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PHM 602- Pregnancy, Labor/Delivery/Lactation, Menopause > Menopause > Flashcards

Menopause Flashcards

1
Q

Menopause definition

A

permanent cessation of menses following the loss of ovarian follicular activity; occurs 1 year after last menses, FSH ≥40 IU

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2
Q

Perimenopause definition

A

immediately prior to menopause and 1st year after menopause begins , characterized by anovulatory bleeding

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3
Q

Postmenopausal definition

A

period greater than 1 year after menopause occurs

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4
Q

Non-hormonal factors that can contribute to menopause

A

Age, surgery (bilateral oophorectomy/hysterectomy), chemotherapy, pelvic radiation, smoking

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5
Q

Two categories of menopause symptoms

A

Vasomotor symptoms (VMS) and Genitourinary syndrome of menopause (GSM)

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6
Q

VMS Sx

A

Hot flashes, night sweats, occur 12-24 months after last menstrual period

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7
Q

GSM Sx: Genital

A

dryness, burning, irritation

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8
Q

GSM Sx: Urinary

A

dysuria, urgency, recurrent UTI Sx

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9
Q

GSM Sx: Sexual

A

dryness, dyspareunia

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10
Q

Other symptoms associated with menopause

A

Menstrual irregularity, sleep disturbances, mood changes, difficulty with memory and concentration, osteoporosis

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11
Q

Types of estrogens for HT

A

Conjugated equine estrogen (CEE), 17-beta estradiol, bioidentical hormones

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12
Q

Where does CEE come from?

A

Pregnant mare’s urine, natural product

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13
Q

17-beta estradiol

A

Synthetic product

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14
Q

Bioidentical hormone information

A

Compounded preparations which are said to provide a unique mix of estradiol, estrone, and estriol at dosages specifically designed for each woman but aren’t FDA regulated

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15
Q

Systemic estrogen routes of administration

A

PO, TD patch, TD emulsion, TD spray, TD gel, vaginal ring, implanted pellet

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16
Q

Vaginal/local estrogen routes of administration

A

Vaginal cream, vaginal tablet, vaginal ring

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17
Q

Common ADEs of estrogen

A

N/V, headache, breast tenderness, heavy bleeding

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18
Q

Serious ADEs of estrogen

A

CHD, stroke, VTE, breast cancer, gallbladder disease

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19
Q

Role of progestogen in combination HT

A

Mitigation of endometrial hyperplasia

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20
Q

Who do you give progestogen to?

A

Women with an intact uterus (aka no hysterectomy)

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21
Q

Progestogen dosing

A

Given a minimum of 12-14 days/month

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22
Q

Progestogen ADEs

A

irritability, depression, headache

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23
Q

Types of progestogen products

A

MPA, norethindrone, micronized progesterone

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24
Q

Preparations of progestogen

A

Systemic/oral

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25
Q

For cyclic use, how often must the progestogen be taken?

A

Minimum of 12-14 days per month

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26
Q

For a woman with a Hx of hysterectomy, is use of progestogens indicated?

A

No

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27
Q

For women with endometriosis with a Hx of hysterectomy, would you use progestogen?

A

Yes, if combined with estrogen it may minimize endometriosis exacerbations

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28
Q

Continuous cyclic treatment regimen

A

Estrogen daily, progestogen given the last 12-14 days of every cycle to give scheduled withdrawal bleeding 1-2 days after the last progestogen dose

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29
Q

Continuous combined treatment regimen

A

Estrogen and progestogen daily, associated with absence of vaginal bleeding

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30
Q

Who is the continuous combined treatment regimen reserved for?

A

Women 2 years post menopause

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31
Q

Continuous long-cycle treatment regimen

A

Estrogen daily, with progestogen given 12-14 days EVERY OTHER MONTH, bleeding periods may be heavier and longer than withdrawal bleeding

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32
Q

Intermittent combined treatment regimen

A

3 days of estrogen alone, followed by 3 days of combined estrogen and progestogen repeated without interruption

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33
Q

Undiagnosed or abnormal bleeding: absolute or relative CI

A

absolute

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34
Q

Known, suspected Hx of breast cancer: absolute or relative CI

35
Q

Known or suspected estrogen or progesterone-dependent neoplasia: absolute or relative CI

36
Q

Active or Hx of VTE: absolute or relative CI

37
Q

Active or recent arterial thromboembolic disease like MI or stroke: absolute or relative CI

38
Q

Liver dysfunction or disease: absolute or relative CI

39
Q

HTN: absolute or relative CI

40
Q

High TGs: absolute or relative CI

41
Q

Impaired liver function: absolute or relative CI

42
Q

Hypothyroidism: absolute or relative CI

43
Q

Fluid retention: absolute or relative CI

44
Q

Severe hypocalcemia: absolute or relative CI

45
Q

Ovarian cancer: absolute or relative CI

46
Q

Exacerbation of endometriosis: absolute or relative CI

47
Q

Exacerbation of asthma, DM, SLE, epilepsy, porphyria, or hepatic hemangioma: absolute or relative CI

48
Q

WHI results for the group who received estrogen and progesterone vs. placebo

A

Increased risk of MI, stroke, breast cancer, blood clots

Decreased risk of colorectal cancer and fractures

49
Q

WHI results for the group who received estrogen only vs. placebo

A

No difference in risk of MI or breast cancer

Increased risk of stroke and blood clots

Decreased risk of hip fractures

50
Q

WHI benefits of HT

A

Relieved Sx of VMS and GSM, decreased hip fracture and osteoporosis and colon cancer

51
Q

What did the WHI do for HT?

A

FDA safety warning labels were added to all estrogen and progestogen products for increased risk of MI, stroke, breast cancer, endometrial cancer, thromboembolism

Use the lowest effective dose possible!

52
Q

Indications for HT therapy

A

Moderate-severe VMS +/- GSM Sx, moderate-severe GSM Sx alone for vaginal therapies

53
Q

What should all patients be reviewed for before starting HT?

A

Contraindications and they should all be offered a discussion on the risks and benefits of HT so they can make an informed decision

54
Q

HT for VMS length of therapy

A

<5 years, goal should be cessation within 5 years

55
Q

HT for GSM

A

Vaginal products only

Low dose vaginal estrogen usually doesn’t require progestin but long-term use may require intermittent progestin

56
Q

Length of therapy for GSM HT therapy

A

Usually require prolonged therapy

57
Q

Contraception during menopause

A

All good to use as long as age ≥40 years old

58
Q

Nonpharm Tx for VMS

A

Cognitive behavioral therapy, hypnosis, mindfulness-based stress reduction, weight loss (limited evidence of benefit)

Cooling techniques, avoidance of triggers, yoga (insufficient evidence)

59
Q

Nonpharm Tx for GSM

A

Nonhormonal vaginal lubricants and moisturizers (1st line for GSM only!)

60
Q

Herbals for menopause

A

Black cohosh and phytoestrogens

No evidence for herbals

61
Q

Androgens for menopause

A

Methyltestosterone and esterfied estrogens, testosterone; administer with or without concurrent estrogen therapy

62
Q

ADEs of androgens

A

Acne, hirsutism, lowering of voice, lipid and liver function changes

63
Q

SERMs for menopause

A

Raloxifene (Evista), ospemifene (Osphena), CEE and bazedoxifene (Duavee)

64
Q

Raloxifene indications

A

Prevention and treatment of osteoporosis

65
Q

Ospemifene indication

A

Severe dyspareunia

66
Q

CEE and bazedoxifene indications

A

moderate-severe Sx of VMS in women WITH A UTERUS, prevention of osteoporosis

67
Q

Raloxifene dosing

A

60mg PO QD

68
Q

Ospemifene dosing

A

60mg PO QD

69
Q

Duavee dosing

A

0.45mg CEE, 20mg bazedoxifene

70
Q

Duavee has an increased risk for…

A

VTE and CVA

71
Q

Duavee ADEs

A

leg cramps, hot flushes, sweating, GI Sx

72
Q

SSRI for menopause

A

Paroxetine mesylate (Brisdelle), used for VMS

73
Q

Paroxetine mesylate dosing

A

7.5mg PO QD

74
Q

Paroxetine mesylate ADE

75
Q

Paroxetine mesylate BBW

A

Suicidality

76
Q

Who do you consider paroxetine mesylate in?

A

Patients with concomitant depression, CIs to HT, or those who don’t wish to take HT

77
Q

SNRIs for menopause

A

Desvenlafaxine, venlafaxine (off-label); effective for VMS

78
Q

Prasterone (Intrarosa) indication

A

Dyspareunia due to menopause

79
Q

Prasterone dosing

A

6.5mg intravaginally QHS daily

80
Q

Clonidine and gabapentin

A

Off-label uses for VMS

81
Q

Patient counseling for HT

A

Systemic HT is highly effective in alleviating VMS +/- GSM

Using the lowest effective dose and limiting therapy to <5 years removes nearly all risk

HT is indicated for healthy women with significant VMS <60 years old and within 10 years of menopause onset

82
Q

Discontinuation of HT

A

Tapered to limit recurrence of hot flashes, slowly D/C over 3-6 months after 4-5 years of therapy

83
Q

What should women experiencing menopause prior to age 45 do regarding HT?

A

Use HT until the natural age of menopause (~51 years old in the US)

PHM 602- Pregnancy, Labor/Delivery/Lactation, Menopause (4 decks)

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