Menopause Flashcards
Definition of menopause?
Permanent cessation of menstrual cycles due to loss of ovarian activity 1 year after last menstrual cycle
Symptoms of menopause?
Vasomotor symptoms
Vaginal atrophy
What causes vaginal atrophy?
Hypoestrogenic state
What are the vaginal changes of menopause?
- Loss of superficial epithelial cells leading to thinning of vaginal tissues
- Vaginal tissues are thin and frail leading to tearing and bleeding
- Loss of subcutaneous fat of labia majora leading to introital narrowing and labia minora fusion
- Loss of vaginal rugae leading to decreased elasticity and narrowing of the vagina
- Increased pH causing decrease in normal vaginal flora leading to infection
- Decreased vaginal secretions leading to dyspaurenia
What are the options for management of vasomotor symptoms of menopause?
Systemic hormonal therapy
Nonhormonal therapy
What are the systemic hormonal therapy options for vasomotor symptoms of menopause?
Standard or low dose
conjugated estrogen
micronized estradiol
transdermal estradiol
What are the non hormonal therapy options for vasomotor symptoms of menopause?
Paroxetine
Clonidine
Gabapentin
What is the most effective therapy for vasomotor symptoms of menopause?
Systemic hormonal therapy with estrogen alone or in combination with progestin
What systemic hormonal therapy do you use in practice?
Low dose Transdermal estradiol patch 0.025mg/day with or without IUD
What non hormonal therapy due you use to treat vasomotor symptoms of menopause?
Paroxetine 7.5mg/day
What are the side effects of hormone replacement therapy?
Breast tenderness
Headache
Bloating
Vaginal bleeding
What is the dosing and timing recommended for treatment of vasomotor symptoms?
Treating with the lowest effective dose for the shortest duration of time that alleviates vasomotor symptoms
What are the risks of systemic hormonal replacement therapy?
Systemic combined= VTE, breast cancer,CHD, Stroke
Systemic estrone alone= VTE
What is the Women’s health initiative study?
Randomized trial that looked at healthy postmenopausal women age 50-77 and demonstrated in slight increase risk of breast cancer, coronary heart disease, stroke and VTE and decreased risk of fractures and colon cancer for women using combined HRT for average of 5 years
For women using estrogen alone there was only an increase risk for VTE
What is the benefit of transdermal estrogen over oral estrogen for systemic hormone therapy?
Can be associated with lower risk of VTE
What should your decision to stop systemic hormone replacement therapy be based on?
Risk benefit ratio of patient and symptoms of menopause
NOT AGE!!
Who are the best candidates for systemic hormone replacement therapy?
- Healthy women
- No contraindications
- Within 10 years of menopause
- Age <60
What is an alternative for systemic hormone therapy treatment in women with a uterus as an alternative to progestin?
Conjugated estogen + bazedoxifene
Can you use progestin alone for treatment of vasomotor symptoms?
No
No data for safety when used alone
Also risk of breast cancer is thought to be related to progestin
What are some herbal remedies women may take for vasomotor symptoms?
St Johns wort
Black cohosh
Ginseng
Ginko
What are options to treat vaginal atrophy symptoms of menopause?
Low dose systemic therapy
Localized estrogen therapy with cream, ring or tablet
What vaginal estrogen therapy do you use for vaginal atrophy treatment?
Conjugated estrogen Premarin cream 0.5-2g/day
What are non hormonal options for vaginal atrophy treatment of menopause?
Vaginal lubricants
Vaginal moisturizers
Estrogen agonist/antagonists
What medication is FDA approved for dyspaurenia in postmenopausal women?
Ospemifene
What are contraindications to systemic hormonal therapy?
History of breast cancer
History of CHD
History of Stroke
History of VTE
Endometrial cancer
Unexplained vaginal bleeding
Active liver disease
