Menopause

Question 1

goals

Answer 1

alleviate or reduce sxs
improve QOL
minimize ADRs

Question 2

non-pharmacological interventions

Answer 2

-avoid vasomotor triggers (hot beverage, spicy food, EToH)
-exercise
-water-based lubricants

Question 3

pharmacotherapy

Answer 3

hormone replacement therapy (HRT): most effective tx for vasomotor sxs and vulvovaginal atrophy esp in women w/ moderate to severe sxs

contraindicated for:
-provided there is not CHD
-significant CHD risk factors
-hx of breast cancer

Question 4

oral estrogen

Answer 4

-moderate-to-severe vasomotor sxs
-vulvovaginal atrophy
-prevention of post-menopausal osteoporosis

Question 5

oral estrogens should NOT be used for

Answer 5

osteoporosis prevention in the absence of vasomotor sxs of menopause or for patients w/ local symptoms ONLY

HOPE trial shows low dose provided equivalent efficacy relief as standard doses

Question 6

oral progestins

Answer 6

used in women with an intact uterus to reduce endometrial hyperplasia and endometrial cancer with estrogen monotherapy

-must be taken a minimum of 12-14 days/month
-NOT nec s/p hysterectomy

Question 7

what’s the length of therapy for HT?

Answer 7

-start close to the time of menopause
-can stop 2-3 years after starting
-longer duration may be associated with CHR, stroke, VTE, various cancers, etc.
-tapper or stop is ok (tapper wont help with hot flashes compared with sudden discon’t

strong consideration to taper in those on higher doses of estrogen or long duration

Question 8

dose taper

Answer 8

progressively decrease dose of estrogen
-may req 3-6m in some
-do not decrease again until sxs are tolerable & imrpove

Question 9

day taper

Answer 9

-dec # of days per week HRT (hormonal replacement therapy) is taken
-do not dec again until sxs are tolerable & improve

Question 10

which hormone should be tapered?

Answer 10

only estrogen, not progesterone

-progesterone is stopped at the end of the taper when completely stopping HRT

Question 11

vulvovaginal complications during menopause can range from

Answer 11

-vag dryness to atrophy
-dyspareunia (painful coitus=sexual intercourse)
-lower urinary tract symptoms (urge incontinence/OAB)

Question 12

local or systemic estrogen therapy for sxs relief:

Answer 12

-restore thickness, elasticity, and lubrication
-reduce the risk of recurrent UTIs

Question 13

in the absence of vasomotor sxs:

Answer 13

local/topical vag estrogen therapy is recommended
-minimal systemic absorption (w/ exceptions) and does not require the concomitant administration of a progestin

Question 14

OAB abbr

Answer 14

OverActive Bladder