Menopause

Question 1

Signs, Sx

Answer 1

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

Question 2

Treatment Algorithm: Vasomotor Sx Only or VM + VV Sx

Answer 2

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

Question 3

Treatment Algorithm: Vulvovaginal Sx Only

Answer 3

Mild: vaginal moisturizers or lubricants

Mod/sev: vaginal estrogen with low-estrogen systemic exposure OR Ospemifene OR Prasterone (VEPO)

Question 4

Vaginal Dryness

Answer 4

Topical lubricants
-Water-soluble products preferred (internal/external)
-Avoid petroleum products

Vaginal moisturizers
-Longer lasting

Question 5

Estrogen (oral)

Answer 5

-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

Question 6

Estrogens (vaginal)

Answer 6

Local tx

AE:
-Discharge
-Candidiasis
-Bleeding
-Nausea

Vagifem, Yuvafem, Imvexxy, Estrace/Premarin Vaginal, Estring

Question 7

Non-oral Estrogens (IM, patch, spray, gel, vaginal)

Answer 7

-Less likely to increase TG, cause pancreatitis/gbd, risk of VTE/stroke

Question 8

Progestogen

Answer 8

-Risk of endometrial cancer/hyperplasia

-Does not increase VTE risk

AE: (look like shit)
-Irritable
-Bleeding (vag)
-Bloating, weight gain
-Breast tender
-Acne
-HA

Question 9

Combined MHT (E+P)

Answer 9

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

Question 10

SERMs

Answer 10

FENES

-Bazedoxifene
*spasm, ND, AP, dizzy, neck pain

-Ospemifene
*hot flash, discharge, vag hemorrhage, hyperhidrosis

Question 11

MHT CIs

Answer 11

-Genital bleeding
-Breast cancer
-E/P-dep neoplasia
-DVT, PE, VTE
-Stroke, MI
-Liver dysfunction

BG NCL

Question 12

SSRIs
-Paroxetine
-Es/Citalopram

Answer 12

DDI: may reduce tamoxifen efficacy

AE:
-ES: Loss of libido (AO)
-CI: QTP

Question 13

SNRIs
-Venlafaxine
-Desvenlafaxine

Answer 13

No DDI with tamoxifen

AE:
-HA, insomnia, anorexia, etc
-Venla: HTN

Question 14

Gabapentinoids

Answer 14

Onset 4w

AE:
-Weight gain, edema
-Dry mouth, blurry vision
-Concentration

Question 15

Clonidine

Answer 15

AE:
-drowsiness, dizziness,
constipation, dry mouth, orthostatic hypotension