Menopause

Question 1

definiton and average age of menopause

Answer 1

age; 51 yo average

definition: 12 mo of amenorrhea after LMP

Question 2

moa of menopause

Answer 2

decline in ooyte numbers through life = decrease in estrogen = increase FSH = ovary is FSH resistant= follicles are depleted = estrogen production ceases

Question 3

vasomotor symptoms of menopause

Answer 3

estrogen withdrawal disturbs the temperature-regulating mechanisms in the hypothalamus –> hot flashes and shivering

Risk factors: obesity, limited physical activity, smoking, triggers (alcohol, hot drinks, warm
environment), Caucasian race

Question 4

risks for systemic hormone therapy

Answer 4

increase risk of uterine and breast cancer; CV risk (do not risk if >10 yr of menopause), VTE

Question 5

contraindication of HT for menopause

Answer 5

unexplained vaginal bleeding, acute liver dysfunction, persona history of ER-dependent cancer, CAD, previous stroke,active VTE

Question 6

non hormonal options for menopause management

Answer 6

SSRI/SNRI, clonidine, gabapentin

Question 7

note:

Cancer Risk with HT

• Additional 8 breast cancers per 10,000 users at 5 years.
• Risk of breast cancer is greater in EPT vs ET alone.
• Similar risk of breast cancer to : early menarche, late menopause, excessive alcohol use, postmenopausal weight gain.
• Uterine: if unopposed estrogen.

Cardiovascular Risk with HT

• HT should NOT be started if the woman is over 10 years since menopause
• There is a risk of VTE: less risk with transdermal preparations, but HT should be avoided in those with high risk of VTE→ those with thrombophilias or active VTE

DuaVive

• New option that is an estrogen plus a SERM
• No need for progesterone because of the SERM acting on breast and other areas

Bazedoxifene

• Agonist to bone, antagonis to uterus/endometrium
• No progestin is necessary
• Indicated for treatment of vasomotor symptoms and osteoporosis