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RCPSC > Menopause > Flashcards

Menopause Flashcards

1
Q

most common cancer overall in Canadian women

A

non-melanoma skin

(second most common = breast)

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2
Q

incidence of breast cancer

A

1/8

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3
Q

non-rx options for vasomotor symptoms in breast ca patients

A

paced breathing
acupuncture
CBT

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4
Q

first line non-hormonal alternative for vasomotor symptoms in breast ca patients

A

venlafaxine

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5
Q

non-hormonal options for refractory VSM in breast ca

A

paroxetine
gapapentin
oxybutinin
clonidine

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6
Q

which non-hormonal Rx should be used in caution if receiving tamoxifen

A

Paroxetine

inhibits CYP2D6 which metabolises tamoxifen to its active compound

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7
Q

non-Rx options for GUSM in breast ca survivors

A

vaginal moisturizers
lubricants
pelvic floor physiotherapy
dilators or vibrators

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8
Q

Hormonal alternatives to local estrogen treatments for GUSM in breast ca

A
  • prasterone (vaginal DHEAS)
  • oral ospemifene (not approved for survivors)
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9
Q

what is better than gabapentin for management of VMS in breast ca patients

A

1) venlafaxine
2) electroacupuncture

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10
Q

aRR LNG-IUS for breast ca

A

1.21

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11
Q

if initiate HRT ___ or more years after MP, then increased risk for adverse cardiac events

A

10years
(RR 1.06)

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12
Q

early menopause has ___% increased risk of
1) CAD
2) CVA
3) Cardiovascular mortality
4) All cause mortality

A

1) CAD 50%
2) CVA 23%
3) CVD mortality 19%
4) all cause mortality 12%

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13
Q

RR for VTE in women >60 or those who initiate HRT more than 10 years after MP

A

1.96

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14
Q

Anabolic therapies

A

Romosozumab
Abaloparatide
Teraparutide

all given S/C.

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15
Q

Antiresorptive therapies

A

Bisphosphonates
Denosumab
Zeledronic acid

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16
Q

Bisphosphonates

A

Alendronate
Risedronate

given PO weekly

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17
Q

SERMs

A

raloxifene,
Bazedoxifene

given PO daily

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18
Q

Romosozumab - indication and contraindication

A

very high risk of fracture, but not for those with cardiac or cerebrovascular disease

ANABOLIC

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19
Q

Teriparatide - indication and contraindication

A

very high risk of fracture,
but not for those with previous radiation therapy or hx of cancer.

ANABOLIC

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20
Q

Common side effects of bisphosphonates

A

GI:
- GERD
- abdominal distention,
- constipation or diarrhoea,

MSK
- pain
- ONJ (rare)
- AFF (rare)

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21
Q

Denosumab - what and for whom?

A

Antiresorptive,
for high or very high risk.

  • Need GFR at least 15.
  • Given 60mg S/C every 6 months
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22
Q

risk of osteonecrosis of the jaw

A

with bisphosphantes or denosumab,
1/10 000 to 100 000 patient years

withhold treatment 6-8 weeks after dental procedure

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23
Q

features of atypical femoral fractures

A
  • short oblique or transverse fracture line
  • cortical thickening

thigh or groin pain for several weeks to months before development of an AFF: get bilateral full femur XR

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24
Q

if AFF found - management

A

stop therapy, offer teriparatide in absence of contraindications

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25
Q

AFF can occur in absence of any drug therapy in ___%

A

20% of cases

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26
Q

risk of AFF on bisphosphonates

A

1/1000
patient years
After 10 years of Rx

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27
Q

FRAX very high risk definition

A

> =30% MOF

> =4.5% hip fracture
or, recent fracture within 12/12
or, multiple fragility fractures

28
Q

FRAX high risk definition

A

> =20% MOF

> =3.5% hip fracture

29
Q

FRAX intermediate risk definition

A

10-20% MOF

30
Q

treatment for very high risk osteoporosis

A

anabolic agent first, followed by an antiresorptive

31
Q

treatment for high risk osteoporosis

A

anabolic,
denosumab,
bisphosphonate,
or MHT

32
Q

treatment for intermediate risk osteoporosis

A

bisphosphonate,
MHT,
or SERM

33
Q

adequate calcium and vit D intake for MP/osteoporosis

A

1200mg Calcium preferably from dietary sources,
Vit D level 75-125

34
Q

prevalence of hot flashes and night sweats

A

80% of women in mid-life;
severe episode ~20%

35
Q

risk factors for VMS

A
  • low SES
  • low education
  • obesity
  • Black and hispanic women
36
Q

most common type of VMS onset

A

late onset (29%)

37
Q

pattern of VMS onset most associated with adverse health effects

A

onset early with persistently high frequency

38
Q

how long does average VMS last

A

3-4 minutes

  • avg 7.4 years
39
Q

neurotransmitters involved in VMS

A

kisspeptin,
neurokinin B,
dynorphin (KND)**

40
Q

MHT reduces hot flashes by:

A

75%

41
Q

contraindications to estrogen MHT

A
  • AUB undiagnosed
  • known or suspected cancer
  • CAD or stroke or VTE
  • known thrombophilia
  • active liver disease
  • known or suspected pregnancy
42
Q

how long does it take for MHT to start working

A
  • as soon as 2 weeks
  • usually 1 month
  • lower doses up to 6 weeks
43
Q

non hormonal VMS option good for sleep disturbances

A

gabapentin

44
Q

complementary therapies with efficacy for VMS

A
  • weight loss
  • CBT (impact only)
  • mindfullness

?clinical hypnosis

45
Q

HRT confers an additional risk of -

A

6 strokes,
8 VTE,
4 PE
per 1000 women

46
Q

POI <45yo risks

A

50% increased risk CAD;
23% increase risk stroke;
19% increased risk CVD mortality

47
Q

criteria for HSDD diagnosis

A

low desire AND DISTRESS,
for 3 or more months for at least 75% of events

48
Q

categories of causes of HSDD

A

1) biological
2) psychological
3) interpersonal
4) drugs

49
Q

targeted exam components for HSDD

A

vulva,
localised tenderness,
ulcers or skin lesions,
hypertonicity of pelvic floor,
visible/palpable lesions

50
Q

Rx options for dyspareunia (MP)

A

1) low dose local estrogen
2) lubricants and moisturizers
3) DHEA ovules
4) PO ospemifene

51
Q

testosterone for HSDD - dose equivalency to male dose

A

1/10th

52
Q

testosterone dose for HSDD

A

1 half pump of 1% androgen gel,
on posterior calf

53
Q

monitoring of testosterone levels

A
  • baseline
  • at 3-6 months
  • every 6 months after that

max 2.8nmol/L

54
Q

how long might it take to see positive effects of testosterone

A

3 months

55
Q

when to discontinue testosterone if no benefit seen

A

6 months

56
Q

rx options for arousal disorders (MP)

A
  1. low dose sildenafil (off-label)
  2. mindfulness
57
Q

rx options for anorgasmia

A

First line:
- psychoeducation,
- mindfulness,
- directed masturbation,
- vibrators

58
Q

what proportion of MP women have GUSM

A

30-50%

59
Q

first line management for GSM

A

non-hormonal:
1. lifestyle
2. moisturisers + lubricants
3. physiotherapy (>=12 weeks)

60
Q

second line management for GSM

A

hormonal:

  1. estrogen
  2. DHEA/prasterone
  3. ospemifene
61
Q

third line option for GSM

A

laser treatment - may be option for those wishing to avoid hormonal rx or who have CI

62
Q

what proportion of women in midlife will have sleep disturbances

A

30%

63
Q

pharmacological options for sleep management in MP

A

1) low dose estradiol
2) venlafaxine
3) daily transdermal estradiol
4) esozopicolone

64
Q

exercise recommendation for sleep disturbances in MP

A

aerobic exercise, 40-60min
x3/week,
x 12 weeks

65
Q

investigations for brain fog

A
  • CBC, BMP, lipid panel
  • TFTs
  • B12 level

RCPSC (17 decks)

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