31 HT for Menopause Besinque Flashcards
What is the definition of Menopause?
Cessation of menses. Defined retrospectively after 12 months without menstruation
What is the definition of Perimenopause?
Begins with first signs and symptoms of endocrine change. Menstrual cycle becomes irregular. Ends one year after final menstrual cycle
What are the two key physiological changes in menopause?
Loss of primary ovarian follicles (which produce the main estrogen in the body (Estradiol). Resulting decrease in serum and tissue estradiol levels and higher Estrone levels (estrogen made from the adrenal gland)
What is Natural/Spontaneous menopause?
Final menstrual period (FMP), confirmed after 12 consecutive months of amenorrhea with no obvious pathologic cause
What is Induced Menopause?
Permanent cessation of menstruation after bilateral oophorectomy or iatrogenic ablation of ovarian function. Induced menopause often has worse symptoms than natural
What are the vasomotor menopause-related symptoms?
HA. Palpitations. Night sweats. Insomnia/sleep disturbance
What are the Genitourniary menopause-related symptoms?
Vaginal dryness. Dyspareunia. Vaginal itching/burning. Urinary frequency, dysuria, urgency. Vaginal dryness/itching/burning is due to atrophy of the vagina in the absence of estrogen
What are some other systemic menopause-related symptoms?
Fatigue. Reduced sexual/arousal. Anxiety, irritability and depression. Cognitive difficulties. Backache/stiffness
What medical conditions are more common after menopause?
Osteoporosis. Atherosclerotic disease
What are the types of Estrogens used in HT?
17 beta-estradiol. Conjugated equine estrogens (CEE). Estrone derivatives (including synthetic conjugated estrogens, esterified estrogens, and others (derived from yam, soy or lab))
What are the contraindications for Systemic Estrogen Therapy (ET)?
Pregnancy. VTE. Breast cancer. Estrogen-sensitive cancers. Liver disease. Hypertriglyceridemia)
What are the types of Progesterons used in HT?
Synthetic progestogens. Structually related to progesterone. Structurally related to testosterone
What are the two types of Progestogens?
Progesterone. Progestins
What are Progesterones?
Produced by ovary after ovulation and by placenta during pregnancy
What are Progestins?
Synthetic progestogens. Structurally related to progesterone (MPA). Structurally related to testosterone (norethindrone, norethindrone acetate, norgestrel, levonorgestrel)
What are the Progestogen Indications?
Primary menopause - related indication for progestogen is endometrial protection from systemic ET. Adequate progestogen recommended for women with an intact uterus using systemic ET. Progestogen generally not indicated with local, low-dose ET for vaginal atrophy
What are the possible side effects of Progestogens?
Swelling and breast pain more common with MPA. Acne and hirsutism more common with levonorgestrel and norethinedrone. Dizziness and fatigue associated with high-dose progesterone. Metabolic effects differ
What Progestogens have a higher rate of causing Acne and Hirsutism?
Levonorgestrel and Norethinedrone
What are the FDA-Approved Indications for HT?
Treatment of moderate-to-severe vasomotor symptoms associated with menopause (most estrogens). Treatment of vulvar and vaginal atrophy (most estrogens). Prevention of postmenopausal osteoporosis (some estrogens)
What are the HT options?
ET. EPT. CC-EPT (continuous-combined estrogen-progestogen therapy (daily administratino of both estrogen and progestogen)). CS-EPT (continuous-sequential estrogen-progestogen therapy (estrogen daily, with progestogen added on a set sequence)). Progestogen (encompassing both progesterone and progestin)
How should dosages be in HT?
Therapeutic goal is lowest effect estrogen dose consistent with individual treatment goals, benefits, and risks, plus corresponding low progestogen dose for women with uterus. Lower doses better tolerated, may have more favorable benefit-risk ratio than standard doses (but lower doses have to been tested in long-term trials). Additional local ET may be needed for persistent vaginal symptoms
What is the normal starting dose for Oral Conjugated Estrogen (CE)?
0.3mg (Premarin)
What is the normal starting dose for Oral Micronized 17 beta-Estradiol?
0.5mg
What is the normal starting dose for Transdermal 17 beta-Estradiol patch?
0.014-0.025mg
What is the typical lowest dose of oral medroxyprogesterone acetate (MPA)?
1.5mg
What is the typical lowest dose of oral norethindrone acetate?
0.1mg
What is the typical lowest dose of oral drospirenone?
0.5mg
What is the typical lowest dose of oral micronized progesterone?
50mg
How many days does progestin need to be used to prevent endometrium problems?
At least 10 days/cycle
What kind of Estrogen Therapy is preferred when solely vaginal symptoms?
Local ET
What is required for endometrial protection from unopposed systemic ET?
Systemic Progestogen