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Reproductive > Hormonal Replacement Therapy: Phillips > Flashcards

Hormonal Replacement Therapy: Phillips Flashcards

1
Q

What is menopause definition?

A

One year without menses

FSH >30

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2
Q

What is perimenopause?

A

Symptoms as we get close, 45-55

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3
Q

What is the average age of menopause?

A

51 or 52

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4
Q

What causes earlier menopause?

A

smoking!

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5
Q

What is post menopause?

A

> 55

or after menopause

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6
Q

What was the avg age of menopause/death 1932?

A

meno: 51
death: 52

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7
Q

What is the avg age of meno/death today?

A

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

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8
Q

When does reproductive life usually end?

A

43, earlier or later

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9
Q

What rises hormonally? lowers?

A

Rises: FSH
Lower: Estrogen

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10
Q

Why do women start HRT?

A

Symptoms
Osteoporosis
CV disease
Anxiety and depression

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11
Q

MC Sx?

A

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

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12
Q

When do hot flashes happen?

A

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

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13
Q

What race is most likely to have hot flashes?

A

Black>white>chinese>hispanic

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14
Q

Tx for HRT?

A

Estrogen with

Progestin: prevents endometrial cancer

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15
Q

What is true for drugs in terms of placebo effect?

A

Just about anything helps… due to placebo effect

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16
Q

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

A

40%

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17
Q

Soy products relate how to placebo?

A

Same as placebo… but there is a huge placebo effect

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18
Q

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

A

No PROGESTIN… no endometrium to prevent cancer in

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19
Q

What happens to vagina in menopause?

A

Vaginal atrophy

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20
Q

What sexual symptoms are not associated with menopause?

A

Depression
Lack of sex interest
Going crazy

21
Q

What is dyspareunia?

A

Pain with intercourse

22
Q

What tx for vaginal pain?

A

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

23
Q

What medical illnesses are associated with menopause?

A

Osteoporosis
Heart disease
Cancer

24
Q

Bone mass peaks at what age?

A

18-31

25
Q

Estrogen therapy has been approved for prevention but not treatment?

A

osteoporosis

26
Q

When do bone density scans begin?

A

65 unless risk factors

27
Q

HRT decreases what risk?

A

Fracture risk

28
Q

What is the WHI?

A

Women’s Health Initiative

29
Q

What were WHI questions?

A

CVD reduced with HRT?

Breast cancer caused by HRT?

30
Q

What are the top 3 killers of older women?

A

CV disease

31
Q

What is notable about CV in hormones?

A

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

32
Q

When do CV complications show up, meet mens stats?

A

age 65

33
Q

What is the major problem with observational studies?

A

BIAS in introduced

34
Q

What did observational studies show for HRT?

A

CV protection

35
Q

What is the gold standard trial?

A

Double blind
placebo
randomized
control trial

36
Q

What were WHI results in 2002?

A

Women are MORE likely to have CV heart attacks!

37
Q

If you are before menopause HRT does what?

A

Positive: vascular remodeling
Decreased intimal thickening
Decreased plaques

38
Q

If you are after menopause HRT causes what?

A

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

39
Q

When did women have heart attacks in HRT WHI study?

A

within 1 year

40
Q

What correlates to risk of MI with HRT?

A

Years since menopause… >20 years increased risk 66%

41
Q

When does breast cancer risk increase in HRT?

A

With use beyond 5 years

42
Q

What is absolute risk in WHI for breast cancer?

A

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

43
Q

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

A

Progestin: breast
Estrogen: endometrial

44
Q

What is sum of breast cancer risk in HRT?

A

Increase risk of breast cancer is seen in 3-5 years of continuous EPT therapy

Progestin adds to the risk

The risk is small

45
Q

What happens to BC risk after HRT is terminated?

A

Returns to baseline

46
Q

Who should be really worried about HRT?

A

Breast cancer family history

47
Q

What is key to deciding HRT?

A

Individualization
Have a convesation
Weigh osteoporosis risk and CV risk

48
Q

Patch decreases what in estrogen? How?

A

Clotting risk: avoids first pass through liver and those effects

Reproductive (31 decks)

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