Hormonal Replacement Therapy: Phillips Flashcards
What is menopause definition?
One year without menses
FSH >30
What is perimenopause?
Symptoms as we get close, 45-55
What is the average age of menopause?
51 or 52
What causes earlier menopause?
smoking!
What is post menopause?
> 55
or after menopause
What was the avg age of menopause/death 1932?
meno: 51
death: 52
What is the avg age of meno/death today?
Meno: 51
death: 87
Women spend 1/3 their life in menopause
When does reproductive life usually end?
43, earlier or later
What rises hormonally? lowers?
Rises: FSH
Lower: Estrogen
Why do women start HRT?
Symptoms
Osteoporosis
CV disease
Anxiety and depression
MC Sx?
Hot flash: gonadotrpin spikes as much as estrogen deficiency
skin and vasodilation makes heat
When do hot flashes happen?
Night… then cooling effect: 5 times a night, sleep disturbance
What race is most likely to have hot flashes?
Black>white>chinese>hispanic
Tx for HRT?
Estrogen with
Progestin: prevents endometrial cancer
What is true for drugs in terms of placebo effect?
Just about anything helps… due to placebo effect
What % of people will have tried self treatment before seeing doctor?
40%
Soy products relate how to placebo?
Same as placebo… but there is a huge placebo effect
If a woman has had a hysterectomy, what is notable about HRT?
No PROGESTIN… no endometrium to prevent cancer in
What happens to vagina in menopause?
Vaginal atrophy
What sexual symptoms are not associated with menopause?
Depression
Lack of sex interest
Going crazy
What is dyspareunia?
Pain with intercourse
What tx for vaginal pain?
Vaginal Estrogen… no need for progestins since not systemic.
Local or systemic.
What medical illnesses are associated with menopause?
Osteoporosis
Heart disease
Cancer
Bone mass peaks at what age?
18-31
Estrogen therapy has been approved for prevention but not treatment?
osteoporosis
When do bone density scans begin?
65 unless risk factors
HRT decreases what risk?
Fracture risk
What is the WHI?
Women’s Health Initiative
What were WHI questions?
CVD reduced with HRT?
Breast cancer caused by HRT?
What are the top 3 killers of older women?
CV disease
What is notable about CV in hormones?
Women were protected until menopause
it gets worse after menopause
estrogen: increases good vascular changes
When do CV complications show up, meet mens stats?
age 65
What is the major problem with observational studies?
BIAS in introduced
What did observational studies show for HRT?
CV protection
What is the gold standard trial?
Double blind
placebo
randomized
control trial
What were WHI results in 2002?
Women are MORE likely to have CV heart attacks!
If you are before menopause HRT does what?
Positive: vascular remodeling
Decreased intimal thickening
Decreased plaques
If you are after menopause HRT causes what?
Over 65 HRT: Plaques are already formed…
Estrogen is thrombogenic: cuts off artery
Adverse effect was in first year!
When did women have heart attacks in HRT WHI study?
within 1 year
What correlates to risk of MI with HRT?
Years since menopause… >20 years increased risk 66%
When does breast cancer risk increase in HRT?
With use beyond 5 years
What is absolute risk in WHI for breast cancer?
4-6 additional invasive cancers/10,000 women/yers with use of HRT for >5 years
Progestin causes risk for what? Estrogen causes cancer risk for what?
Progestin: breast
Estrogen: endometrial
What is sum of breast cancer risk in HRT?
Increase risk of breast cancer is seen in 3-5 years of continuous EPT therapy
Progestin adds to the risk
The risk is small
What happens to BC risk after HRT is terminated?
Returns to baseline
Who should be really worried about HRT?
Breast cancer family history
What is key to deciding HRT?
Individualization
Have a convesation
Weigh osteoporosis risk and CV risk
Patch decreases what in estrogen? How?
Clotting risk: avoids first pass through liver and those effects
