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3
Q

What is the median age of menopause in North America?

A

51yo

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4
Q

What are other terms for “perimenopause”

A

The climacteric or the menopausal transition

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5
Q

What happens to estrogen levels during menopausal transition?

A

Decreases

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6
Q

What happens to progesterone levels during menopausal transition?

A

Decreases

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7
Q

What happens to FSH levels during menopausal transition?

A

Increases

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8
Q

How long does a vasomotor episode typically last?

A

1-5 minutes

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9
Q

Where on their bodies do women typically experience vasomotor symptoms?

A

Upper body, particularly face, neck, and chest

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10
Q

In women who experience hot flushes during menopausal transition, what percentage experience them daily?

A

87%

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11
Q

In women who experience hot flushes during menopausal transition, what percentage experience more than 10 per day?

A

33%

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12
Q

What is the median duration of time that women experience hot flushes?

A

Median duration of 4 years and 10.2 years have been reported

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13
Q

Does evidence show that the thermoregulatory zone of women is narrowed, widened, or stays the same during menopausal transition?

A

Narrows, one of the theories to explain hot flushes

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14
Q

Are hot flushes more or less common or no effect in obese women?

A

More common

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15
Q

What percentage of menopausal women experience 1 or more symptom of vaginal atrophy?

A

10-40%

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16
Q

What symptoms are associated with vaginal atrophy?

A

Vaginal or vulvar dryness, discharge, itching, dyspareunia, bleeding

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17
Q

What are physical signs of vaginal atrophy?

A

Thinning of tissue, loss of vaginal rugae and elasticity, narrowing/shortening of vagina, bleeding/fissures, loss of subcutaneous fat in labia majora, narrowing introitus, fusion of labia minora, shrinking of clitoral prepuce and urethra. More alkaline pH.

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18
Q

How does vaginal atrophy change risk of infections?

A

Increases risk of urogenital infection

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19
Q

What hormonal therapy is approved for treatment of vasomotor symptoms?

A

Estrogen alone or in combination with progestin. Data do not support progestin-only, testosterone, or compounded bioidentical hormones

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20
Q

What is the dose range for conjugated estrogen for hormone therapy?

A

0.3-0.625mg/d

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21
Q

What is the dose range for micronized estradiol-17beta for hormone therapy?

A

0.25-1mg/d

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22
Q

What is the dose range for transdermal estradiol-17beta for hormone therapy?

A

0.014-0.05mg/d

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23
Q

What dose of paroxetine is used for treatment of vasomotor symptoms?

A

7.5mg/d

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24
Q

What dose of clonidine is used for treatment of vasomotor symptoms?

A

0.1mg/d

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25
Q

What dose of gabapentin is used for treatment of vasomotor symptoms?

A

600-900mg/d

26
Q

What is the goal of hormone therapy in patient suffering from vasomotor symptoms?

A

Decrease the number of episode, not eliminate entirely

27
Q

What is the average decrease (%) in number of hot flushes for women on oral estrogen or estrogen/progestin?

A

75% reduction

28
Q

What is the guiding principle for prescribing hormone therapy?

A

Lowest effective dose for shortest duration of time to relieve symptoms

29
Q

What did the Women’s Health Initiative find regarding risks of hormone therapy?

A

Slightly increased risk of breast cancer, coronary heart disease, stroke, and venous thromboembolic events

30
Q

What did the Women’s Health Initiative find regarding benefits of hormone therapy?

A

Decreased risk of fractures and colon cancer after an average 5 years on combined HT

31
Q

What percentage of women have recurrent vasomotor symptoms after discontinuation of hormone therapy?

A

50%

32
Q

Should hormone therapy for symptomatic menopausal patients be tapered or stopped abruptly?

A

Insufficient evidence to recommend one method of discontinuation

33
Q

At what age should hormone therapy for menopausal symptoms be stopped?

A

No age cut off. The decision to stop/continue should be individualized based on symptoms and risk-benefit ratio

34
Q

What hormone therapies are available for vasomotor symptoms for women with a uterus?

A

Combined estrogen/progestin and estrogen/bazedoxifene (SERM)

35
Q

What is the benefit of using conjugated estrogen and bazedoxifene for treatment of hot flushes in menopausal women?

A

Treat hot flushes, protection against endometrial hyperplasia/cancer, increases bone mineral density

36
Q

Which arm of the Women’s Health Initiative showed increased risk of breast cancer?

A

Combined estogen and progestin, not estrogen alone

37
Q

What does addition of testosterone to hormone therapy for menopausal symptoms improve?

A

Improves sexual function scores and number of satisfying sexual episodes for postmenopausal women

38
Q

What is tibolone?

A

Synthetic steroid with tissue-specific estrogenic and progestogenic effects (not available in US). Appears to have beneficial effects on bone density, vasomotor symptoms, and vaginal symptoms without estrogenic effects on uterus or breasts

39
Q

What are bioidentical hormones?

A

Plant-derived hormones that are chemically similar or structurally similar to those produced by the body

40
Q

What nonhormonal medications are effective for the treatment of vasomotor symptoms?

A

SSRIs, SNRIs, clonidine, and gabapentin

41
Q

What is the only nonhormonal therapy that has FDA approval for the treatment of vasomotor symptoms?

A

Paroxetine (7.5mg/d)

42
Q

What is the mechanism of action of clonidine?

A

Centrally active alpha 2-agonist. Antihypertensive agent, used off label for vasomotor symptoms

43
Q

What is the effect of gabapentin 900mg/d on hot flushes?

A

45% reduction in frequency and 54% reduction in symptoms severity

44
Q

Does black cohosh help vasomotor symptoms?

A

Conflicting results. Doesn’t help the liver though, liver toxicity has been reported

45
Q

Does ginseng help hot flushes?

A

no

46
Q

Does St. John’s wort help hot flushes?

A

No

47
Q

Does ginkgo biloba help hot flushes?

A

No

48
Q

Does dang gui bu xue tang (chinese herb) help hot flushes?

A

More effective than placebo for management of mild vasomotor symptoms

49
Q

Which vitamin has some efficacy in treating vasomotor symptoms?

A

Vitamin E (800IU/d), one less hot flush per day

50
Q

Does acupuncture alone improve vasomotor symptoms?

A

No

51
Q

Does reflexology alone improve vasomotor symptoms?

A

No

52
Q

What beverages have been associated with increased severity and frequency of vasomotor symptoms?

A

Alcohol and caffeine

53
Q

What hormonal treatment is recommended for women with only vaginal symptoms related to menopause?

A

Local estrogen therapy. Low-dose systemic estrogen therapy formulation are FDA approved

54
Q

Does vaginal estrogen increase risk for endometrial hyperplasia?

A

No. Not according to Cochrane meta-analysis of 19 trials with 4,162 women

55
Q

Does vaginal estrogen increase risk for patients with history of hormone-sensitive breast cancer?

A

Uncertain. Try nonhormonal methods first-line. Short-term use may be considered with appropriate counseling from oncologist about potential risks

56
Q

Is raloxifene effective treatment for menopausal vaginal symptoms? Vasomotor symptoms?

A

No x 2

57
Q

Is tamoxifen effective treatment for menopausal vaginal symptoms? Vasomotor symptoms?

A

No x 2

58
Q

What is ospemifene? Is it effective treatment for menopausal vaginal symptoms?

A

SERM. Improves vaginal atrophy without stimulating endometrium

59
Q

What are nonhormonal therapies for menopausal vaginal symptoms?

A

Nonestrogen water-based or silicone-based vaginal lubricants and moisturizers

60
Q

What is the difference between vaginal lubricants and vaginal moisturizers?

A

Lubricant: Intended to relieve friction and dyspareunia related to vaginal dryness during intercourse
Moisturizer: Intended to trap moisture and provide long-term relief of vaginal dryness

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