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CDM 4 Exam 1 > Lecture 7 - Menopause > Flashcards

Lecture 7 - Menopause Flashcards

1
Q

Definition of Menopause

A

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

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2
Q

menopausal transition

A

period of gradually declining ovarian function

cyce irregularity

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3
Q

Perimenopausal

A

immediately prior to and 1 year after menopause

start to experience symptoms

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4
Q

Hormonal changes menopause

A

Estradiol 90% dec = dec estrogen, progesterone, androgens

FSH = 10-15X inc

LH = 4-5X inc

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5
Q

3 main categories of Perimenopausal changes

A

CNS = headache, sleep and mood swings/depression anxiety
Vasomotor symptoms
Genitourinary syndrome of menopause (GSM)

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6
Q

Can you use estrogen of migraine with aura?

A

nah dont wanna use

if no aura, transdermal estrogen would be preferred

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7
Q

medication related causes of hot flashes?

A

Tamoxifen = cancer
Raloxifene = osteoporosis
Androgen derivative therapy = prostate cancer

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8
Q

Hot flash risk factors

A

Early/surgical menopause
High BMI, sedentary lifestyle
Smoking
Stress, Anxiety, depression

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9
Q

Pathophysiology of GSM?

A

Dec vag secretions
inc vag pH

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10
Q

Symptoms of GSM

A

Genital dryness, burning, irritation
sexual lack of lub, impaired function
Inc urgency and frequency, UTI

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11
Q

Mild Vasomotor symptoms….Life style medications

A

Avoid triggers = Spicy foods**
reduce tobacco and alc
Dress in layers
Drink cold water
Dec room temp
Relaxation/stress reduction

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12
Q

If Moderate/Severe Vasomotor symptoms….MHT

A

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

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13
Q

CI for Estrogen MHT

A

Breast cancner
DVT/PE
Stroke/MI w/I 1yr
Liver dysfunction
Migraine with aura

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14
Q

Continuous MHT oral

A

cycle = Premarin
content = estrogen every day
Comment = only for women who had hysterectomy

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15
Q

Contiuous cyclic MHT oral

A

cycle = Premphase
content = estrogen every day, progesterone every 12-14 days
Comments = scheduled withdrawal bleeding, 1-2 after stop progesterone

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16
Q

Continuous combined MHT oral

A

Cycle = prempro
Content = estrogen and progesterone every day
Comments = unpredictable bleeding or spotting for 6-12 months, then stop

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17
Q

Continuous/EAA MHT oral

A

Cycle = Duavee
Content = Estrogen + Estrogen agonist/antagonist every day
Comment = vasomotor symptoms and osteoporosis prevention

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18
Q

Situation where transdermal patch might be preferred

A

used where you want lower DVT/CVD risk, lower TG

preferred pts who have migraines w/o aura

19
Q

Note on Estrogen only patch

A

must be combined with oral progestogen if uterus intact

20
Q

important info about creams and rings?

A

High dose and low dose formulations and directions

21
Q

For vag creams, if vasomotor symptoms then use….

A

high dose formulations
progestogen if uterus intact

22
Q

For vag ring/cream/gels, if vag symptoms then use…

A

low dose formulations
dont need progestogen

23
Q

Duavee (Estrogen/Bazedoxifine) indication

A

moderate/severe hot flashes
Prevention of osteoporosis

24
Q

Duavee CI

A

Breast cancer
thromboembolism
Abrnomal uterine bleeding

25
Q

Duavee warnings

A

Dont take additional estrogens
Cancer ( endometrial, breast, ovarian)
Gallbladder disease
D/c if vision changes, jaundice or high TGs

26
Q

Paroxetine mesylate (Brisdelle) Indications and interactions

A

moderate/severe hot flashes

CYP2D6 inhib = dec conversion of tamoxifen to active metabolite

only FDA approved

27
Q

Paroxetine mesylate (Brisdelle) warnings

A

box warning = suicidal thoughts

Hyponatremia
bleeding
bone fractures
manic symptoms

28
Q

Paroxetine mesylate SE

A

anticholinergic effects

sweating, dec libido, Headache, dizziness, Nausea,tiredness

29
Q

Black Cohosh MOA

A

mixed competitive agonist activity at serotonin receptor

possible estrogenic activity

30
Q

Black Cohosh Efficacy

A

questionable

31
Q

Black Cohosh Efficacy

A

questionable
may reduce freq compared to baseline but not placebo

32
Q

Black Cohosh Safety

A

CI = breast cancer
Recommend periodic LFT due to contamination

33
Q

Soy for hotflash

A

Protein&raquo_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**

34
Q

Bioidenticals

A

not really recommended or FDA approved

35
Q

GSM mild symptoms non-pharm

A

pelvic floor exercises
vag dilator therapy
vag activity

inc bood flow to vag

36
Q

GSM mild symptoms, things that provide symptomatic relief

A

Apply lube before sex

apply moisturizers 2-3 times per week to vag

** Avoid natural oils due to inc risk of infections **

37
Q

GSM moderate/severe symptom treatmetns

A

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

38
Q

When can vag creams for GSM be preferred

A

if atrophy of vulva in addition to vagina

can be messier, but more flexible with dosing and admin freq

39
Q

When are Vag rings indicated GSM?

A

indicated for LUTS as well as vag symptoms

placed by provider

40
Q

Ospemifene (Osphena) used specifically for

A

painful sex or dry vag

41
Q

Ospemifene CI

A

Endometrial cancer
CVD, H/o of MI/stroke
H/o of DVT/PE
breast cancer

42
Q

Ospemifene SE

A

Hot flash
endometrial hyperplasia
muscle spasm
vag discharge
hyperhidrosis
stroke/DVT
Endometrial cancer

43
Q

Prasterone (Intrarosa)

A

insert

used for pain during sex

DHEA = converted into estrogen and androgen in vag tissue

Oral is not equal

CDM 4 Exam 1 (12 decks)

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