Menopausal Hormone Therapy (MHT) and Selective Estrogen Receptor Modulators (SERMS)

Question 1

Define menopausal transition and post menopause time intervals

Answer 1

• Menopausal transition (peri) - 2 skipped cycles progressing to 60+ days of amenorrhea
• Post menopause - 12 mo of complete amenorrhea

Question 2

What is the primary therapy of menopausal symptoms

Answer 2

Estrogen

Question 3

When do you give estrogen only v. E/P?

Answer 3

Intact uterus = must give E/P

Question 4

Six available forms of estrogenic therapy

Answer 4

Estradiol, Conjugated estrogens (CEE), Synthetic conjugated estrogens-A, synthetic conjugated estrogens-B, esterified estrogens (EE), estroPIPate (piperazine)

Question 5

**Three main forms of progestinic components for MHT

Answer 5

• Medroxyprogesterone (MPA), Methyltestosterone –> E/P

- Progesterone - P ONLY

Question 6

Estrogen only Hormone therapy - MOA

Answer 6

MOA - bind to endogenous estrogen receptors in various tissues throughout body
Effect - endometrial proliferation

Question 7

***Effects of estrogen-only hormone therapy

Answer 7

Endometrial proliferation.

• **Decreased production/activity - cholesterol, anti-thrombin 3, osteoclastic activity (bone turnover).
• **Increased production/activity - TG, clotting factors, platelet aggregation, Na/Fluid retention, TBG

Question 8

Menopausal Hormone Therapy should NOT be used in people with what? Should NOT be used to prevent what?

Answer 8

• CVD or dementia

- Do not use to prevent: bone loss, or colon cancer

Question 9

Goal of SERMs

Answer 9

Beneficial E-agonist actions in select tissue with anti-E antagonist action sin other tissues - bone, brain, breast, endometrium

Question 10

Two main SERMs

Answer 10

Ospemifene, Bazedoxifene

Question 11

When do you use Ospemifene?

Answer 11

ORAL therapy for dyspaerunia - sx of vulvar/vaginal atrophy of menopause.

Question 12

MOA ospemifene

Answer 12

E-agonist in vagina, E-antagonist in breast

Question 13

SE of ospemifene

Answer 13

Increase in menopause sx - hot flashes/sweating, vaginal discharge, E-effects on coagulation, endometrial hyperplasia.

Question 14

CI of ospemifene

Answer 14

Vaginal bleeding, thromboembolic dz, estrogen-related neoplasia

Question 15

Tx use for Bazedoxifene (w/CEE). Only use in what types of females.

Answer 15

For women with intact uterus.

Tx of moderate to severe vasomotor sx associated with menopause. Prevention of post-menopausal osteoperosis.

Question 16

MOA of bazedoxifene

Answer 16

Antagonist activity in endometrium - acts like progestin and opposes estrogen. Replaces P in women with intact uterus.

Question 17

SE - E-related with Bazedoxifene specific

Answer 17

hot flashes/sweating, abdominal and breast pain, leg cramps, HA

Question 18

CI of Bazedoxifene

Answer 18

Same situations that estrogens are CI in.

Question 19

MHT is an acceptable option for treating moderate to severe

menopausal symptoms in ____ women.

Answer 19

MHT is an acceptable option for treating moderate to severe
menopausal symptoms in relatively young (up to
age 59 or within 10 years of menopause) and healthy women w/o risk factors.

Question 20

For Women with Vaginal Symptoms Only, the preferred treatments are low doses of ___.

Answer 20

low doses of vaginal estrogen

topical

Question 21

Woman with a uterus takes:

Woman without a uterus takes:

Answer 21

With = E/P
Without = E only

Question 22

For Women at Risk of Blood Clots/Stroke:

Answer 22

USE SOMETHING ELSE.
o Although risks of blood clots and strokes increase with either
type of MHT, risk is rare in 50‐59 year‐old age group

Question 23

For Women at Risk of Breast Cancer
o An increased risk of breast cancer seen within ____ of
continuous E/P therapy
o Risk of breast cancer ____ after MHT is stopped

Answer 23

For Women at Risk of Breast Cancer
o An increased risk of breast cancer seen within 3‐5 YEARS of
continuous estrogen with progestin therapy
o Risk of breast cancer DECREASES after MHT is stopped