B8.029 Large Group: Hormone Therapy

Question 1

components of midlife women’s sexual interest/function

Answer 1

biological/hormonal
lack of appropriate stimuli
interpersonal
expectation of negative outcome
contextual
intrapersonal development history

Question 2

how to date the onset of menopause in women with endometrial ablations and amenorrhea

Answer 2

yearly FSH and E levels

Question 3

why is it important to date menopause

Answer 3

timing hypothesis: want to initiate ET within 5-7 years of entering menopause
risks of stroke, MI, and DVT increase significantly if you initiate ET 5-10 years out from menopause

Question 4

alternatives to ET for vasomotor symptoms in women 8-10 years from menopause

Answer 4

paroxetine
clonidine
gabapentin
may use local estrogen with minimal risk

Question 5

benefits of estrogen on atherosclerosis

Answer 5

decreased LDL oxidation
decreased LDL binding/accumulation
decreased monocyte adhesion to endothelium
decreased macrophage accumulation
decreased smooth muscle cell proliferation
increased endothelial function
increased vasodilation

Question 6

adverse effects of estrogen on established plaques

Answer 6

increased inflammation > increased plaque instability
increased MMP expression > increased plaque instability/rupture
increased neovascularization > increased plaque hemorrhage
increased thrombosis > increased clot formation

Question 7

is endometrial ablation contraception?

Answer 7

no

important to treat these individuals with progestin to prevent endometrial hyperplasia/cancer

Question 8

recommendations for women who are perimenopausal and seeking treatment

Answer 8

hormone contraception

VMS can start long before the FMP

Question 9

changes in hormones with menopause

Answer 9

decreasing circulating estradiol
FSH levels rise
LH remains normal/slight increase and plateau 1 year after FMP
increased free T levels rise as SHBG drop 40%
increasing estrone is the predominate circulating estrogen in menopause
ovary continues to produce T and androstenedione

Question 10

effects of oophorectomy on T

Answer 10

T levels 40-50% lower than women with ovaries

Question 11

treatment options for bothersome sequelae to androgen excess (hirsutism, acne, hair thinning)

Answer 11

1. oral estrogen therapy: raises SHBG and decreases bioavailable androgens
2. drospirenone for progestogen

Question 12

action of drospirenone

Answer 12

has anti-androgenic activity and blocks peripheral androgen receptors

Question 13

pros of oral estrogen

Answer 13

familiar, easy
beneficial effects on HDL, LDL, total cholesterol
large amount of data
low cost
decreases free T

Question 14

cons of oral estrogen

Answer 14

risk of stroke, thrombosis
increase triglycerides, CRP, SHBG, thyroid binding globulin, other hepatic proteins
decrease free T

Question 15

pros of transdermal/vaginal systemic E

Answer 15

avoid hepatic first pass effect
less increase TG than oral
less effect CRP than oral
fewer GI adverse effects than oral
less risk of venous thrombosis

Question 16

cons of transdermal/vaginal systemic E

Answer 16

patch/adhesive sensitivity/residue
patch visible
cost
gels, creams can transfer to others
lower SHBG raise bioavailable T

Question 17

pros of vaginal E

Answer 17

vaginal benefit at lower doses

low does therapy avoids adverse systemic events

Question 18

cons of vaginal E

Answer 18

increase vaginal dc
less convenient to use
lack long term uterine safety data for low dose products

Question 19

pros of progestogens

Answer 19

reduced risk endometrial hyperplasia/cancer in women with uterus on ET
micronized progesterone decreases insomnia

Question 20

cons of progestogens

Answer 20

EPT higher risk of breast cancer than ET
progestogens reduce beneficial effect of oral ET on HDL
bloating
dysphoric for some women