Gyne I Flashcards
What is first line tx for primary dysmenorrhea?
NSAIDs
What are the contraindications for progestin therapy?
Pregnancy, undiagnosed vaginal bleeding, known or suspected carcinoma of the breast
What are the side effects of danazol?
Androgenic side effects b/c androgenic agonist- hirsutism, irreversible voice deepening, decreased breast size, weight gain and increased LDL/decreased HDL
What is first line pharmacological tx for osteoporosis?
Bisphosphonates
What is considered to be second line tx for osteoporosis?
Desnosumab
What education should be provided for administration of bisphosphonates?
Should be taken in AM on empty stomach with full glass of water and pt must remain upright for 30 minutes or longer after taking
Who can hormone therapy be useful for?
Osteoporosis who also suffer from VMS, women in perimenopause with VMS symptoms, those who experience early loss of ovarian function to help with heart health/bones/brain
For women experiencing perimenopause/menopause, who should hormone therapy be considered for?
Those <60 years of age who are <10 years past menopause
What type of hormone therapy must be initiated for women who have a uterus?
Combination therapy- estrogen and progesterone
What are some CI for estrogen therapy? (menopause)
Undiagnosed vaginal bleeding, active liver disease, active thromboembolic disease, known/suspected carcinoma of the breast/other estrogen-sensitive tumors, pregnancy
What are the CI for progesterone therapy?
Undiagnosed vaginal bleeding, known/suspected carcinoma of the breast, pregnancy
What routes are estrogen therapy available in? (menopause)
Topical transdermal (gel/patch) or oral
Who should topical estrogen be considered for?
Those with migraines, high triglycerides, HTN, malabsorption, low libido. Reduces the first pass through the liver (?reduced VTE risk)
What are some of the adverse effects of estrogen therapy? (menopause)
Breakthrough bleeding (first few months), nausea, headache, bloating/water retention, breast tenderness
What education should be provided to patients started on topical estrogen (Estrogel/Divigel)?
Estrogel can be applied to the abdomen or inner thighs (should not rotate application site) and Divigel should be applied to L and R thigh, alternating sites
What is recommended with progesterone therapy and route of administration?
Topical should not be used for those with intact uterus who are on estrogen- there’s not enough endometrial protection to prevent hyperplasia
How long should hormone therapy be continued for?
No official indication on when to D/C therapy, normally based on patient and symptom relief and should review yearly to determine ongoing need. Those who start in early/premenopause should continue until average age of menopause
What is the recommended therapy for genitourinary syndrome of menopause (GSM)?
Vaginal estrogen in the forms are creams, intravaginal tablets (may be preferred d/t less systemic absorption), and/or estradiol-releasing rings
What other therapies can be considered for genitourinary symptoms of menopause?
Vaginal moisturizers, hyaluronic acid, and/or vaginal lubricants
What are the non-pharm tx options for osteoporosis?
Balance and functional training 2x/week to reduce risk of falls, progressive resistance training 2x/week, adequate nutrition
What is the recommendation for calcium and Vit D intake for males 51-70 years?
Calcium 1000 mg/d via diet and/or supplements
What is the recommendation for calcium and Vit D intake for females 50 years or older and males >70 years?
Calcium 1200 mg/d
What is the recommended Vit D intake for those aged 51-70 years?
600 IU/D
What is the recommended vit D intake for those 70 and older?
800 IU/D
