Menopause Flashcards
Signs, Sx
Vasomotor
-Hot flashes, night sweats, warmth, chills
Genitourinary
-Vaginal dryness, burning, irritation, sexual dysfunction, dysuria, UTIs
Other
-Psych: depression, anxiety, mood sings, concentration
-Sleep disturbances
Treatment Algorithm: Vasomotor Sx Only or VM + VV Sx
Mild: non-pharm + vaginal moisturizers or lubricants
Mod/sev: is MHT contraindicated?
Yes: non-hormonal therapy (SNRI/SSRI, clonidine, gabapentin, pregabalin) + moisturizers/lubri
No: EAR SE
*Hysterectomy:
-Estradiol acetate intravaginal ring
-Systemic estrogen
*No Hyster: BE SET PEAR
-Oral or transdermal estrogen
-Estradiol acetate intravaginal ring + progestin
-Conj estrogen and bazedoxifene
Treatment Algorithm: Vulvovaginal Sx Only
Mild: vaginal moisturizers or lubricants
Mod/sev: vaginal estrogen with low-estrogen systemic exposure OR Ospemifene OR Prasterone (VEPO)
Vaginal Dryness
Topical lubricants
-Water-soluble products preferred (internal/external)
-Avoid petroleum products
Vaginal moisturizers
-Longer lasting
Estrogen (oral)
-Most effective treatment of hot flashes
-Decrease LDL/chol, increase HDL
-Increase BMD
AE:
-Nausea, HA, breast tenderness, bleeding
-CHD, stroke, VTE, breast cancer, gallbladder disease
Premarin, Menest, Estrace
Estrogens (vaginal)
Local tx
AE:
-Discharge
-Candidiasis
-Bleeding
-Nausea
Vagifem, Yuvafem, Imvexxy, Estrace/Premarin Vaginal, Estring
Non-oral Estrogens (IM, patch, spray, gel, vaginal)
-Less likely to increase TG, cause pancreatitis/gbd, risk of VTE/stroke
Progestogen
-Risk of endometrial cancer/hyperplasia
-Does not increase VTE risk
AE: (look like shit)
-Irritable
-Bleeding (vag)
-Bloating, weight gain
-Breast tender
-Acne
-HA
Combined MHT (E+P)
Cyclic/Sequential
-Estrogen daily but progestogen only 12-14 days
-Withdrawal bleeding
-For late meno or early postmen
Continuous
-Estrogen and pro daily
-No bleeding (spotting)
-Less endo cancer
-For 2 years postmen
SERMs
FENES
-Bazedoxifene
*spasm, ND, AP, dizzy, neck pain
-Ospemifene
*hot flash, discharge, vag hemorrhage, hyperhidrosis
MHT CIs
-Genital bleeding
-Breast cancer
-E/P-dep neoplasia
-DVT, PE, VTE
-Stroke, MI
-Liver dysfunction
BG NCL
SSRIs
-Paroxetine
-Es/Citalopram
DDI: may reduce tamoxifen efficacy
AE:
-ES: Loss of libido (AO)
-CI: QTP
SNRIs
-Venlafaxine
-Desvenlafaxine
No DDI with tamoxifen
AE:
-HA, insomnia, anorexia, etc
-Venla: HTN
Gabapentinoids
Onset 4w
AE:
-Weight gain, edema
-Dry mouth, blurry vision
-Concentration
Clonidine
AE:
-drowsiness, dizziness,
constipation, dry mouth, orthostatic hypotension
