Hormone Therapy, SERMs and TSECs Flashcards
Vasomotor Symptoms of Menopause
Hot flashes Night sweats Vaginal Dryness/dyspareunia Sleep Disturbances Mood Swings Incontinence
When is Hormone therapy indicated for menopause
When there is presence of vasomotor symptoms that changes quality of life.
Other issues seen in menopause besides the vasomotor symptoms
Osteopenia/porosis Cardiac issues (ACS, MI, CVD)
What is required to be coadministered with Estrogen in women with an intact uterus?
Progestins
4 types of Estrogen available for MHT
- Estradiol
- Conj Estrogens (CE)
- Esterified Estrogens (EE)
- Estropipate- contains sulfate*
3 types of Progestin available
Medroxyprogestrone
Methyltestosterone
Progesterone
Why is progestin important to administer with estrogen for woman with intact uterus?
Progestin opposes the endometrial hyperplasia caused by estrogen, which decreases risk of endometrial cancer.
Does estrogen therapy have the same effect in all tissues?
No- depends on the specific drug
What is the expected effect on cholesterol levels with estrogen therapy?
Decreased Total Cholesterol and LDL
Increased HDL
What is the effect of estrogen on anti-thrombin III?
Decreases, leading to a decreased thrombin activation
What products are increased by estrogen?
Triglycerides
Clotting factors
Platelet Aggregation
5 major considerations for Hormone therapy
- For younger women (up to 59)
- If vaginal dryness is only complaint, use low dose vaginal estrogen
- Uterus there? PROGESTIN
- Risk of Clot/Stroke? Either type of therapy will increase risk
- Increased risk of Breast Cancer within 5 years of MHT
Risks associated with combined Estrogen and Progestin therapy
Breast cancer CHD Stroke VTE GB disease Incontinence
Benefit of BOTH combined and estrogen-only therapy
Decreased fractures
SERMs to know
Ospemifene
Clomiphene
A woman presenting with dyspareunia as vaginal atrophy on PE, and complains of vaginal dryness. Which SERM is indicated?
Ospemifene
What is the effect of Ospemifene at the vagina and breast, respectively?
Agonist at Vagina
Antagonist at Breast
Bazedoxifene
TSEC w/ CE
Treats Vasomotor symptoms of menopause & helps prevent osteoporosis
Antagonist at endometrium and breast, agonist at bone
Clomiphene
Indicated for infertility
Inhibits negative feedback of estrogen on HPO axis, causing increased estrogen release via increased GnRH
How long can a patient take clomiphene?
Max of 3 cycles due to increased risk of ovarian cancer and cysts. Also increased risk of multiparity
