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Reproduction > Exam 3 lecture 5 > Flashcards

Exam 3 lecture 5 Flashcards

1
Q

FSH level in menopause

A

> 40 mIU/mL

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2
Q

hormone therapy indications

A
  • moderate to severe vasomotor symptoms (hot flashes, night sweats)
  • vulvovaginal atrophy (vag dryness & dyspareunia-painful sex)
  • prevention of postmenopausal osteoporosis
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3
Q

contraindications to HT

A
  • active or history of thromboembolism
  • CHD
  • stroke or TIA
  • history of breast cancer or estrogen dependent neoplasm
  • prego
  • active liver disease
  • undiagnosed vaginal bleeding
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4
Q

HT black box warnings

A
  • increase risk of breast cancer
  • increase risk of dementia
  • increase risk of endometrial cancer
  • should not be used to prevent CHD
  • should be used the shortest term possible
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5
Q

non-pharmacologic treatment

A

smoking cessation, limit alcohol & caffeine, limit hot beverages & spicy foods, dress in layers, reduce stress, increase exercise, deep slow breathing, water-based lubes, kegel exercises

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6
Q

Estrogen recommendation in menopause

A

LOWEST effective dose for SHORTEST amount of time possible

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7
Q

women taking estrogen with an INTACT uterus need

A

progesterone to prevent endometrial hyperplasia and endometrial cancer

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8
Q

topical products for women only experiencing

A

vulvovaginal atrophy

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9
Q

continuous cycle hormone therapy

A
  • estrogen & progesterone for 12-14 days each month
  • menses return for 1-2 days after last progesterone dose
  • withdrawal bleeding shorter and lighter than typical menstrual cycle
  • less spotting or break through bleeding
  • if pt is menstruating, start estrogen on day 5 and continue for 3 weeks
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10
Q

continuous combined hormone therapy

A
  • estrogen and progesterone administered daily
    women do NOT experience withdrawal bleeding
  • may experience unpredictable break-through bleeding for 6-12 months
  • best for women 2 years post-menopausal due to unpredictable bleeding
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11
Q

continuous long cycle hormone therapy

A
  • aka cyclic withdrawal
  • estrogen is given daily
  • progesterone is given every other month for 12-14 days
  • results in 6 periods per year
  • bleeding may be longer and heavier than continuous cyclic
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12
Q

intermittent combined hormone therapy

A
  • aka continuous-pulse of pulse-progesterone
  • estrogen therapy alone for 3 days followed by combined estrogen & progesterone for 3 days. then repeat
  • lower incidence of uterine bleeding
  • may be better tolerated
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13
Q

estrogens

A
  • premarin, cenestin. menest, estrace, femtrace, ogen
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14
Q

progesterones

A
  • provera, prometrium, aygestin
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15
Q

combined products

A
  • prempro, premphase, angeliq, femHRT, activella, ortho-prefest
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16
Q

low-dose hormone therapy

A
  • decreases hot flashes, improved vulvovaginal atrophy, increased bone mineral density, and endometrial protection
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17
Q

low-dose hormone therapy drugs

A

CEE, synthetic equine estrogens, oral micronized 17 B-estradiol, transdermal 17 B-estradiol, esterfied estrogens, estropipate

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18
Q

androgen treatment indications

A
  • treatment of moderate-to-severe vasomotor symptoms associated with menopause not improved by estrogens alone
  • may improve issues with sexual function such as decrease libido and decreased pleasure
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19
Q

androgen therapy drugs

A
  • covaryx HS- esterified estrogens 0.625mg and methyltestosterone
  • covaryx- esterified estrogens 1.25mg and methyltestosterone 2.5mg
20
Q

counseling points

A
  • take oral products with food to minimize GI distress

- symptoms may improve in as early as a few days-weeks

21
Q

estrogen ADE

A
  • common: N, HA, bloating, breast tenderness, bleeding

- serious: CHD, stroke, VTE, breast cancer, gallbladder disease

22
Q

progesterone ADE

A
  • comon: N, HA, weight gain, bleeding, irritability, depression
  • serious: VTE, decreased bone mineral density
23
Q

Managing ADE

A
  • reduce dose, change preparation, change administration- transdermal may have less ADE
24
Q

application sites of transdermal patch

A

trunk, preferably abdomen

- rotate sites, wait at least 1 week before site is used again

25
Q

if patch falls off

A
  • apply same patch to new area or apply a new patch

- maintain original schedule

26
Q

begin patch

A

1 week after last day of oral hormone therapy

27
Q

transdermal patch drugs

A

climara, menostar, alora, estrderm, vivelle-dot, combipatch, climarapro

28
Q

Divigel

A
  • spread a think layer on left or right upper thigh, alt. site daily
29
Q

estrogel

A
  • prime pump 2-3 times

- apply to arm (shoulder to waist) daily

30
Q

elestrin- gel

A
  • prime 10 times

- apply to upper arm and shoulder daily

31
Q

estrasorb - skin emulsion

A
  • apply to each leg (thick and calf) for 3 minutes until absorbed QAM
  • excess should be rubbed into the buttocks
32
Q

evamist- topical spray

A
  • prime 3 times w/ lid on
  • apply 1 spray to inner forearm daily
  • do not wash area for 1 hour
33
Q

estring, femring- vaginal ring

A
  • replace every 90 days

- femring- systemic absorption

34
Q

vagifem- vaginal tablet

A
  • 1 tablet daily for 2 weeks, then 1 tablet twice weekly
35
Q

estrace- vaginal cream

A
  • lie on back with knees up and gentle insert applicator
  • apply at bedtime to improve absorption
  • 2-4g/day for 1-2 week then 1/2 dose for 1-2 weeks then 1g 1-3 times/wk
36
Q

vasomotor symptoms typically resolve within

A

4 years

37
Q

women who initiated hormone therapy 10 years after menopause were at higher risk of

A

CHD

38
Q

VTE was lower in women who started hormone therapy

A

<60

39
Q

diagnosis of breast cancer increases after

A

3-5 years of hormone therapy (estrogen+ progesterone)

40
Q

bioidentical hormone therapy (BHT)

A
  • custom made HT
  • dose determined by salivary hormone testing
  • not tested for safety or eficacy
41
Q

non-hormonal treatment

A
  • antidepressants, gabapentin, clonidine
42
Q

antidpressants

A
  • fluoxetine, citalopram, paroxetine, sertraline, venlafaxine
  • recommended first line for women w/ CI to HT
43
Q

gabapentin

A
  • reduced frequency & severity of hot flashes
  • 900mg/day
  • dizziness and somnolence may occur
44
Q

clonidine

A
  • effective for symptom control
  • 0.1-0.4mg daily
  • sedation, dry mouth, & hypotension may limit use
45
Q

alternative treatment agents

A

black cohosh, soy, phytoestrogens, red clover, evening primrose oil, dong quai, passionflower, sage, valerian, wild yam

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