Exam 2 - Menopause: hormonal symptom management

Question 1

True/false: Pregnancy is still possible until 12 months of amenorrhea

Answer 1

True - Doses of hormone therapy NOT enough as contraceptives

Question 2

At what age is it recommended to transition to hormone therapy for women undergoing menopause?

Answer 2

Age 55 years

Question 3

Which form of therapy, estrogen therapy (ET) or estrogen/progesterone therapy (EPT), is recommended for women with an intact uterus with menopause?

Answer 3

Estrogen and progesterone therapy (EPT)

• Protect against endometrial building effects of estrogen (endometrial hyperplasia)

Question 4

Do women post hysterectomy require hormone therapy?

Answer 4

Do NOT require progesterone therapy

Question 5

Do women who are treated with local/topical estrogen require progesterone therapy?

Answer 5

They do not require progesterone therapy

• Patients will undergo endometrial surveillance with ultrasound after 6-12 months, then annually

Question 6

When would EPT systemic therapy be indicated? Local therapy?

Answer 6

Systemic therapy - hot flashes

Local therapy - vaginal atrophy/dryness

Question 7

What are the three dosing options for EPT therapy?

Answer 7

• Sequential EPT
• Continuous combined EPT
• Intermittent-combined EPT

Question 8

How would patients normally take EPT following the sequential schedule?

Answer 8

Take estrogen daily and add progesterone for 10-14 days each month to create withdrawal bleed

Question 9

What are the pros and cons of sequential EPT?

Answer 9

Pros

• Eliminates estrogen free days which induce hot flashes
• Good for perimenopause transition

Question 10

How would patients take EPT according to the continuous-combined regimen?

Answer 10

Estrogen and progesterone daily

• May experience amenorrhea

Question 11

How would patients take EPT according to the intermittent-combined regimen?

Answer 11

Continuous-pulsed EPT, both intermittent and sequential

• Estrogen given daily and progesterone intermittently for 3 days, then 3 days off (repeated without interruption)

Question 12

How long is hormone therapy before discontinuation is considered?

Answer 12

• Hormone therapy should be treated for shortest during necessary for symptom relief
• Consider d/c after 5 years of therapy

Question 13

What are contraindications to hormone therapy?

Answer 13

• Undiagnosed vaginal bleeding
• Known/suspected history of breast cancer, suspected estrogen dependent cancer
• History of DVT, pulmonary embolism, CVA, MI
• Liver disease
• Pregnancy