Hormone therapy in women

Question 1

what is perimenopause

Answer 1

begins with the onset of menstrual irregularity and ends 12 months after the last menstrual period which marks the beginning of menopause

Question 2

what is menopause?

Answer 2

permanent cessation of menses caused by the loss of ovarian follicular activity

Question 3

what hormonal changes are seen during menopause?

Answer 3

increase in FSH and LH

> 90% decrease in estradiol concentrations

Question 4

menstrual cycle irregularity most often caused by…

Answer 4

increased frequency of anovulatory cycles

Question 5

sxs of perimenopause or menopause?

Answer 5

vasomotor sx (hot flushes and night sweats), sleep disturbances, mood changes, probs w/concentration, vaginal dryness and dyspareunia, arthralgia

Question 6

lab tests for perimenopause/menopause?

Answer 6

Perimenopause: FSH on day 2 or 3 of the menstrual cycle greater than 10 to 12 IU/L

Menopause: FSH greater than 40 IU/L

Question 7

4 indications for hormone therapy?

Answer 7

Bothersome vasomotor symptoms (VMS)

Prevention of bone loss

Hypoestrogenism caused by hypogonadism, castration, or primary ovarian insufficiency (POI)

Genitourinary symptoms (GSM)

Question 8

in women w/an intact uterus, hormone therapy consists of…

Answer 8

an estrogen PLUS a progestogen

Question 9

in women who have undergone hysterectomy…

Answer 9

estrogen therapy is given unopposed by a progestogen

Question 10

what is the most effective tx option for alleviated vasomotor and vaginal sxs?

Answer 10

hormone therapy

Question 11

MHT (menopause hormone tx) puts pt at increased risk of…

Answer 11

CV dz, breast CA, osteoporotic fx, and VTE

Question 12

use of a systemic estrogen in women w/an intact uterus must always be accompanied by….

Answer 12

a progestogen or an estrogen agonist antagonist for endometrial protection

Question 13

contraindications for HRT

Answer 13

Undx’d abn genital bleeding, h/o cancer of the breast, estrogen- or progesterone-dep neoplasia, active DVT, PE, or a h/o arterial thromboembolic disease (ie. CVA, MI), liver dysfx or dz

Question 14

4 indications for hormone therapy

Answer 14

Bothersome VMS

Prevention of bone loss

GSM

Hypoestrogenism caused by hypogonadism, castration of Primary Ovarian Insufficiency (POI)

Question 15

non-pharmacological tx?

Answer 15

lifestyle: wearing layered clothing, lowering room temp, decr intake of hot/spicy foods and hot beverages (caffeine), exercise

Question 16

what are some progestogen (oral cyclic administration) tx options used for endometrial protection?

Answer 16

Medroxyprogesterone acetate, Micronized progesterone (most tolerated), Norethindrone acetate

-can’t be given on their own

Question 17

alternative to estrogen tx options for hot flushes?

Answer 17

Venlafaxine, Desvenlafaxine, Paroxetine/paroxetine CRd, Megestrol acetate, Clonidine, Gabapentin

Question 18

sxs of adrogen insufficiency?

Answer 18

manifested as diminished sense of well-being
persistent or unexplained fatigue

sexual function changes such as decreased libido, decreased sexual receptivity, and decreased pleasure

Question 19

what are some androgen regimens used for women?

Answer 19

Methyltestosterone in combo w/ esterified estrogens, testosterone pellets, transdermal testosterone system, oral tablet flibanserin

Question 20

Phytoestrogens 3 main classes?

Answer 20

isoflavones, lignans, and coumestans,

found in plants or their seeds

Question 21

what are phytoestrogens?

Answer 21

plant compounds w/estrogen-like bio activity

Question 22

how long should yo rx Hormone therapy?

Answer 22

should be used only as long as sxs control is necessary, typically 2-3yrs

Question 23

ADE’s for progestogen?

Answer 23

bloating, pre-menstrual-like sxs.

Question 24

what are bioidentical hormones?

Answer 24

natural progesterone and testosterone (estrone, estradiol, estriol) appear to carry same risks as traditional hormone therapy

Question 25

does HRT prevent pregnancy?

Answer 25

NOOOOO