HRT for menopause Flashcards
What did the Women’s Health Initiative show
No increase in overall mortality with HRT
- Increased risk of breast cancer, VTE, stoke and coronary artery disease
- Decreased risk of osteoporosis and colon cancer
What did the HERS/HERS II show
Cardioprotective when HT/ET given close to menopause
Lower coronary artery calcium scores
What did the estrogen and thromboembolism study show
Transdermal estrogen has a lower VTE risk
What are contraindications to HT use
Pregnancy
Existing breast cancer
Estrogen-sensitive tumor
Undiagnosed vaginal bleeding
Active liver disease
History of VTE or thrombophilia
Coronary heart disease
CVA/ TIA
Vaginal estrogen cream
Minimal absorption, no VTE risk
When do you stop HRT
ACOG recommends against stopping HRT at 65 if pt wishes to continue
When do you start HRT
Can be safely initiated in women <10yrs from menopause and <60yrs of age if no contraindications
What should you do before starting HRT
Calculate CVD risk and Breast cancer risk
What are non medication options for VMS in menopause
Keep sleeping/living area cool
Dress in layers
Avoid hot foods and beverages and spicy foods
Avoid alcohol and caffeine
Consume soy products **
Increase water
Stress reduction
Exercise
Acupuncture
What are non estrogen options for VMS
SSRI/SNRI
Gabapentin
Clonidine
Progesterone
Veozah
What is ospemifene
Estrogen agonist and antagonist that improves vaginal atrophy without stimulating the endometrium
Dose: 60mg/d
What is veozah (fezolinetant)
MOA: neurokinin 3 receptor antagonist
CI: cirrhosis, severe renal impairment or endstage renal disease, concomitant use with CYP1A2 inhibitors
SFx: abdominal pain, diarrhea, insomnia, back pain, LFTs elevation
What is the risk of combined HRT (E+P)
VTE and breast cancer
