Hormone therapy in women Flashcards
(25 cards)
what is perimenopause
begins with the onset of menstrual irregularity and ends 12 months after the last menstrual period which marks the beginning of menopause
what is menopause?
permanent cessation of menses caused by the loss of ovarian follicular activity
what hormonal changes are seen during menopause?
increase in FSH and LH
> 90% decrease in estradiol concentrations
menstrual cycle irregularity most often caused by…
increased frequency of anovulatory cycles
sxs of perimenopause or menopause?
vasomotor sx (hot flushes and night sweats), sleep disturbances, mood changes, probs w/concentration, vaginal dryness and dyspareunia, arthralgia
lab tests for perimenopause/menopause?
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
4 indications for hormone therapy?
Bothersome vasomotor symptoms (VMS)
Prevention of bone loss
Hypoestrogenism caused by hypogonadism, castration, or primary ovarian insufficiency (POI)
Genitourinary symptoms (GSM)
in women w/an intact uterus, hormone therapy consists of…
an estrogen PLUS a progestogen
in women who have undergone hysterectomy…
estrogen therapy is given unopposed by a progestogen
what is the most effective tx option for alleviated vasomotor and vaginal sxs?
hormone therapy
MHT (menopause hormone tx) puts pt at increased risk of…
CV dz, breast CA, osteoporotic fx, and VTE
use of a systemic estrogen in women w/an intact uterus must always be accompanied by….
a progestogen or an estrogen agonist antagonist for endometrial protection
contraindications for HRT
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
4 indications for hormone therapy
Bothersome VMS
Prevention of bone loss
GSM
Hypoestrogenism caused by hypogonadism, castration of Primary Ovarian Insufficiency (POI)
non-pharmacological tx?
lifestyle: wearing layered clothing, lowering room temp, decr intake of hot/spicy foods and hot beverages (caffeine), exercise
what are some progestogen (oral cyclic administration) tx options used for endometrial protection?
Medroxyprogesterone acetate, Micronized progesterone (most tolerated), Norethindrone acetate
-can’t be given on their own
alternative to estrogen tx options for hot flushes?
Venlafaxine, Desvenlafaxine, Paroxetine/paroxetine CRd, Megestrol acetate, Clonidine, Gabapentin
sxs of adrogen insufficiency?
manifested as diminished sense of well-being
persistent or unexplained fatigue
sexual function changes such as decreased libido, decreased sexual receptivity, and decreased pleasure
what are some androgen regimens used for women?
Methyltestosterone in combo w/ esterified estrogens, testosterone pellets, transdermal testosterone system, oral tablet flibanserin
Phytoestrogens 3 main classes?
isoflavones, lignans, and coumestans,
found in plants or their seeds
what are phytoestrogens?
plant compounds w/estrogen-like bio activity
how long should yo rx Hormone therapy?
should be used only as long as sxs control is necessary, typically 2-3yrs
ADE’s for progestogen?
bloating, pre-menstrual-like sxs.
what are bioidentical hormones?
natural progesterone and testosterone (estrone, estradiol, estriol) appear to carry same risks as traditional hormone therapy
