LEC9

Question 1

Non pharm treatment for Mild menopausal symptoms

Answer 1

• lifestyle modifications, including:
  1-layered clothing.
  2-lower room temp.
  3-decrease hot and spicy and caffiene.
  4-excercise.

Question 2

the mainstay of management of menopausal symptoms?

Answer 2

• Pharmacologic therapy which include hormonal (estrogen with or without progestogen) and nonhormonal medication)

Question 3

treatment of menopause with an intact uterus in women in Menopausal hormonal therapy should use?

Answer 3

– systemic MHT consists of an estrogen plus a progestogen or a tissue-selective estrogen complex (estrogen/bazedoxifene) to prevent endometrial hyperplasia

Question 4

treatment in menopausal women who have undergone hysterectomy

Answer 4

Estrogen monotherapy

Question 5

treatment of Mild vulvovaginal symptoms

Answer 5

may be adequately managed with nonhormonal lubricants and moisturizers

Question 6

in Perimenopausal Women Combined hormonal contraceptives (containing low-dose estrogen and progestogen) provide?

2 things

Answer 6

contraception and vasomotor symptom relief

Question 7

Perimenopausal women should NOT use estrogen-containing contraceptives if

Answer 7

• They smoke or have a history of estrogen-dependent cancer,
• Cardiovascular or cerebrovascular disease, hypertension,
• Diabetes with vascular disease, or risk factors for thromboembolism,
• liver disease, or migraine headaches.

Question 8

perimenopausal women with AUB (Abnormal Uterine Bleeding) bleeding due to anovulatory cycles should use?

Answer 8

a progestin-only intrauterine device

Question 9

treatment of mild vasomotor symptoms

Answer 9

lifestyle modification.

keep in mind the most effective treatment for vasomotor symptoms is MHT

MHT = menopausal hormonal therapy

Question 10

treatment and goal of treatment for Most women with moderate-to-severe vulvo vaginal symptoms

Answer 10

goal: symptom relief

treatment:
1- Local (vaginal) estrogen delivery:
-is preferred when vaginal symptoms are the only menopausal symptom. complaint

2- Vaginal estrogen:
-has also been shown to improve atrophic symptoms.

3-(SERM) ospemifene. (most important)

Question 11

Women with moderate-to-severe dyspareunia
(painfull intercourse)

Answer 11

intravaginal dehydro epiandrosterone prasterone (DHEA).

Question 12

who has the most favorable benefit-to-risk profile in Menopausal hormone therapy?

Answer 12

recently menopausal women

Question 13

menopausal hormonal therapy

• Risk of VTE and stroke higher in ………….., lower in ……………?

Answer 13

higher in oral MHT and lower in Transdermal MHT

Question 14

• Menopausal hormone therapy is contraindicated in?

Answer 14

women with a personal history of breast cancer

the risk of MHT realted breast cancer appears to be associated with the addition of progestogen,
,However use of estrogen alone appears to decrease rather than increase breast cancer risk.

Question 15

Mention the oral estrogens

simple

Answer 15

1- Estradiol
2-A micronized form of estradiol (oIs readily absorbed from the small intestines)
3-Ethinyl estradiol

Question 16

indicated for treatment of moderate-to severe vasomotor symptoms when oral treatment is inapropriate?

Answer 16

FEMRING

Question 17

For women above the age of 60 can use………… for menopausal therapy

Answer 17

• Estradiol pellets

Question 18

mention progestogens in menopausal therapy?

Answer 18

1- norethindrone
(also known as norethisterone), norgestrel, and levonorgestrel.
2-Drospirenone.
3-Micronized progesterone.

Question 19

• Common adverse effects of progestogens

Answer 19

1-irritability,
2-headache,
3-weight gain,
4-bloating

intrauterine device may be assuciated with fewer adverse effects

Question 20

mention Menopausal Hormone Therapy Regimens

Answer 20

1-Continuous Cyclic Estrogen–Progestogen (Sequential) Treatment, (scheduled withdrawal bleeding).

2-Continuous Combined Estrogen–Progestogen Treatment (best one).

3-Continuous Long-Cycle Estrogen–Progestogen Treatment, (developed to decrease the incidence of uterine bleeding). (– results in six periods per year). (* Bleeding episodes may be heavier and last for more days than withdrawal bleeding ).

4-Intermittent Combined Estrogen–Progestogen Treatment, (lower the incidence of uterine bleeding ) (fewer side effects ).

2- drug example * conjugated equine estrogens 0.625 mg/day plus medroxyprogesterone acetate (best for hyperplasia in abscense of vaginal bleeding)

Question 21

(SERMs) used in menopausal therapy and thier generation

Answer 21

1-Tamoxifen (1st gen).
2-raloxifene (2nd gen).(decrease risk of osteoprosis and breast cancer)
3-bazedoxifene (3rd gen). (FDA approved for use in moderate-to-severe vasomotor symptoms and prevention of osteoporosis)

Question 22

mention the drug that has Has 1-beneficial effects on mood and libido.
2- improves menopausal symptoms and vaginal atrophy.
3-Protect against bone loss.
4-and significantly reduces the risk of vertebral fractures in postmenopausal women with osteoporosis.

Answer 22

Tibolone