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Therapeutics > Ex. 4 L1 - MHT 1 (35) > Flashcards

Ex. 4 L1 - MHT 1 (35) Flashcards

1
Q

When menopause is diagnosed

A

Confirmed after 12 consecutive months of amenorrhea (absence of menstruation)

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2
Q

Premenopause

A

The time period of endocrine changes BEFORE cessation of menstruation

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3
Q

Perimenopause (Climacteric)

A

The period of endocrine changes SURROUND the menopause

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4
Q

Menopause Median age of onset US

A

51 years (40-58)

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5
Q

Postmenopause

A

The time period of endocrine changes AFTER cessation of menstruation

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6
Q

Women spend _% of their lives postmenopausal

A

40%

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7
Q

Premature menopause

A

AKA “premature Ovarian Insufficiency” (POI)
Occurs before age 40
Hysterectomy, radiation therapy, chemotherapy
1% of women develop premature ovarian failure before 40
Increase risk of mortality and morbidity

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8
Q

Symptom statistics

A

Worst symptoms occur during first 1-2 years
Symptoms last 7+ years for most women

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9
Q

Causes of menopause

A

Physiologic
-Extensive deterioration of the follicular cells and ova w/aging
-Decrease estrogen and progesterone levels -> increase FSH and LH level
Surgery
-Removal of ovaries (oophorectomy)
Chemotherapy
-Breast cancer chemotherapy
Radiation therapy

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10
Q

Clinical presentations of menopause: Vasomotor

A

Hot flashes
Night sweats
(50-87% of symptoms)

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11
Q

Clinical presentations of menopause: Mix

A

Irregular Menses
Episodic Amenorrhea
Sleep Disturbance
Mood changes (depression, irritability)
Fatigue
(generally lower number due to embarrassment of reporting)

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12
Q

Clinical presentations of menopause: Genitourinary

A

Vulvovaginal atrophy (vaginal dryness, dyspareunia)
Urinary tract dysfunction
Sexual dysfunction
Urinary frequency, urgency
(27-84%)
Lower incidence of reporting due to embarrassment

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13
Q

Long term consequences of menopause

A

CV disease
Bone loss
Osteoarthritis
Body composition
Skin changes
Balance

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14
Q

Treatment of Menopausal symptoms: Nonpharmacologic therapies: recommended

A

Weight loss
Cognitive behavioral therapy
Clinical hypnosis
Stellate ganglion block

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15
Q

Treatment of Menopausal symptoms: Nonpharmacologic therapies: NOT recommended

A

Lifestyle:
-cooling techniques
-Avoid triggers
-Yoga/exercise
-Dietary modifications
Mind body techniques
-Mindfulness-based interventions
Paced respiration
Dietary supplements
-Soy foods and soy extracts, soy metabolite equol
Supplements/herbal remedies
-cannabis
Others:
Acupuncture, calibration of neural oscillations, chiropractic intervention

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16
Q

Indications for menopausal hormone therapy

A

Vasomotor symptoms
Vulvovaginal atrophy
Osteoporosis prevention (not main tx for osteoporosis)

17
Q

Contraindications to MHT: ABSOLUTE

A

Any contraindications = stop immediately
Unexplained vaginal bleeding
Pregnancy
Estrogen-dependent malignancies
-Endometrial cancer
-Breast cancer
Stroke
Active thromboembolic disorders (or prior history)
Active liver disease

18
Q

Contraindications to MHT: Relative

A

Contraindications = patient’s choice to continue/discontinue
Uterine leiomyoma
Migraine headaches with aura
Seizure disorders
Diabetes
Hypertriglyceridemia (>400mg/day)
Active gallbladder disease
High risk for heart disease
Family hx of breast cancer

19
Q

Estrogen monotherapy is only for women (with/without) a uterus

A

Without

20
Q

Estrogen monotherapy products: Oral

A

Premarin (conjugated estrogens)
Menest (esterified estrogen)
Estrace generics (micro ionized estradiol)

21
Q

Estrogen monotherapy products: topical

A

Topical Gel (EstroGel, Divigel, Elestrin)
Topical Spray (Evamist)
IF other family members handle these, can cause S.E. (ex. gynecomastia)

22
Q

Estrogen monotherapy products: IM injections

A

Estradiol cypionate (Depo-estradiol)
Estradiol valerate (Delestrogen)
not typically used
Used more so in gender changing therapy

23
Q

Estrogen monotherapy products: Transdermal

A

Preferred
Climara
Lyllana
Menostar
Minivelle
Vivelle-dot
Dotti

-17B estradiol
Put patch on: continuous delivery of estrogen
Bypassing GI tract: avoid first pass, lower incidence of stroke, clots, dyslipidemia etc.

24
Q

Estrogen monotherapy products: intravaginal

A

Vaginal cream (Estrace, Premarin)
Vaginal Insert (Imvexxy)
Vaginal tablet (Vagifem, Yuvafem)
Vaginal Ring (Estring, Femring)
EXCEPTION:
Estring - does not have high amount of systemic absorption (localized)
Femring: Delivers appropriate amount for symptoms
Ring is bigger than string

25
Q

Topical vaginal products should be prescribed for women

A

Exclusively experiencing vulvovaginal atrophy (Local)

26
Q

Women with an intact uterus: When to use estrogen?

A

Should be prescribed a progestin IN ADDITION TO estrogen in order to decrease the risk of endometrial hyperplasia and endometrial cancer

27
Q

Women’s Health initiative study:

A

15 yr research program
Address most common causes of death, disability and poor quality of life in postmenopausal women
Clinical trials + observational study
Effects of hormone therapy, diet modification and Calcium/vitamin D
With uterus:
Conj. estrogen: 0.635 mg/day + medroxyprogesterone 2.5mg/day
W/o uterus:
Conj. estrogen 0.625

28
Q

Major clinical outcomes of WHI study: Estrogen and Progesterone

A

Increase:
CV: heart attacks, stroke and venous thromboembolism
Invasive breast cancers
Decrease:
Colorectal cancers
Hip fractures

29
Q

Major clinical outcomes of WHI study: Estrogen alone

A

Increase:
Strokes
Venous thromboembolism
Decrease:
Hip fractures
No difference
CHD
Invasive breast cancers
Colorectal disease

30
Q

Estrogen only: Age groups

A

-50-59 years favorable risk benefit profile
-60-69 increase risk of CHD and stroke
-70-79 highest risk of CHD and stroke

31
Q

Estrogen and Progestin age groups

A

-50-59: lowest risk
-60-69: Increasing risk
-70-79: Highest risk

32
Q

The women’s health initiative showed estrogen + progestin increased the risk of all of the following EXCEPT

A

Fracture (decreases)

33
Q

The WHI showed estrogen alone increased all of the following except:

A

Heart attack (age <60 within 10 years of menopause)
Fractures
Risk of breast cancer

Therapeutics (61 decks)

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