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Exam 4 (MHT/ Thyroid/ Osteoporosis) P1 Therapeutics > Menopausal Hormone Therapy (Chen) > Flashcards

Menopausal Hormone Therapy (Chen) Flashcards

1
Q

what is premenopause?

A

the time period of endocrine changes BEFORE cessation of menstruation

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2
Q

what is perimenopause (climacteric)?

A

the period of endocrine changes SURROUND the menopause

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3
Q

what is postmenopause?

A

the time period of endocrine changes AFTER cessation of menstruation

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4
Q

what are some causes of menopause?

A
  1. physiologic (Inc. FHS and LH)
  2. surgery
  3. chemo
  4. radiation therapy
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5
Q

what are some signs of menopause?

A

hot flashes, night sweat, fatigue, mood, dryness, ect.

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6
Q

what are some contraindications of MHT?

A
  1. pregnancy
  2. unexplained bleeding
  3. stroke
  4. active thromboembolic
  5. active liver disease
  6. estrogen malignancies
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7
Q

when is estrogen monotherapy appropriate for a patient?

A

a women without a uterus

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8
Q

when is it appropriate to give a patient a progestin?

A

the women has an intact uterus
– needed to decrease the risk of endometrial cancer and hyperplasia

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9
Q

what was found in the women’s health initiative study for estrogen only therapy?

A

women <60 years within 10 years of menopause had no evidence of CHD
1. lower risk of breast cancer

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10
Q

what was found in the women’s health initiative study for estrogen- progestin therapy?

A

there was a higher risk of breast cancer

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11
Q

what are the current recommendations for MHT?

A

age <60 or within 10 years of last period

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12
Q

what are the three options of therapy treatment for combined estrogen and progestin?

A
  1. continuous cyclic
  2. continuous long
  3. continuous combined
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13
Q

tell me about continuous cyclic therapy?

A
  1. estrogen administered daily
  2. progestin at least 12-14 days of 28 day cycle
  3. preferred
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13
Q

tell me about continuous long cycle ?

A
  1. rare
  2. progesterone administered 12-14 days every other month
  3. limited safety data and endometrial protection is unclear
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14
Q

tell me about estrogen combined?

A
  1. initial unpredictable spotting or bleeding
  2. for women >2 years post-final menstrual period
  3. best for long term endometrial protection
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15
Q

how do you decide on a regimen for MHT?

A

look at picture

16
Q

what is the recommended treatment duration?

A
  1. no set duration
  2. balance an individuals ongoing benefits with personal risks that may be increasing with age
  3. evaluate annually
  4. consider periodic trails of tapering to safer low-dose routes
17
Q

what meds are alternatives for vasomotor symptoms?

A
  1. gabapentin
  2. oxybutynin
  3. SSRI/SNRI
  4. fezolinetant
18
Q

what are SSRIs/SNRIs used for and some examples and MAJOR INTERACTION?

A
  1. used for hot flashes
  2. SSRI
    –> paroxetine
    –> lexapro/ celexa
  3. SNRI
    –> effexor, pristiq, cymbalta
  4. AVOID paroxetine with TAMOXIFEN
    –> string inhibitors (2D6) reduce efficacy OF TAMOXIFEN
19
Q

what is a last resort for hot flashes and non-hormonal therapy for vasomotor symptoms?

A
  1. fezolinetant
    –> concomitant use with CYP1A2 inhibitors
    –> check liver function test before initiation at 3,6,9 months
20
Q

If women is within 10 years since menopause and low CVD (<5%) what do you do?

A

may use MHT (oral or transdermal)

21
Q

If women is within 10 years since menopause and moderate CVD (5-10%) what do you do?

A

avoid oral and preferred to use transdermal

22
Q

If women is within 10 years since menopause and high CVD (>10%) what do you do?

A
  1. avoid systemic MHT
    –> especially for women with Mod to high breast cancer risk
  2. if genitourinary symptoms may consider low dose vag estrogen or other treatment
23
Q

what are the first line non-hormonal treatment for genitourinary symptoms?

A
  1. lube
  2. vaginal moisterizers
24
Q

what are the second line estrogen treatment for genitourinary symptoms?

A
  1. topical
  2. low dose oral contraceptive
25
Q

what medications are used in the treatment of mod-severe dyspareunia?

A
  1. ospemifene
  2. prasterone
26
Q

tell me about ospemifene

A
  1. BBW
    –> endometrial cancer
    –> stroke
    –> VTE
  2. postmenopause women
  3. hot flashes 7-12% as a side effect
27
Q

tell me about prasterone

A
  1. postmenopausal women
  2. contraindications:
    –> undiagnosed vaginal bleeding
  3. avoid if history of breast cancer

Exam 4 (MHT/ Thyroid/ Osteoporosis) P1 Therapeutics (5 decks)

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