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#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
What dose of gabapentin is used for treatment of vasomotor symptoms?
600-900mg/d
26
What is the goal of hormone therapy in patient suffering from vasomotor symptoms?
Decrease the number of episode, not eliminate entirely
27
What is the average decrease (%) in number of hot flushes for women on oral estrogen or estrogen/progestin?
75% reduction
28
What is the guiding principle for prescribing hormone therapy?
Lowest effective dose for shortest duration of time to relieve symptoms
29
What did the Women's Health Initiative find regarding risks of hormone therapy?
Slightly increased risk of breast cancer, coronary heart disease, stroke, and venous thromboembolic events
30
What did the Women's Health Initiative find regarding benefits of hormone therapy?
Decreased risk of fractures and colon cancer after an average 5 years on combined HT
31
What percentage of women have recurrent vasomotor symptoms after discontinuation of hormone therapy?
50%
32
Should hormone therapy for symptomatic menopausal patients be tapered or stopped abruptly?
Insufficient evidence to recommend one method of discontinuation
33
At what age should hormone therapy for menopausal symptoms be stopped?
No age cut off. The decision to stop/continue should be individualized based on symptoms and risk-benefit ratio
34
What hormone therapies are available for vasomotor symptoms for women with a uterus?
Combined estrogen/progestin and estrogen/bazedoxifene (SERM)
35
What is the benefit of using conjugated estrogen and bazedoxifene for treatment of hot flushes in menopausal women?
Treat hot flushes, protection against endometrial hyperplasia/cancer, increases bone mineral density
36
Which arm of the Women's Health Initiative showed increased risk of breast cancer?
Combined estogen and progestin, not estrogen alone
37
What does addition of testosterone to hormone therapy for menopausal symptoms improve?
Improves sexual function scores and number of satisfying sexual episodes for postmenopausal women
38
What is tibolone?
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
What are bioidentical hormones?
Plant-derived hormones that are chemically similar or structurally similar to those produced by the body
40
What nonhormonal medications are effective for the treatment of vasomotor symptoms?
SSRIs, SNRIs, clonidine, and gabapentin
41
What is the only nonhormonal therapy that has FDA approval for the treatment of vasomotor symptoms?
Paroxetine (7.5mg/d)
42
What is the mechanism of action of clonidine?
Centrally active alpha 2-agonist. Antihypertensive agent, used off label for vasomotor symptoms
43
What is the effect of gabapentin 900mg/d on hot flushes?
45% reduction in frequency and 54% reduction in symptoms severity
44
Does black cohosh help vasomotor symptoms?
Conflicting results. Doesn't help the liver though, liver toxicity has been reported
45
Does ginseng help hot flushes?
no
46
Does St. John's wort help hot flushes?
No
47
Does ginkgo biloba help hot flushes?
No
48
Does dang gui bu xue tang (chinese herb) help hot flushes?
More effective than placebo for management of mild vasomotor symptoms
49
Which vitamin has some efficacy in treating vasomotor symptoms?
Vitamin E (800IU/d), one less hot flush per day
50
Does acupuncture alone improve vasomotor symptoms?
No
51
Does reflexology alone improve vasomotor symptoms?
No
52
What beverages have been associated with increased severity and frequency of vasomotor symptoms?
Alcohol and caffeine
53
What hormonal treatment is recommended for women with only vaginal symptoms related to menopause?
Local estrogen therapy. Low-dose systemic estrogen therapy formulation are FDA approved
54
Does vaginal estrogen increase risk for endometrial hyperplasia?
No. Not according to Cochrane meta-analysis of 19 trials with 4,162 women
55
Does vaginal estrogen increase risk for patients with history of hormone-sensitive breast cancer?
Uncertain. Try nonhormonal methods first-line. Short-term use may be considered with appropriate counseling from oncologist about potential risks
56
Is raloxifene effective treatment for menopausal vaginal symptoms? Vasomotor symptoms?
No x 2
57
Is tamoxifen effective treatment for menopausal vaginal symptoms? Vasomotor symptoms?
No x 2
58
What is ospemifene? Is it effective treatment for menopausal vaginal symptoms?
SERM. Improves vaginal atrophy without stimulating endometrium
59
What are nonhormonal therapies for menopausal vaginal symptoms?
Nonestrogen water-based or silicone-based vaginal lubricants and moisturizers
60
What is the difference between vaginal lubricants and vaginal moisturizers?
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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