exam 2 menopause pp Flashcards
menopause
when last period was 12 months ago
can be induced by hysterectomy due to removal of ovarian tissue
perimenopause
transitional period when hormonal and biologic changes begin
usually lasts 4-5 years
hot flashes
episodes of flushing and heat in the upper body and face, can be followed by chill
decrease in progesterone
decrease in estrogen
increase in FSH
increase in LH
night sweats
hot flashes at night
sleep can be impaired and cause mood changes
GUS
irritation, dryness, burning itching, vulvovaginal atrophy
dyspareunia, discomfort
urgency, frequency, recurrent UTI
what is most effective for VMS
systemic estrogen
estrogen causes
decrease LH
can improve bone density
VTE and stroke
cancer- endometrial and breast
dementia >65 y/o
progestin give to women who
have an intact uterus (at least 12-14 days of the month)
ADE- mood disturbances and spotting
micronized are safer than synthetic
hormone therapy used when
healthy symptomatic women within 10 years of menopause <60 y/o and no contraindications
GSM without VMS
topical vaginal products
transdermal prescribed when
ADE with oral products: elevated TGs and liver function abnormalities
theses have less risk for VTE and gallbladder disease
estrogen contraindications
hormone dependent cancer
DVT or PE
CVA or MI in last 12 months
acute liver/gallbladder disease
undiagnosed uterine bleeding
known protein C or S or antithrombin deficiency
pregnancy
benefits of systemic therapy
treats VMS
treats vulvar and vaginal atrophy, dryness, and dyspareunia
decreased risk of osteoporosis, increases bone mineral density
may decrease CHD risk in young and recently postmenopausal women
are compounded bioidentical therapies recommended?
no
non hormonal therapies
cognitive behavioral therapies and hypnosis
paroxetine (and citalopram, escitalopram, venlafaxine, desvelafaxine)
gabapentin
pregabalin
clonidine
fezolinetant
oxybutynin
may be beneficial
weigh loss
mindfulness based stress reduction
s-equol soy isoflavone derivatives
stellate ganglion block
not recommended
cooling techniques
trigger avoidance
exercise
yoga
paced respiration relaxation
OTC sup/herbals
acupuncture
calibration of neural oscillations
chiropractor
Womens health initiative (WHI) purpose
define risks & benefits of interventions to decrease heart disease, breast and colorectal cancer, and osteoporotic fractures in postmenopausal women
HRT boxed warning
endometrial cancer (in women with uterus not using progestin)
dementia (>65 y/o)
increase risk of VTE and stroke (age 50-79)
breast cancer (when estrogen used alone)
HRT warnings
increased risk of breast cancer
ovarian cancer
increased risk of retinal vascular thrombosis
increased HDL, TG and decreased LDL
HRT side effects
edema
HTN
HA
weight gain
depression
nausea
abdominal pain
patch side effects
redness
irritation of skin
remove prior to MRI
difference in continuous regimens
cyclic- scheduled withdrawal bleeding that is predictable
combined- induces amenorrhea and may have irregular bleeding for 6-12 months
long cycle- fewer withdrawal bleeding episodes (every other month)
phytoestrogens
soy- VMS in women who can make equol
may decrease hot flashes
soy decreases effectiveness of warfarin
if not responsive to soy the can try s-equol
