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Endocrinology > Menopause > Flashcards

Menopause Flashcards

1
Q

Natural menopause

A

The time of a person’s final menstrual period
* Diagnosed after no periods for 12 consecutive months

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2
Q

Induced menopause

A

Experience (before natural menopause) with bilateral oophorectomy (removal of both ovaries) ablation of ovarian function with chemotherapy or pelvic radiation

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3
Q

Perimenopause

A
  • Most often begins between 45 and 55
  • Starts at onset of menstrual irregularity and ends 12 months after final menstrual period
  • Abnormal uterine bleeding
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4
Q

Abnormal Uterine Bleeding

A
  • Characterized by a deviation of regularity, frequency, duration, or volume of menstrual fluid
  • Most often caused by the increased frequency of anovulatory cycles
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5
Q

What are some vasomotor symptoms?

A
  • Hot flashes
  • Night sweats
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6
Q

What are some symptoms of genitourinary syndrome of menopause?

A
  • Vaginal atrophy leading to dryness, burning, irritation
  • Dyspareunia (sexual discomfort or pain)
  • Urinary urgency, dysuria, incontinence, and recurrent UTIs
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7
Q

What are some psychological symptoms?

A
  • Depression and anxiety
  • Sleep disturbance
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8
Q

What are postmenopausal women at an increased risk for?

A
  • Osteoporosis
  • Bone fractures
  • CHD
  • Increased memory loss
  • Other cognitive difficulties
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9
Q

How do you diagnosis menopause?

A
  • Elevated FSH level is NOT required
  • In patients with uterus/ovaries under age 45, rule out other causes of menstrual cycle dysfunction
  • In patients with hysterectomy without bilateral oophorectomy, elevated FSH and low estradiol concentrations may support diagnosis
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10
Q

What are some non-pharmacological treatments?

A
  • Smoking cessation
  • Exercise
  • Avoid hot, spicy foods
  • Avoid caffeine
  • Layer clothes
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11
Q

Menopausal Hormone Therapy

A
  • Estrogen replacement therapy
  • Effective for vulvovaginal symptoms
  • Effective for moderate to severe vasomotor symptoms
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12
Q

What MHT are you using if the patient had a hysterectomy?

A
  1. Estrogen + Progesterone
  2. Estrogen + Bazedoxifene
  3. Low-dose vaginal estrogen
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13
Q

Intravaginal estrogen products are preferred when?

A

In patient with only genitourinary symptoms
* No need to give with progestogen
* Local action, except with Femring, which achieves systemic levels

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14
Q

What are the adverse effects of estrogen?

A
  • Nausea
  • Breast tenderness
  • Increased risk of migraine
  • Headache
  • Thromboembolic events
  • Gallbladder disease
  • Hypertriglyceridemia
  • HTN
  • Increased the risk of endometrial cancer
  • Small increase in risk of breast cancer and cardiovascular events
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15
Q

Progestin

A
  • Prevent estrogen-induced endometrial hyperplasia and cancer when co-administered when estrogen
  • Can be used continuously or cyclically
  • At least 12-14 days of progestogen therapy per month is required
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16
Q

Conjugated equine estrogen (CEE)

A
  • Administer 21 days on and 7 days off
  • Vaginal estrogen
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17
Q

Estradiol cream (Estrace)

A
  • Vaginal estrogen
  • 2-4 g daily for 2 weeks, then half-dose daily for 2 weeks; maintenance 1 g 1-3 times per week
18
Q

Estradiol tablets (Vagifem)

A
  • Once weekly for 2 weeks, then twice weekly
19
Q

Estring (intravaginal ring)-estradiol

A
  • Intravaginal estrogen
  • 90 days
20
Q

Femring (intravaginal ring)

A
  • Intravaginal estrogen
  • 90 days
21
Q

Topical emulsion (Estrasorb)

A

Apply to legs
* topical estradiol

22
Q

Topical gel (EstroGel metered-dose pump)

A
  • Apply from wrist to shoulder
  • Topical estradiol
23
Q

Topical gel (Elestrin metered-dose pump)

A

Apply to upper arm
* Topical estradiol

24
Q

Topical gel (Divigel)

A
  • Apply to upper thigh
  • Topical estradiol
25
Q

Transdermal spray

A
  • Apply to inner forearm
  • Topical estradiol
26
Q

Does cyclic regmines of progestins cause withdrawal bleeding?

A

Yes

27
Q

What are the common adverse effects of progestin?

A
  • Breast soreness
  • Some experience “premenstrual-like” symptoms such as mood swings and bloating
  • Vaginal bleeding iwth cyclic progestin and in the early months of continuous estrogen-progestin (if newly menopausal)
  • Risk of CHD with MPA use
28
Q

What are the contraindications of MHT?

A
  • Unexplained vaginal bleeding
  • Active liver disease, liver failure
  • Prior estrogen-sensitive breast or endometrial cancer
  • History of CHD or stroke
  • History of or high risk for VTE
  • Untreated HTN
29
Q

When is transdermal estrogen preferred over oral estrogen?

A
  • Hypertriglyceridemia
  • Active gallbladder disease
  • Thrombophilia such as factor V Leiden
  • Migraine headaches with aura
30
Q

What is the risk vs benefits of having cardiovascular disease when taking MHT?

A
  • Reduced when estrogen-only used in newly menopausal patient
  • No increase if estrogen + progestin therapy initiated within 10 years of menopause
  • Increased risk if initiated more than 10 years since menopause
31
Q

What is the risk vs benefits of having breast cancer when taking MHT?

A
  • Increased risk when estrogen + progestin therapy if used > 10 years
  • Use of estrogen alone may decrease risk
32
Q

What is the risk vs benefits of having osteoporosis when taking MHT?

A
  • Estrogen therapy reduces bone turnover and increases bone density
  • Standard-dose MHT reduces postmenopausal osteoporotic fractures
33
Q

What is the risk vs benefits of having ischemic when taking MHT?

A

Increased risk with estrogen only and estrogen + progestin

34
Q

What is the risk vs benefits of having VTE when taking MHT?

A
  • Increased risk of with personal risk factors including obesity, previous history of VTE, presence of Factor V Leiden mutation
35
Q

Bazedoxifene

A
  • FDA-approved for use in severe vasomotor symptoms and prevention of osteoporosis
  • Antagonist in breast and uterus
  • Must be used with estrogen
36
Q

What are the side effects of Bazedoxifene?

A
  • Muscle spasms
  • Nausea
  • Diarrhea
  • Dyspepsia
37
Q

Ospemifene

A
  • FDA-approved for the treatment of moderate-to-severe dyspareunia from menopausal vulvar and vaginal atrophy
  • Nearly full estrogen agonist effect in the vaginal epithelium; antagonist in breast and uterus
38
Q

What is the side effect of ospemifene?

A
  • Hot flashes
  • Vaginal discharge
  • Muscle spasms
39
Q

Prasterone (Intrarosa)

A
  • Once daily vaginal insert
  • DHEA
  • FDA-approved for treatment of moderate-to-severe dyspareunia
    • Local effect = decrease vaginal dryness
  • Does NOT carry boxed warning for VTE or endometrial hyperplasia like other estrogen-containing products
40
Q

What are some side effects of Prasterone (Intrarosa)?

A
  • Vaginal discharge and abnormal Pap smear (atypical squamous cells of undetermined significance)

Endocrinology (10 decks)

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