Menopausal Hormone Therapy (Chen) Flashcards
what is premenopause?
the time period of endocrine changes BEFORE cessation of menstruation
what is perimenopause (climacteric)?
the period of endocrine changes SURROUND the menopause
what is postmenopause?
the time period of endocrine changes AFTER cessation of menstruation
what are some causes of menopause?
- physiologic (Inc. FHS and LH)
- surgery
- chemo
- radiation therapy
what are some signs of menopause?
hot flashes, night sweat, fatigue, mood, dryness, ect.
what are some contraindications of MHT?
- pregnancy
- unexplained bleeding
- stroke
- active thromboembolic
- active liver disease
- estrogen malignancies
when is estrogen monotherapy appropriate for a patient?
a women without a uterus
when is it appropriate to give a patient a progestin?
the women has an intact uterus
– needed to decrease the risk of endometrial cancer and hyperplasia
what was found in the women’s health initiative study for estrogen only therapy?
women <60 years within 10 years of menopause had no evidence of CHD
1. lower risk of breast cancer
what was found in the women’s health initiative study for estrogen- progestin therapy?
there was a higher risk of breast cancer
what are the current recommendations for MHT?
age <60 or within 10 years of last period
what are the three options of therapy treatment for combined estrogen and progestin?
- continuous cyclic
- continuous long
- continuous combined
tell me about continuous cyclic therapy?
- estrogen administered daily
- progestin at least 12-14 days of 28 day cycle
- preferred
tell me about continuous long cycle ?
- rare
- progesterone administered 12-14 days every other month
- limited safety data and endometrial protection is unclear
tell me about estrogen combined?
- initial unpredictable spotting or bleeding
- for women >2 years post-final menstrual period
- best for long term endometrial protection
how do you decide on a regimen for MHT?
look at picture
what is the recommended treatment duration?
- no set duration
- balance an individuals ongoing benefits with personal risks that may be increasing with age
- evaluate annually
- consider periodic trails of tapering to safer low-dose routes
what meds are alternatives for vasomotor symptoms?
- gabapentin
- oxybutynin
- SSRI/SNRI
- fezolinetant
what are SSRIs/SNRIs used for and some examples and MAJOR INTERACTION?
- used for hot flashes
- SSRI
–> paroxetine
–> lexapro/ celexa - SNRI
–> effexor, pristiq, cymbalta - AVOID paroxetine with TAMOXIFEN
–> string inhibitors (2D6) reduce efficacy OF TAMOXIFEN
what is a last resort for hot flashes and non-hormonal therapy for vasomotor symptoms?
- fezolinetant
–> concomitant use with CYP1A2 inhibitors
–> check liver function test before initiation at 3,6,9 months
If women is within 10 years since menopause and low CVD (<5%) what do you do?
may use MHT (oral or transdermal)
If women is within 10 years since menopause and moderate CVD (5-10%) what do you do?
avoid oral and preferred to use transdermal
If women is within 10 years since menopause and high CVD (>10%) what do you do?
- avoid systemic MHT
–> especially for women with Mod to high breast cancer risk - if genitourinary symptoms may consider low dose vag estrogen or other treatment
what are the first line non-hormonal treatment for genitourinary symptoms?
- lube
- vaginal moisterizers
