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RDS Test 2 > B8.029 Prework: Menopause Hormone Therapy > Flashcards

B8.029 Prework: Menopause Hormone Therapy Flashcards

1
Q

prescription of estrogen therapy

A

unopposed estrogen is prescribed:

a) systemically for women who do not have a uterus
b) locally in very low doses for any woman with vaginal symptoms

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2
Q

prescription of estrogen-progestogen therapy

A

added to ET to protect women with a uterus against endometrial cancer, which can be caused by estrogen alone

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3
Q

bioidentical hormone therapy

A

consists of hormones chemically identical or very similar to those made in the body

1) FDA approved and tested
2) unapproved and untested from compounding pharmacies

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4
Q

genitourinary syndrome of menopause

A

genital symptoms:
dryness, burning, irritation
sexual symptoms:
lack of lubrication, discomfort or pain, impaired function
urinary symptoms:
urgency, dysuria, recurrent urinary tract infections

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5
Q

vasomotor symptoms of menopause

A

hot flashes
night sweats
episodes of profuse heat accompanied by sweating and flushing, experienced predominantly around the head, neck, chest, and upper back

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6
Q

natural estrogens

A 
E2- estradiol
-primary in reproductive years
E1- estrone
-weakest
-produced by placenta
E3- estriol
-primary post menopause
-aromatization of fat
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7
Q

clinical use populations of HT

A

hypogonadism
menstrual abnormalities
premature ovarian insufficiency
menopause hormonal deficiency

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8
Q

clinical use of estrogen therapy

A

prevent and treat vasomotor symptoms (VMS)
prevent and treat genitourinary syndrome of menopause (GSM)
prevent osteoporosis
premature ovarian insufficiency/menopause
-helps prevent premature osteoporosis, heart disease, dementia

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9
Q

why would perimenopausal women use hormonal contraception?

A

offers a viable option for both symptomatic perimenopausal women and those who wish to avoid pregnancy
menopausal EPT will NOT suppress ovulation and will result in unpredictable uterine bleeding

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10
Q

which contraceptives are used in perimenopausal women

A

combination estrogen progestin (pills, patch, ring)

depo-medroxyprogesterone acetate is an alternative hormonal contraception that may help vasomotor symptoms

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11
Q

who cannot get OCP

A

women >35 who smoke

other potential contraindications: HTN, DM, obesity

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12
Q

noncontraceptive benefits of hormone contraceptions

A 
suppress vasomotor symptoms
restore predictable bleeding
decrease dysmenorrhea
enhance BMD
lower risk of endometrial and ovarian cancer
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13
Q

when to stop hormonal contraception

A

INDIVIDUALIZATION
consider stopping 51-52
stop at 55 if requires contraception
if pregnancy is a concern, check FSH/E2 on day 7 placebo x 2

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14
Q

what can happen when you transition from hormone contraception to HT

A

hot flashes may reappear transiently

low dose OCPs have higher hormone levels than HT

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15
Q

progestogen indications

A

endometrial protections from systemic ET
women with an intact uterus using systemic ET
not indicated with low dose local ET for GSM

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16
Q

HT for vasomotor symptoms

A

ET with or without progestogen

almost all systemic HT products are approved for vasomotor symptom relief

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17
Q

HT for vaginal symptoms

A

ET is most effective treatment of moderate to severe symptoms of vulvar and vaginal atrophy
systemic and local ET products available

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18
Q

HT for osteoporosis

A

reduced fracture risk in postmenopausal women
HT approved for PREVENTING postmenopausal osteoporosis not TREATING it
benefits quickly dissipate after discontinuation of HT

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19
Q

how does low dose ET improve sexual satisfaction

A

improves lubrication and increases blood flow and sensation in vaginal tissue
*not recommended as sole treatment of other sexual function problems (low libido)

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20
Q

HT for urinary tract health

A

local ET may help some with overactive bladder
vaginal ET helps decrease recurrent UTI
ultra low dose transdermal has no effect on incontinence

21
Q

HT effect on coronary heart disease

A

ET may reduce CHD and coronary artery calcification when initiated in younger and more recently postmenopausal women
*currently not recommended for solely cardiac disease prevention

22
Q

black box warning for HT

A

includes adverse HT risks: cardiovascular disorders, endometrial cancer, breast cancer, and probably dementia

23
Q

contraindications to ET/EPT

A

undiagnosed AUB (for local ET)
known, suspected, or history of breast cancer
known or suspected history of E dependent neoplasia
active or history of DVT, PE
active or history of arterial thrombotic disease (MI, stroke)
liver dysfunction or disease
known/suspected pregnancy
known hypersensitivity ET or EPT

24
Q

potential adverse effects of ET

A 
uterine bleeding
breast tenderness
nausea
changes in shape of cornea (contact lens intolerance)
headache, migraine
25
Q

potential adverse effects of progestogens

A 
abdominal bloating
fluid retention in extremities
headache, migraine
dizziness
mood changes
uterine bleeding
26
Q

FDA approved oral estrogen products

A

17B-estradiol (bioidentical)

conjugated estrogens

27
Q

use of ospemifene

A

SERM, agonist in vulvar/vaginal region

for moderate to severe dyspareunia, symptoms of vaginal atrophy

28
Q

paroxetine

A

for moderate to severe vasomotor symptoms

non-hormonal option

29
Q

transdermal estrogen products

A

patch, gel, spray

all 17B-estradiol

30
Q

local vaginal estrogen products

A 
creams:
-17B-estradiol
-conjugated estrogens
rings:
-17B-estradiol
-estradiol acetate
tablet:
-estradiolhemihydrate
softgel suppository:
-estradiol
31
Q

progestogens available

A

medroxyprogesterone acetate
micronized progesterone
intrauterine levonorgestrel IUD

32
Q

types of EP therapy regimens

A 
continuous cyclic (sequential)
continuous cyclic (sequential)
continuous combined
33
Q

continuous cyclic (sequential) HT

A

E daily

P 12-14 d/mo

34
Q

continuous cyclic (sequential) long cycle HT

A

E daily
P 14 d q 2-6 mo
not recommended as standard therapy
require endometrial monitoring

35
Q

drospirenone

A

progestogen agent
analog to spironolactone
used for hirsutism
increased risk of clots!

36
Q

dosing of HT

A

use lowest dose that treats symptoms

titrate every 4-6 weeks

37
Q

HT and risk of VTE

A

oral ET increases VTE risk in postmenopausal women
VTE risk emerges soon after HT initiation and decreases over time
higher risk in women > 60
lower risk with transdermal and lower oral HT doses
higher risk in obese women and those with factor V leiden

38
Q

oral estrogen and first pass effect

A 
increases:
-plasma fibrinogen
-clotting factors VII and X
-triglycerides
-platelet aggregation
decreases:
-antithrombin III
39
Q

non oral estrogen drug delivery effects

A 
decreases:
-CRP
-prothrombin activation peptide
-antithrombin activity
-tissue plasminogen activator
little to no increase:
-triglycerides
-factors VII and X
40
Q

discuss the difference in delivery of transdermal and ring ET from oral ET

A

transdermal and ring bypass the GI conversion of estradiol to estrone with less increase in triglyceride levels, clotting factors, and globulins

41
Q

progesterone and thromboembolism risk

A

synthetic forms may increase risk of TE

micronized P does not appear to increase risk of TE

42
Q

HT and stroke risk

A

both ET and EPT appear to increase ischemic stroke risk and have no effect on hemorrhagic stroke risk
moderate risk age 60-69
high risk 70+

43
Q

HT and diabetes

A

EPT (but not ET) reduces new onset DM, but not approved for this use

44
Q

HT and endometrial cancer

A

not recommended with history of surgically treated endometrial cancer greater than stage 2
unopposed systemic ET in postmenopausal women with an intact uterus is associated with increased endometrial cancer risk related to dose and duration of use

45
Q

HT and cognitive aging/dementia

A

evidence is mixed

certain forms of progestins, lead to declines in memory

46
Q

HT and use in premature menopause/POI

A

likely risks are smaller and benefits greater in younger women (<50)
use of HT or oral contraception until median age of menopause is recommended, at which time decision can be reevaluated

47
Q

bioidentical hormones

A

compound preparations not recommended

not tested for efficacy, safety, batch standardization, or purity

48
Q

duration of use of HT

A

with EPT, increased risk of breast cancer and mortality with 3-5 years of use
with ET, no increase of breast cancer with early menopausal use
with ET, potential cardiac benefits with early use

49
Q

SUMMARY OF HT

A

absolute risks in healthy women 50-59 are low
long term use or HT initiation in older women, however, has greater risks
breast cancer risk increased with EPT beyond 3-5 years
ET can be considered for longer duration of use due to its more favorable safety profile

RDS Test 2 (24 decks)

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