L16-Men/Women Flashcards
List the women conditions covered in this lecture.
- PMS
- Mastalagia
- Dysmenorrhea
- Perimenopause/menopause
List the women conditions covered in this lecture.
- BPH
____ of people use NHPs and among the higher users are ____ w/ ______.
-~70-80%, women w/ adv education.
T/F: The use of NHPs by women is increasingly popular. Why or why not?
TRUE.
- Frustation over AE of mainstay pharm therapies.
- Concern over LT safety of hormonal agents (Women’s Health Initiative)
- Misconception that NHPs are safer.
What is the Women’s Health Initiative?
- longitudadal study found a corrrelation between specific hormonal therapies w/ certain types of cancer, etc
- came out in 2002
- caused a lot of concerns w women who used hormonal therapies and steered more people to NHP.
W/ regards to NHPs, safety is the main concern.
If pt wants to take a product, what do you tell them if not safe?
Safety is the main concern. If pt wants to take a product that has limited benefits but safe, ok to give but educate them on the limited studies done on efficacy. BUT if NOT safe for the patient, then MUST educate them on that.
- PMS & Mastalgia.
What is PMS?
- Both physical/behavioral Sxs occurring repetitively in 2nd half of the menstrual cycle & interfere w/ aspects of women’s life.
- Etiology unknown; women who suffer are ++ sensitive to normal hormone
- PMS & Mastalgia.
Define affective Sx of PMS.
depression, irritability, anxiety, nervousness, decreased concentration
- PMS & Mastalgia.
Define somatic Sx of PMS.
breast pain, bloating and swelling, headache, tiredness, body aches
- PMS & Mastalgia.
What is the general approach to Tx PMS?
- exercise, relaxation techs (mild, mod, severe)-effective?
- SNRI, SSRI (mod-sev)-> more for affective (mood): can be used continuously or cyclically
- cyclic OC use (drospirenone) or continuous OC use (any progestin)
- role of NHP??
- PMS & Mastalgia.
Define mastaglia.
Hint: list Sx.
- bresast tenderness or pain: dull ache, heaviness, tightness, burning sensation
- cyclic vs noncyclic; can be variable depending on hormonal fluctuation
- PMS & Mastalgia.
T/F: New onset of Mastalgia does not need to be evaluated by MD - can just self-Tx.
FALSE
-new onset must always be evaluated by MD; rule out pathology (breast cancer)
- PMS & Mastalgia.
Define cyclic mastalgia.
List Sx.
- 70% of women experience some mild pain/ swelling cyclically; before menstruation (1wk)
- usually presents initially btwn ages of 20-40y
- generally bilateral; can radiate to axilla area
- caused by hormonal changes related to ovulation that stimulate the proliferation of normal glandular breast tissue= pain
1) PMS & Mastalgia.
List the NHPs used to Tx. Indicated whether product is indicated for PMS and/or Mastalgia.
- Ca - PMS
- Vit B6 - both
- Chasteberry - both
- Mg - PMS
- Ginkgo biloba - both
- Ca
List MOA.
MOA: variations in estrogen levels during premenstrual period may limit Ca absorption and metab-> lower Ca levels; may contribute to mood and other sx associated w PMS
-Ca involved in production of 5HT
- Ca
Safety rating?
Likely safe!
- must consider all intake sources
- SE= GI upset, constipation
- Ca
Effectiveness?
- likely effective at 1000mg dose
- > water retention and pain of PMS (and this was found in multiple studies)
- Ca
Would you recommend? If so, what dosage?
YAS
- DOSE= 1000 mg daily
- Ca
We often do not account for Ca intake via dietary sources, would you recommend a lower dose of Ca to accommodating this?
PENDING (i.e. NOT YET)
-there was another study comparing 500mg to placebo, which did have mild benefit BUT then they tried to compare it to 1000mg which they cannot (and until they actually do more studies, 1000 is considered more effective)
- Vit B6.
Indication?
Natural sources?
MOA?
- used for both PMS and mastalgia
- found in cereal grains, legumes, veggies, liver, meat and eggs
mech: unclear, may possess some anti-inflam properties. Some theories minor Vit B6 def
- Vit B6.
Safety?
POSSIBLY SAFE!
-When taken orally, exceeding RSA (1-2mg)
- SE: n/v, heartburn, loss of appetite, headache
- Sensory neuropathy at high dose (>1000mg daily)-> therefore if pt does use it you have to keep them at a safe dose
- Vit B6.
Effectiveness?
-possibly effective (50-1000) may improve mastalgia and possibly PMS-related depression (limited evidence-> need more studies); more evidence as combo w Mg
- Vit B6.
Would you recommend? If so what dosage?
MEH - don’t recommend… unless they DESPY.
-50-100 mg - but probs won’t even recommend.
- Chasteberry.
Indication?
AI?
- both PMS and mastalgia
- AI: berry (fruit) - flavonoids, linoleic acid, progestins, ect
- some women w PMS and mastalgia have elevated prolactin levels
- Chasteberry.
MOA?
-components of chsteberry inhibit prolactin release through DA receptor agonism (D2)
- Chasteberry.
Safety?
LIKELY SAFE!
- safety use in studies up to 1.5y
- SE: mild, Gi rxn, itching, rash, headache, fatigue, acne, and menstrual disturbances
- Chasteberry.
Efficacy?
POSSIBLY EFFECTIVE!
Dose: 20-40mg (typical dose) may improve mastalgia and PMS-related sx
- Chasteberry.
Would you recommend? If so, what dose?
APPROVED!
Dose: 20-40 mg
-evidence rating B
-bottom line: a safe well-tol herbal med that may be effective in tx of cylical breast discomfort and PMS
- Mg.
DA NATTY SOURCE?
-found in legumes, whole grains, veggies (broccoli, squash, green leafy veggies), seeds and nuts (almonds)
- Mg.
MOA?
-intracellular levels of Mg found to be lower in women w PMS
- Mg.
DIS SAFE?
LIKELY SAFE.
SE: loose stools
>counsel them to drink lots of fluids and NOT go over recommended dose of 350mg
- Mg.
Efficacy?
- POSSIBLY EFFECTIVE: for 200mg elemental Mg (common dose) may improve PMS sx (mood, fluid retention)
- often combined w B6 to help w PMS reltaed anxiety sx (nervous tension, mood swings, irritability)
- Mg.
Is you going deal dis? if so what dose?
YEEE!
-200 mg elemental Mg!
- Ginko biloba.
AI: flavonoids, several terpene trilactones unique to ginko
-supposed to be used for both PMS and mastalgia BUT mech is unclear (possibly due to anti-inflam properties)
- Ginko biloba.
Safety?
LIKELY SAFE!
- BUT some concern over carcinogenic effects in animals -> therefore probs not likely safe.
- SE: mild GI upset, headache, dizziness, palpitations, constipation and allergic skin rxns
- Ginko biloba.
EFFECTIVE?
POSSIBLY EFFECTIVE - ginko leak extract
-Dose: 80mg bid or 40mg tid) may reduce breast tenderness and other physical/psychological PMS syndrome (start on day 16 or cycle and continue until day 5)
- Ginko biloba.
Would you recommend? Dose?
LOL NAH we aint fucking with this.
- v low efficacy, potentially carcinogenic effect
- Dose: 80 mg BID, 40 mg TID mg if despy
1) PMS & Mastagalia
What would you recommend for PMS?
What would you recommend for mastalgia?
PMS: Ca, chasteberry, Mg
Mastalgia: chasteberry
2) Dysmenorrhea
Describe.
- presence of recurrent, crampy, lower ab pain that occurs in menses in the absence of demonstratable disase that could account for these sx
- n/d, fatigue, headache
2) Dysmenorrhea
____% of reproductive age women experience painful periods.
-50-90%
2) Dysmenorrhea.
T/F: Pain begins at onset of menses, improves over 12-72h post
TRUE!
2) Dysmenorrhea
General Tx approach.
- heat, exercise, yoga, sex, diet (maybe veg or increased dairy)
- acupunture
- NSAID, OCs, IUDs, injectable contraception