Hormonal Replacement Therapy Flashcards
When does menopause officially begin?
12 months after the last menstrual period
What happens to FSH and LH in menopause?
INCREASE
What are the 4 indications approved by the FDA for hormone replacement?
- Vasomotor symptoms**
- Preventing bone loss
- Hypoestrogenism caused by hypogonadism, castration, or primary ovarian insufficiency
- Genitourinary symptoms*
What is the difference in hormone therapy if your patient has a uterus or not?
Uterus - combination of estrogen + progesterone
(this is for endometrial protection)
No uterus - unopposed estrogen
Risk of breast cancer with menopause hormone therapy is associated with which hormone?
progesterone with estrogen
estrogen alone doesn’t increase risk
When can you consider using HRT (systemic estrogen therapy) in a recent postmenopausal patient at increased risk of bone fracture?
If alternative therapies are contraindicated or cause excessive ADE
Which two types of symptoms is Hormone replacement therapy best for?
- Vasomotor symptoms
2. Genitourinary symptoms
Describe how time after menopause effects risk with HRT?
- If <10 years after menopause, pros out weight the cons
- If >10 years after menopause, don’t initiate therapy because more risk for coronary heart disease, stroke, venous thromboembolism, and dementia
Absolute contraindications for HRT?
- Abnormal genital bleeding
- Breast cancer (hx, known, suspected)
- Estrogen/Progesterone dependent neoplasia
- VTE (stroke, MI)
- Liver dysfunction
If a menopausal patient has vasomotor symptoms but has a contraindication to HRT what is the therapy of choice?
- SNRI
- SSRI
- Clonidine
- Gabapentin
Vasomotor symptoms: Non-pharmacologic treatment
- wearing layered clothing
- lowering room temperature
- decreasing hot spicy foods, caffeine, and hot beverages
- exercise
If a patient has liver function problems what type of estrogen should they receive?
NOT oral
- patch
- topical
- transdermal spray
- vaginal
- implantable pellet
What is important to educate your patient about their use of HRT?
HRT doesn’t provide adequate contraception
Alternative medications to Estrogen for the treatment of hot flushes
- Venlafaxine (SNRI) [Effexor]
- Desvenlafaxine (SNRI) [Pristiq]
- Paroxetine* -only one that is not considered off-label
- Megestrol acetate
- Clonidine
- Gabapentin
Gabapentin: ADEs
- Somnolence
- Dizziness
- Ataxia
**increase dose gradually
Androgen insufficiency: Signs and symptoms
- diminished sense of well being
- Persistent fatigue
- Decreased libido
Food sources of estrogen
- soybean
- cereals
- flaxseed
- alfalfa sprouts
Black Cohosh: overview
- herbal supplement
- possible benefit for vasomotor symptoms
- ADE: hepatotoxicity
How long should HRT last?
Shortest time possible (2-3 years typically)
breast cancer risk increases after 5 years of combined hormone therapy
After starting a patient on HRT, when do they follow up?
6 weeks
If a patient is having breast tenderness how should you adjust the estrogen dose?
- decrease
- switch to transdermal
What should you look out for with a patient on Progestogen?
- bloating
- pre-menstrual symptoms (PMS)
Solution: switch to another progestogen
Should you use bioidentical hormones?
NO
