Hormones

Question 1

Antidepressants for hot flashes

Answer 1

Venlafaxine=Effexor37.5mg for 1st wk, then 75mg to \ nausea
Desvenlafaxine
Paroxetine 7.5mg/d FDA appr; not w/ TMX
Citalopram
Escitalopram

If one doesn’t work, different one can be tried.

Question 2

Non E, non antidepressant tx of menopause symptoms:

Answer 2

Gabapentin *900mg/d; > night symptoms
start at 100’qhs, /by 100’ q3 d till 900’
when switching from SSRI, overlap x 2wks

at 2400’ as good as E but HA, dizziness, disorientation

Pregabalin 300mg
Clonidine (dry mouth, dizziness, constipation, sedation) TTS-1 patch>po but $
Oxybutin 5-10’ (20-50% dry mouth)

Question 3

Hot flashes: less common, high dose progesterone options:

Answer 3

medroxyprogesterone acetate: 500mg depot - in one study better than venlafaxine (80 vs 50% score reduction)

Norethindrone acetate 10’/d

Tibolone in EU for 20y; > for sexual dysfunction in PMN; / risk of stroke and breast ca

Question 4

REI: is risk of PCOS increased with obesity?

Answer 4

Only minimally

degree of obesity has increased over time in PCOS patients reflecting the rise in general population