Menopausal Hormonal Therapy

Question 1

what are the symptoms of menopause?

Answer 1

hot flashes, night sweats, vaginal dryness, painful intercourse, sleep distubances, mood problems

Question 2

can you use estrogen alone as a treatment for menopausal symtpoms in a woman WITH a uterus? why?

Answer 2

NO- need a progestin as well

due to the increase in endometrial hyperplasia and carcinoma from unopposed estrogen

Question 3

what are the available estrogens for therapy?

Answer 3

estradiol
conjugated equine ( most common in the USA)
synthetic conjugated A
synthetic conjugated B
esterified Estrogens
estropipate

Question 4

what are teh available progestin components?

Answer 4

medroxyprogesterone

methyltestosterone

Question 5

hwo do you dose the patients?

Answer 5

whatever works for them, pills, patches, rings, creams… etc..

Question 6

what is the MOA of the estrogen?

Answer 6

generate increase DNA and resulting protein regulation

Question 7

what is the big risk with with estrogen therapy?

Answer 7

increased chances of clotting

due to decreased anti-thrombin III, increased clotting factors, and increased platelet aggregation

Question 8

can you use menopausal hormone therapy for cardiovascular disease, or dementia?

Answer 8

NO

Question 9

what are the findings for the estrogen + progestin study? increased? decreased?

Answer 9

increased–> risk of CHD, stroke, PE, DVT, ovarian cancer, invasive breast cancer, dementia
DECREASED–> risk of colorectal cancer, endometrial cancer, all fractures

Question 10

what were the finding of the estrogen alone study?

Answer 10

INCREASED- risk of stroke , DVT
NO INCREASE in invasive breast cancer
NO CHANGE in- CHD, dementia, cancers, PE, mortality
DECREASED- risk for hip fractures

Question 11

what are some conditions that you do NOT use menopausal hormone therapy in?

Answer 11

histroy of breast/ovarian cancer, family Hx, osteoporosis Hx or risk of,

Question 12

how long do you wait to reevaluate someone on MHT?

Answer 12

5 years, see if they can get by with no medication, ( a lot of woman can)

Question 13

what are teh SERMS?

Answer 13

tamoxifen, toremifene, roloxefine

Question 14

what do you use tomoxifen and toremifine for?

Answer 14

prevention/ treatment of ER + breast cancer

Question 15

what do you use raloxifene for?

Answer 15

prevention and treatment of osteoporosis

or breast cancer PROPHYLAXIS in high risk ( GAIL score over 1.66%

Question 16

what is the extra MOA that toremifine has?

Answer 16

HPO axis effect- promote production of transforming growth factor beta ( an inhibitory growth factor)

Question 17

which drugs have a positive effect on lipid profile?

Answer 17

tamoxifen and toremifine ( toremifine also has HDL effects)

decreases- TC, LDL

Question 18

what are the side effects of tamoxifen and toremifine?

Answer 18

DVT/PE/stroke

hot flashes, nausea, menstrual irregularities

Question 19

what aer teh effects of roloxifene?

Answer 19

estrogenic effect on bones ( anti-resorptive)
+ effects on lipid profile
NO risk of endometrial cancer

Question 20

can you use raloxifene in pregnancy?

Answer 20

NO, categroy X

Question 21

what aer teh antiestrogens?

Answer 21

clomiphene, and fulvestrant

Question 22

what do you use the anti-estrogens for?

Answer 22

clomiphene- infertility in anovulatory women

fulvestrant- metastatic ER+ breast cancer after tamoxifen treatment failure

Question 23

what is the MOA of clomiphene?

Answer 23

blocks inhibitory actions of estrogen on hypothalamus GnRH and pituitary gonadotropin release

Question 24

what are teh side effects of clomiphene?

Answer 24

multiple births

Question 25

what is the MOA of fulvestrant?

Answer 25

hinders ER dimerization and increases degradation therby abolishing ER mediated gene transcription ( not just a receptor blocker)- why it works in breast cancer that didnt respond to tamoxifen