211 - Menopause and HRT Flashcards

1
Q

Who should be treated with hormone replacement therapy?

(In the context of menopause)

A

People with…

  • Moderate to severe vasomotor symtpoms that affect their quality of life
  • NO contraindications
    • Cannot have hormone-sensitive breast cancer, CHD, VTE, Liver disease, unexplained vaginal bleeding
  • LMP less than 10 years ago
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

If estrogen hormone replacement therapy is only indiated for perimenopausal people with vasomotor symtoms, what treatments are avilable for patients experiencing vulvovaginal symptoms?

A
  • Topical estrogen
  • Lubricant, moisturizer, dilator
  • SERM

Don’t start systemic therapy if sx are only local

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q
A

FSH

  • FSH is elevated post-menopause
  • In the transition period, it will fluctuate; not super helpful to measure

Changes in menstrual bleeding patterns = better predictor of menopausal stage than serum FSH during transition

Heavy periods -> lighter/spaced out -> no more periods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List 3 new health problems that are more likely to arise after menopasue

A
  • Depression
  • Osteoporosis
    • Associated with estrogen deficiency
  • CAD/CHD
    • Associated with estrogen decline

But estrogen hormone therapy is currently not indicated to prevent CHD (useful in preventing osteoporosis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A

SNRI

  • Estrogen contraindicated in patients with hx of breast cancer
  • SSRIs contraindicated in pts on tamoxifen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Describe the hormonal changes that occur in perimenopause

A
  • Initially, decreased inhibin B
  • -> loss of feedback inhibition, resulting in increased FSH
  • -> Temporarily increases estrogen from ovary
    • ​-> heavy menstrual periods
  • -> Follicle continues to deplete
  • -> Can no longer respond to increasing FSH
  • -> estrogen falls
  • Also - Anti-mullerian hormone diminishes during perimenopause*
  • Thank you @Frank!*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the vasomotor symptoms associated with menopause

A
  • Flushing
  • Increased HR/palpitations
  • Sweating followed by chills
  • Hot flashes

The menopasue FISH!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which cancer drug is an absolute contraindication for SSRIs?

A

Tamoxifen

  • Typical pt: Hx of breast cancer, on tamoxifen*
  • Cannot give estrogen therapy or SSRI; use SNRI (venlafaxine)*
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What hormones should be used for hormone replacement therapy?

A

Estrogen is the hormone that will treat vasomotor sx

  • If the pt has a uterus, estrogen + progestin
    • Unopposed estrogen -> endometrial cancer
  • If the patient does not have a uterus, can use estrogen only
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

List the contraindications to hormone replacement therapy (7)

A
  • Vaginal bleeding (unexplained)
  • Liver disease (active)
  • VTE or PE (previous)
  • Thrombophilia
  • HTN (untreated)
  • Estrogen-dependent neoplasia
  • Hx of CHD, Stroke, TIA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
A

B: Topical estroen

  • Safe in pts with hx of breast cancer
  • Don’t need systemic therapy if sx are only local
  • Offer vaginal moisturizer if pt wantst to avoid estrogen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
A

A

  • B is post-menopausal (>1 year since LMP)
  • C has primary ovarian insufficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What changes in menstrual cycles are likely to occur during perimenopause?

A
  • At first, periods become heavier
    • As ovarian estrogen is upregulated in response to increasing FSH
  • Then, they become lighter and mose spaced out
    • Follicle is depleted, can no longer respond to increasing FSH
  • Finally, they stop completely
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which gonadotropin is most reliably elevated in a post-menopausal female?

A

FSH

(But may fluctuate wildly during transition!)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly