LEC9 Flashcards
Non pharm treatment for Mild menopausal symptoms
- lifestyle modifications, including:
1-layered clothing.
2-lower room temp.
3-decrease hot and spicy and caffiene.
4-excercise.
the mainstay of management of menopausal symptoms?
- Pharmacologic therapy which include hormonal (estrogen with or without progestogen) and nonhormonal medication)
treatment of menopause with an intact uterus in women in Menopausal hormonal therapy should use?
– systemic MHT consists of an estrogen plus a progestogen or a tissue-selective estrogen complex (estrogen/bazedoxifene) to prevent endometrial hyperplasia
treatment in menopausal women who have undergone hysterectomy
Estrogen monotherapy
treatment of Mild vulvovaginal symptoms
may be adequately managed with nonhormonal lubricants and moisturizers
in Perimenopausal Women Combined hormonal contraceptives (containing low-dose estrogen and progestogen) provide?
2 things
contraception and vasomotor symptom relief
Perimenopausal women should NOT use estrogen-containing contraceptives if
- 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.
perimenopausal women with AUB (Abnormal Uterine Bleeding) bleeding due to anovulatory cycles should use?
a progestin-only intrauterine device
treatment of mild vasomotor symptoms
lifestyle modification.
keep in mind the most effective treatment for vasomotor symptoms is MHT
MHT = menopausal hormonal therapy
treatment and goal of treatment for Most women with moderate-to-severe vulvo vaginal symptoms
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)
Women with moderate-to-severe dyspareunia
(painfull intercourse)
intravaginal dehydro epiandrosterone prasterone (DHEA).
who has the most favorable benefit-to-risk profile in Menopausal hormone therapy?
recently menopausal women
menopausal hormonal therapy
- Risk of VTE and stroke higher in ………….., lower in ……………?
higher in oral MHT and lower in Transdermal MHT
- Menopausal hormone therapy is contraindicated in?
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.
Mention the oral estrogens
simple
1- Estradiol
2-A micronized form of estradiol (oIs readily absorbed from the small intestines)
3-Ethinyl estradiol
indicated for treatment of moderate-to severe vasomotor symptoms when oral treatment is inapropriate?
FEMRING
For women above the age of 60 can use………… for menopausal therapy
- Estradiol pellets
mention progestogens in menopausal therapy?
1- norethindrone
(also known as norethisterone), norgestrel, and levonorgestrel.
2-Drospirenone.
3-Micronized progesterone.
- Common adverse effects of progestogens
1-irritability,
2-headache,
3-weight gain,
4-bloating
intrauterine device may be assuciated with fewer adverse effects
mention Menopausal Hormone Therapy Regimens
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)
(SERMs) used in menopausal therapy and thier generation
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)
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.
Tibolone
