Lecture 24: Hormone Replacement Therapy

Question 1

Estrogen Actions: Desirable Effects
The Brain:
(3)

Answer 1

• Regulates area that prepares body for reproduction
• Helps maintain stable temperature and avoid hot flashes
• May help protect memory

Question 2

Estrogen Actions: Desirable Effects

The Breasts:

Answer 2

Programs glands to produce milk

Question 3

Estrogen Actions: Desirable Effects
The Liver and Heart:
(2)

Answer 3

• Helps regulate production of cholesterol in the liver

- helps avoid atherosclerosis and heart attacks

Question 4

Estrogen Actions: Desirable Effects

The Uterus:

Answer 4

• Programs the uterus to nourish a fetus

Question 5

Estrogen Actions: Desirable Effects

The Bones:

Answer 5

• Maintains density

Question 6

Estrogen Actions: Undesirable Effects

The Breasts:

Answer 6

-Promotes breast cancer

Question 7

Estrogen Actions: Undesirable Effects

The Uterus:

Answer 7

• Promotes cancer of the uterine lining

Question 8

Pre-Menopause

Before menopause, ovaries produce:

Answer 8

• Estrogen

- Progesterone

Question 9

Pre-Menopause
During years of ovarian estrogen production, women benefit from these activities:
(3)

Answer 9

• Protection against cardiovascular disease
• Estrogen prevents atherosclerotic lesion formation
• Prevents or reversal of bone loss (osteoporosis)

Question 10

Menopause

Average age of menopause in US is:

Answer 10

51

Question 11

Menopause

Common symptoms associated with estrogen deficiency are:

Answer 11

• Hot flashes
• Vaginal Atrophy
• Sleep Disturbance

Question 12

Conjugated Equine Estrogen (CEE)
Premarin is a commercial name for a compound drug consisting primarily of conjugated estrogens for hormone therapy. It consists of

Answer 12

• Estrone (> 50%)
• Equilin (15-25%)
• Equilienin

Question 13

Conjugated Equine Estrogen (CEE)

Estrogen are conjugated because:

Answer 13

• of it being hydrophilic side-groups attached

Question 14

Conjugated Equine Estrogen (CEE)

Estrone sulfate is easily absorbed and converted to ______ by body

Answer 14

Estradiol

Question 15

Conjugated Equine Estrogen (CEE)

Premarin is isolated from

Answer 15

Mare’s urine

Question 16

Conjugated Equine Estrogen (CEE)

Prempro is CEE plus this; a synthetic Progesterone.

Answer 16

Medroxyprogesterone acetate (MPA)

Question 17

Progestin helps reduce the risk of endometrial cancer by:

Answer 17

maintaining endometrial atrophy in women with uterus

Question 18

CEE + MPA study was stopped in July 2002

This was because women taking CEE + MPA demonstrated health problems such as:

Answer 18

• increased risk of stroke
• increased risk of venous thromboembolic events
• increased risk of invasive breast cancer

Question 19

Estrogen alone study was stopped in Feb 2004

When women were taking CEE alone, they demonstrated health problems with:

Answer 19

• increased risk of stroke

Question 20

Studies dound the CEE + MPA conferred the following health benefits:
(2)

Answer 20

• Decreased risk of colorectal cancer

- Decreased risk of hip fractures

Question 21

Estrogen also:

Answer 21

• decreases risk of hip fractures

Question 22

The USPTF recommends against routine use of ____ and _____ for the prevention of chronic conditions in ___-_______ women

Answer 22

estrogen; progesterone

post-menopausal

Question 23

Hazard Ratio

The hazard ratio is

Answer 23

explanatory variable on the hazard of an event

Question 24

Hazard Ratio

Hazard ratio is the estimate of:

Answer 24

relative risk (RR)

Question 25

Hazard Ratio | Relative Risk is

Answer 25

Risk of events relative to exposure

Question 26

Hazard Ratio | Relative Risk is calculated by:

Answer 26

Probability of the event occurring in exposed group | Probability of the event occurring in non-exposed group

Question 27

Hazard Ratio | If Relative Risk is 1, then it means:

Answer 27

there is no difference in risk between two groups

Question 28

Hazard Ratio | If Relative Risk is > 1, then it means:

Answer 28

Event is more likely to occur in experimental group than control group

Question 29

Hazard Ratio | If Relative Risk is < 1, then it means:

Answer 29

Even is less likely to occur in the experimental group than control group

Question 30

Global Index Hazard Ratio | These 8 represent first event for each participant among the following:

Answer 30

1. CV Disease 2. Stroke 3. PE 4. Breast Cancer 5. Endometrial Cancer 6. Colorectal Cancer 7. Hip Fracture 8. Death due to other causes

Question 31

Therapeutic Window of Opportunity Hypothesis | Estrogen have _____ effects prior to menopause

Answer 31

beneficial

Question 32

Therapeutic Window of Opportunity Hypothesis | Estrogen have adverse affects when started well beyond the:

Answer 32

menopausal transition

Question 33

Therapeutic Window of Opportunity Hypothesis | Perhaps estrogens may have beneficial effects if initiated around entry to

Answer 33

menopause

Question 34

Atherosclerosis is:

Answer 34

buildup of plaque in blood vessels

Question 35

Plaque consists of:

Answer 35

fat, cholesterol, calcium and other molecules

Question 36

Estrogen and Atherosclerosis | Endogenous estrogens are thought to be _____ against coronary artery atherosclerosis

Answer 36

protective

Question 37

Estrogen and Atherosclerosis | Atherosclerosis begins in ____ and progress with increasing ___.

Answer 37

youth; age

Question 38

Estrogen and Atherosclerosis | Coronary Hear Disease is extremely rare in ____ age women compare to men of the ___ age

Answer 38

fertile; same

Question 39

Estrogen and Atherosclerosis Women experiencing early menopause or surgically-induced menopause are more likely to develop ___ than premenopausal women of the same age

Answer 39

Coronary Heart Disease (CAD)

Question 40

Thrombus is:

Answer 40

blood clot that is formed in blood vessels when plaque erupts

Question 41

Thromboembolus is:

Answer 41

a piece of thrombus that breaks loose and travels through bloodstream where it can become stuck in a narrow vessels

Question 42

``` Estrogen and Atherosclerosis Exogenous estrogens (ET/HT) administered well beyond menopausal transition can have ______ effects. ```

Answer 42

harmful

Question 43

Effects of exogenous estrogen on complicated plaque can: | 2

Answer 43

- Increase inflammatory response - which promotes growth of atherosclerotic plaque - Increases MMP - destabilizes and promotes rupture of the plaque

Question 44

MMP is

Answer 44

Matrix Metalloproteinase

Question 45

Current Recommendations | Hormone Therapy should be initiated around:

Answer 45

onset of menopause

Question 46

Current Recommendations Treating menopausal related symptoms such as: (3)

Answer 46

- Hot flashes - Vaginal Atrophy - Sleep disturbances

Question 47

Current Recommendations | To treat or reduce risk of disorders such as:

Answer 47

- Osteoporosis and/or fractures | - CAD