Lecture 7 - Menopause Flashcards
Definition of Menopause
permanent cessation of menses resulting from loss of ovarian follicular activity
12 consecutive months of amenorrhea (w/o menstruation)
avg age 51, premature if before 40
menopausal transition
period of gradually declining ovarian function
cyce irregularity
Perimenopausal
immediately prior to and 1 year after menopause
start to experience symptoms
Hormonal changes menopause
Estradiol 90% dec = dec estrogen, progesterone, androgens
FSH = 10-15X inc
LH = 4-5X inc
3 main categories of Perimenopausal changes
CNS = headache, sleep and mood swings/depression anxiety
Vasomotor symptoms
Genitourinary syndrome of menopause (GSM)
Can you use estrogen of migraine with aura?
nah dont wanna use
if no aura, transdermal estrogen would be preferred
medication related causes of hot flashes?
Tamoxifen = cancer
Raloxifene = osteoporosis
Androgen derivative therapy = prostate cancer
Hot flash risk factors
Early/surgical menopause
High BMI, sedentary lifestyle
Smoking
Stress, Anxiety, depression
Pathophysiology of GSM?
Dec vag secretions
inc vag pH
Symptoms of GSM
Genital dryness, burning, irritation
sexual lack of lub, impaired function
Inc urgency and frequency, UTI
Mild Vasomotor symptoms….Life style medications
Avoid triggers = Spicy foods**
reduce tobacco and alc
Dress in layers
Drink cold water
Dec room temp
Relaxation/stress reduction
If Moderate/Severe Vasomotor symptoms….MHT
reduce freq by 75% and severity by 87%
Limit txm to time of symptoms at lowest dose needed**
Benefits dissipate quickly once stopping txm, gradually dec or lengthen dose interval
consider d/c after 5 yrs or >60
CI for Estrogen MHT
Breast cancner
DVT/PE
Stroke/MI w/I 1yr
Liver dysfunction
Migraine with aura
Continuous MHT oral
cycle = Premarin
content = estrogen every day
Comment = only for women who had hysterectomy
Contiuous cyclic MHT oral
cycle = Premphase
content = estrogen every day, progesterone every 12-14 days
Comments = scheduled withdrawal bleeding, 1-2 after stop progesterone
Continuous combined MHT oral
Cycle = prempro
Content = estrogen and progesterone every day
Comments = unpredictable bleeding or spotting for 6-12 months, then stop
Continuous/EAA MHT oral
Cycle = Duavee
Content = Estrogen + Estrogen agonist/antagonist every day
Comment = vasomotor symptoms and osteoporosis prevention
Situation where transdermal patch might be preferred
used where you want lower DVT/CVD risk, lower TG
preferred pts who have migraines w/o aura
Note on Estrogen only patch
must be combined with oral progestogen if uterus intact
important info about creams and rings?
High dose and low dose formulations and directions
For vag creams, if vasomotor symptoms then use….
high dose formulations
progestogen if uterus intact
For vag ring/cream/gels, if vag symptoms then use…
low dose formulations
dont need progestogen
Duavee (Estrogen/Bazedoxifine) indication
moderate/severe hot flashes
Prevention of osteoporosis
Duavee CI
Breast cancer
thromboembolism
Abrnomal uterine bleeding
Duavee warnings
Dont take additional estrogens
Cancer ( endometrial, breast, ovarian)
Gallbladder disease
D/c if vision changes, jaundice or high TGs
Paroxetine mesylate (Brisdelle) Indications and interactions
moderate/severe hot flashes
CYP2D6 inhib = dec conversion of tamoxifen to active metabolite
only FDA approved
Paroxetine mesylate (Brisdelle) warnings
box warning = suicidal thoughts
Hyponatremia
bleeding
bone fractures
manic symptoms
Paroxetine mesylate SE
anticholinergic effects
sweating, dec libido, Headache, dizziness, Nausea,tiredness
Black Cohosh MOA
mixed competitive agonist activity at serotonin receptor
possible estrogenic activity
Black Cohosh Efficacy
questionable
Black Cohosh Efficacy
questionable
may reduce freq compared to baseline but not placebo
Black Cohosh Safety
CI = breast cancer
Recommend periodic LFT due to contamination
Soy for hotflash
Protein»_space; Supplements
mod dec severity and frequency
Takes 1-2 months to see effect
not effective in photoflash related to Breast cancer treatment
** women with estrogen-dependent cancers should avoid soy supplements**
Bioidenticals
not really recommended or FDA approved
GSM mild symptoms non-pharm
pelvic floor exercises
vag dilator therapy
vag activity
inc bood flow to vag
GSM mild symptoms, things that provide symptomatic relief
Apply lube before sex
apply moisturizers 2-3 times per week to vag
** Avoid natural oils due to inc risk of infections **
GSM moderate/severe symptom treatmetns
Low dose vag estrogen
takes 1-2weeks for improvement, 3-4 months full effect
Progestogen not indicated, efficacy similar among products
avoid women h/o breast cancer until talk with oncologist
When can vag creams for GSM be preferred
if atrophy of vulva in addition to vagina
can be messier, but more flexible with dosing and admin freq
When are Vag rings indicated GSM?
indicated for LUTS as well as vag symptoms
placed by provider
Ospemifene (Osphena) used specifically for
painful sex or dry vag
Ospemifene CI
Endometrial cancer
CVD, H/o of MI/stroke
H/o of DVT/PE
breast cancer
Ospemifene SE
Hot flash
endometrial hyperplasia
muscle spasm
vag discharge
hyperhidrosis
stroke/DVT
Endometrial cancer
Prasterone (Intrarosa)
insert
used for pain during sex
DHEA = converted into estrogen and androgen in vag tissue
Oral is not equal
