Hormonal Replacement Therapy: Phillips

Question 1

What is menopause definition?

Answer 1

One year without menses

FSH >30

Question 2

What is perimenopause?

Answer 2

Symptoms as we get close, 45-55

Question 3

What is the average age of menopause?

Answer 3

51 or 52

Question 4

What causes earlier menopause?

Answer 4

smoking!

Question 5

What is post menopause?

Answer 5

> 55

or after menopause

Question 6

What was the avg age of menopause/death 1932?

Answer 6

meno: 51
death: 52

Question 7

What is the avg age of meno/death today?

Answer 7

Meno: 51
death: 87
Women spend 1/3 their life in menopause

Question 8

When does reproductive life usually end?

Answer 8

43, earlier or later

Question 9

What rises hormonally? lowers?

Answer 9

Rises: FSH
Lower: Estrogen

Question 10

Why do women start HRT?

Answer 10

Symptoms
Osteoporosis
CV disease
Anxiety and depression

Question 11

MC Sx?

Answer 11

Hot flash: gonadotrpin spikes as much as estrogen deficiency
skin and vasodilation makes heat

Question 12

When do hot flashes happen?

Answer 12

Night… then cooling effect: 5 times a night, sleep disturbance

Question 13

What race is most likely to have hot flashes?

Answer 13

Black>white>chinese>hispanic

Question 14

Tx for HRT?

Answer 14

Estrogen with

Progestin: prevents endometrial cancer

Question 15

What is true for drugs in terms of placebo effect?

Answer 15

Just about anything helps… due to placebo effect

Question 16

What % of people will have tried self treatment before seeing doctor?

Answer 16

40%

Question 17

Soy products relate how to placebo?

Answer 17

Same as placebo… but there is a huge placebo effect

Question 18

If a woman has had a hysterectomy, what is notable about HRT?

Answer 18

No PROGESTIN… no endometrium to prevent cancer in

Question 19

What happens to vagina in menopause?

Answer 19

Vaginal atrophy

Question 20

What sexual symptoms are not associated with menopause?

Answer 20

Depression
Lack of sex interest
Going crazy

Question 21

What is dyspareunia?

Answer 21

Pain with intercourse

Question 22

What tx for vaginal pain?

Answer 22

Vaginal Estrogen… no need for progestins since not systemic.
Local or systemic.

Question 23

What medical illnesses are associated with menopause?

Answer 23

Osteoporosis
Heart disease
Cancer

Question 24

Bone mass peaks at what age?

Answer 24

18-31

Question 25

Estrogen therapy has been approved for prevention but not treatment?

Answer 25

osteoporosis

Question 26

When do bone density scans begin?

Answer 26

65 unless risk factors

Question 27

HRT decreases what risk?

Answer 27

Fracture risk

Question 28

What is the WHI?

Answer 28

Women's Health Initiative

Question 29

What were WHI questions?

Answer 29

CVD reduced with HRT? | Breast cancer caused by HRT?

Question 30

What are the top 3 killers of older women?

Answer 30

CV disease

Question 31

What is notable about CV in hormones?

Answer 31

Women were protected until menopause it gets worse after menopause estrogen: increases good vascular changes

Question 32

When do CV complications show up, meet mens stats?

Answer 32

age 65

Question 33

What is the major problem with observational studies?

Answer 33

BIAS in introduced

Question 34

What did observational studies show for HRT?

Answer 34

CV protection

Question 35

What is the gold standard trial?

Answer 35

Double blind placebo randomized control trial

Question 36

What were WHI results in 2002?

Answer 36

Women are MORE likely to have CV heart attacks!

Question 37

If you are before menopause HRT does what?

Answer 37

Positive: vascular remodeling Decreased intimal thickening Decreased plaques

Question 38

If you are after menopause HRT causes what?

Answer 38

Over 65 HRT: Plaques are already formed... Estrogen is thrombogenic: cuts off artery Adverse effect was in first year!

Question 39

When did women have heart attacks in HRT WHI study?

Answer 39

within 1 year

Question 40

What correlates to risk of MI with HRT?

Answer 40

Years since menopause... >20 years increased risk 66%

Question 41

When does breast cancer risk increase in HRT?

Answer 41

With use beyond 5 years

Question 42

What is absolute risk in WHI for breast cancer?

Answer 42

4-6 additional invasive cancers/10,000 women/yers with use of HRT for >5 years

Question 43

Progestin causes risk for what? Estrogen causes cancer risk for what?

Answer 43

Progestin: breast Estrogen: endometrial

Question 44

What is sum of breast cancer risk in HRT?

Answer 44

Increase risk of breast cancer is seen in 3-5 years of continuous EPT therapy Progestin adds to the risk The risk is small

Question 45

What happens to BC risk after HRT is terminated?

Answer 45

Returns to baseline

Question 46

Who should be really worried about HRT?

Answer 46

Breast cancer family history

Question 47

What is key to deciding HRT?

Answer 47

Individualization Have a convesation Weigh osteoporosis risk and CV risk

Question 48

Patch decreases what in estrogen? How?

Answer 48

Clotting risk: avoids first pass through liver and those effects