Day 3- Menopause and Infertility Flashcards
What are symptoms of Perimenopause?
What are the symptoms of menopause or climacteric?
What are other pathologies of menopause?
Starts around age 45, Lasts about 4.8 years, Conception is still possible, marked by menstrual and vasomotor irregularities, FSH levels increases and estrogen levels decrease but are still variable.
Average age is 51, diagnosed retrospectively(After 12 consecutive months of spontaneous cessation of menses), vasomotor symptoms are likely, no possibility of conception.
Primary ovarian insufficiency(menopause occurring under the age of 40 w/o a known cause), drug induced menopause, surgical menopause.
How can you predict menopause?
What happens to hormones after menopause?
Are both ER alpha and beta found in bones?
AMH(anti-mullerian hormone), It declines as primordial follicles decline(this is what initiates the process of menopause), undetectable at menopause. Presence of VMS(positively coorelates with approaching FMP), genetics, Smoking(decrease by up to 2 years), Ethnicity(hispanic
What happens to the body during menopause?
What is MHT for menopause?
What are common A/E’s of MHT?
Thinning of the endometrium, skin becomes dry and tough, increases osteoclast activity. Atrophy, decreased muscle tone and vaginal mucosa of vagina.
Most effective treatment for vasomotor and genitourinary syndrome of menopause. Also approved for osteoporosis prevention. This is ET and EPT.
Nausea/vomiting, dizziness, weight gain, breast changes, possible uterine bleeding, in WHI 40% of patients taking hormones dropped out.
What are serious A/E’s of MHT?
What are estrogens drug interactions?
What are your types of oral estrogens?
Endometrial,breast, or ovarian cancer. VTE, stroke, gallbladder disease, dementia.
Anastrozole, Tamoxifen, and other breast cancer drugs. Cyp3a4 interactors, ospemifene(may cause toxic side effects).
Premarin, Estropipate, Micronized 17b-estradiol.
What are your oral progestin/progesterone products?
Do all estrogen patches contain 17b-estradiol?
What are your twice a week patches?
Medroxyprogesterone acetate(Provera), Micronized progesterone, Norethindrone Acetate.
Yes.
Alora, Minivelle, Vivelle. Others are once a week.
Which products have local effect?
Are oral or transdermal products better?
What big things happened in the HERS trial?
Conjugated equine estrogens, estrace, estring(only vaginal ring that does this), vagifem or yuvafem.
Transdermal, less first pass metabolism and side effects.
Included postmenopausal women with established CHD. Recommended against use of HRT for 2nd prevention of CHD. No significant difference.
What big things happened in the HERS2 trial?
What big things happened in the WHI combined trial?
What big things happened in the WHI estrogen only trial?
No significant difference in any outcome of HERS trial survivors.
Worse with CHD, VTE, Stroke, Breast Cancer. Better with colorectal and all fractures.
Worse with stroke and DVT, Better for all fractures, No change for CV, Breast/colorectal cancer.
What causes ovulatory disorders?
When is a couple considered infertile?
What is primary vs secondary infertility?
PCOS, Hyperprolactinemia, thyroid dysfunction, excessive exercise and weight changes.
After 12 months or more of frequent/unprotected intercourse.
Primary is female has never given birth to a live infant, secondary is female has a history of successful birth.
What are some lifestyle changes that can enhance fertility?
How does clomiphene work?
What are clomiphene’s A/E’s?
Healthy weight(between 19-35 BMI), no smoking, alcohol, limit caffeine, no illicit drug use, toxins, or solvents. Intercourse 3 days leading up to ovulation.
binds estrogen receptors leading to increased FSH, failure is 6 cycles using clomiphene.
Hot flashes, multiple births, GI distresses, ovarian enlargments, rare is OHSS(can start w/i 24 hours but may manifest 7-10 days later). CI’d in pregnancy, liver disease, menstrual irregularities and uncontrolled thyroid.
How is ganirelix better than leuprolide for infertility?
What is treatment of menstrual irregularities in perimenopause?
When is metformin used for infertility?
less risk of ovarian hyperstimulation and cycle cancellations.
Low dose OC is 1st line, 2nd line is cyclic oral progestins or progesterone monotherapy. Next is NSAIDs, transexamic acid or intranasal desmopressin
Primarily for PCOS, Second line to anti estrogen, usually used with Clomiphene.
What are supportive therapies for vasomotor symptoms?
What is pharmacotherapy for vasomotor symptoms?
Can you use phytoestrogens for vasomotor symptoms?
layered clothing(use a personal fan), lower room temp, avoid hot/spicy food and beverage, increase exercise/lose weight, acupuncture/reflexology, smoking cessation.
MHT(estrogen replacement), Progestin, Bazedoxifene. Can also use SSRI’s or SNRI’s, Gabapentin(900 mg), Clonidine(<0.1 mg).
Mixed efficacy.
Do aromatase inhibitors have lesser chance of multiple births than clomiphene and what are the side effects?
What facts are important when using hCG or rCG?
What facts are important with FSH gonadotropins and hMG?
Yes, flushing, edema, N/V, chest pain and hot flashes, Watch for CNS depression, decreased bone mineral density and increased cholesterol in continuous use, CI’d in pregnancy.
Promotes ovulation once follicle has matured. Injectable. Watch for edema, depression, fatigue, HA, irritability, CI’d in hormone dependent tumors, could cause multiple births.
Step up or Step down dosing.
How do you treat genitourinary syndrome of menopause?
How do you treat urinary incontinence as secondary therapy?
How do you treat decreased libido?
Vaginal moisturizers and lubricants, Topical vaginal estrogen, systemic estrogen, Ospemifene.
Estrogen, Anticholinergics, B-adrenoreceptor agonists.
Androgens, bupropion, PDE-5 inihibitors, Filbanesrin.
What is 1st line therapy for patients with GSM and VMS?
What points are important about Ospemifene?
What did the FDA letter say about biosimilars?
Systemic estrogens, Need opposing progestin if there is a uterus and use lowest effective dose.
Can cause VMS, significantly improved vaginal symptoms.
Can’t make without investigational drug letter and must not claim it’s better.
What compound in skin can metabolize topical progesterone?
Is esterified estrogen with testosterone FDA approved to treat sexual dysfunction in post menopausal women?
What are estrogens Contraindications?
5-alpha reductase. Some pharmacies test saliva to adjust medication.
NO!!!
Pregnancy, DVT, PE, Active or recent stroke, history of MI, undiagnosed abnormal uterine bleeding, estrogen dependent neoplasia, severe liver dysfunction or disease.
