Menopause Flashcards
What are vasomotor symptoms of menopause?
hot flashes, night sweats
What is the first line pharmacological treatment for vasomotor symptoms of menopause?
systemic hormone therapy (menopause hormone therapy)
What is menopause hormone therapy (MHT)?
estrogen + progestin (NEEDED if woman has intact uterus!!)
Describe: transdermal estrogen
-bypass first pass metabolism
-lower VTE risk
-no impact on triglycerides
-lower stroke risk
Describe: Oral Estrogen
-higher VTE risk
-decrease libido
-increase triglycerides
Describe: Estradiol
lower risk of thrombosis, lower risk of MI
Dosing: Estrogen only
-in use in those WITHOUT a uterus
-oral prep taken daily
-patch
Dosing: Continuous-Cyclical Combined
-use in patients with uterus
-estrogen taken daily
-progesterone is taken 10-14 days a month (withdrawal bleeding can occur due to absence of progesterone)
Dosing: Continuous-Combined
-use in patients with a uterus
-estrogen + progestin used continuously
-unpredictable bleeding may occur
Indications: Conjugated equine estrogens/Medroxyprogesterone (Prempro)
-moderate to severe vasomotor symptoms due to menopause
-moderate to severe symptoms of vulvar and vaginal atrophy due to menopause (use topical therapies for sole treatment of vulvar and vaginal atrophy)
-osteoporosis treatment
Adverse Reactions: Prempro
headache, abdominal pain, nausea, mastalgia, dysmenorrhea, diarrhea
What is Duavee?
conjugated equine estrogen (CEE) + selective estrogen receptor modulator (SERM)
Indication: Duavee
postmenopausal women WITH a uterus for vasomotor symptoms (suggested to use in women who are at risk for breast cancer), osteoporosis prevention
Adverse effects: Duavee
diarrhea, muscle spasms, nausea, may increase risk of stroke and DVT
Contraindications to Hormone Therapy in postmenopausal women?
-unexplained vaginal bleeding
-liver disease
-prior estrogen- sensitive cancer (breast cancer)
-prior coronary heart disease, stroke, or MI
-prior venous thromboembolism
-personal history or inherited risk of thromboembolic disease
FDA Boxed Warning: Estrogen + Progestin
-do NOT use for prevention of cardiovascular disease or dementia
-increased risk of stroke, DVT, PE, MI
-increased risk of invasive breast cancer
-increased risk of probable dementia among women 65 and older
FDA Boxed Warning: Estrogen-only products
-do NOT use for prevention of CVD or dementia
-increased risk of endometrial cancer in those with a uterus taking unopposed estrogen
-increased risk of stroke/DVT
-increased risk of probable dementia among women 65 and older
When is it safe to begin HT for Menopause?
pt with no contraindications who are within 10 years of menopause and/or <60 yo
What are the non-pharmacological treatment options for menopause?
-cognitive behavioral therapy
-clinical hypnosis
-temperature control
-yoga
-avoid spicy food
-exercise
-acupuncture
-paced respiration
What herbal therapies can be used for menopause?
isoflavones/phytoestrogens (no evidence, avoid in breast cancer pt), black cohosh
Describe: SSRI for Menopause
unknown MOA for menopause
-escitalopram
-paroxetine 7.5mg= approved for vasomotor symptoms, side effects: N/V, HA, fatigue, AVOID IN breast cancer pt on TAMOXIFEN
-fluoxetine (not as effective)= avoid in pt on tamoxifen
Describe: SNRI for Menopause
-venlafaxine (most common)= side effects: GI upset, sleep disturbances, blood pressure increase
-desvenlafaxine (inconsistent results)
-duloxetine
MOA: Fezolinetant (Veozah)
neurokinin-3 receptor antagonist
Adverse Effects: Fezolinetant
headache, nausea, UTI, diarrhea, URI, fatigue, cough, may increase hepatic transaminases
Monitoring: Fezolinetant
-baseline tests to assess liver damage
-AST, ALT (liver tests) every 3 months for first 9 months
Max dose of gabapentin for menopause?
900 mg/day in divided doses
What is the non-pharmacological first line treatment for vaginal symptoms of menopause?
vaginal moisturizer or lubricant= Replense (polycarbophil bioadhesive polymer)
What other products can be used to treat vaginal symptoms of menopause?
-vaginal estrogen
-prasterone (Intrarosa)
-ospemifene (Osphena)
Describe: prasterone (Intrarose)
DHEA that is converted to androgens and estrogens in a vaginal insert that restores vaginal tissue
Describe: Ospemifene (Osphena)
-FDA approved for dyspareunia (painful sex)
-MOA: SERM
-may result in hot flashes
