Menopause Flashcards
Signs and Sx
Vasomotor symptoms
-hot flashes, night sweats, warmth, chills
-spontaneous or triggered by alcohol, caffeine, smoking etc
Genitourinary syndromes
-vaginal dryness, burning, irritation, sexual dysfunction, dysuria, urgency, UTIs
Other
-psychological, sexual, sleep disturbances
TREATMENT OVERVIEW
- Lifestyle mods
- OTC lubricants/moisturizers
- Hormonal therapies (estrogen +/- progesterone, androgen)
- Non-hormone alternatives
- CAMsL
Lifestyle Mods
- Avoid triggers
- Layered clothing, lower RT
- Exercise
- Ca/VD supplements
- Smoking cessation
Vaginal Dryness
Topical lubricants
-water soluble preferred
-internal, external, PRN
-avoid petroleum
Vaginal moisturizers
-last longer
Estrogen Effects
-Most effective for hot flashes
-Reverse GU atrophy
-Decrease LDL/TC, increase HDL/TG
-Increase bone mineral density
AE:
-Nausea, HA, bleeding, breast tenderness
-Serious: CHD risk, stroke, VTE, breast cancer, gallbladder disease
Dosing Estrogen
Initiate lowest effective dose for sx control
0.625 mg/d oral conj estrogen
same as
1 mg/d oral 17B estradiol
same as
0.05 mg/d transdermal estradiol
Low-dose estrogen regimens include:
~About half of reg doses
-0.3 mg conj estrogens
-0.5 mg micronized 17β-estradiol
-0.014 to 0.0375 mg transdermal
Vaginal Estrogens
-Local, minimizes systemic exposure
AE: discharge, vulv candidiasis, bleeding, nausea
-Estradiol 10 mcg tab, 4 mcg insert
-Estradiol 0.01% cream
-CEE 0.625 mg/g cream
-Estradiol 2 mg ring
Oral Estrogens
-[Estrone] is 5-7 x higher than [estradiol]
-Metabolized during first pass
0.3-0.45 mg conj estrogen, esterified 0.3, estradiol 1-2 mg
Nonoral Estrogens Dosing
Bypass first-pass liver metabolism
= [Estradiol] > [estrone]
-Less likely to increase triglycerides
-Less likely to cause gallbladder disease or pancreatitis
-Less risk of VTE, stroke, CAD
Progesterone Effects
AE:
-Irritability
-Vaginal bleeding
-Bloating, weight gain, increase appetite
-Headaches
-Breast tenderness
-Acne
COMBINED MHT (E+P)
Cyclic, aka Sequential
*MPA, micronized pro, norethindrone acetate
-Best in late menopausal transition and early post-menopause
Continuous
*Norethindrone
-Best for pts at least 2 years postmenopausal
Risks of Systemic MHT
-Cardio: CAD, PVD, stroke, VTE
-Diabetes
-Cancer: breast, endometrial, ovarian, lung
-Osteoporosis
-Cognitive, mood, dementia
-Gallbladder disease
-Body weight
MHT Contraindications
Absolute (VBN LAG)
* Undiagnosed abnormal genital bleeding
* History of breast cancer
* Estrogen- or progesterone-dependent neoplasia
* Active DVT, PE, or history of VTE
* Active or recent (in past year) arterial thromboembolic disease (stroke, MI)
* Liver dysfunction/disease
Summary of NAMS Position
Vaso sx = estrogen +/- progesterone
GSM = estrogen, local if sole vaginal sx
Sexual = low dose estrogen
Osteoporosis = MHT
CHD = estrogen ~+/- progesterone
VTE = transdermal forms
SSRIs
Paroxetine 7.5 mg
Prams 10 mg
AE: anorgasmia, loss of libido (esc), OTc pro (cit)
DDI: tamoxifen
