Menopause Flashcards
What is natural menopause?
> 1 year of permanent no menses
What is perimenopause?
prior to pause where cycle becomes irregular
What is premature menopause?
<40
What is the difference between primary ovarian insufficiency and premature menopause?
POI= <40 but can still have irregular cycles
How do we treat premature menopause or POI? What is dose?
restore estrogen levels until menopause
may need higher doses
give calcium and vitamin D
What can predispose people to earlier menopause?
smoking, chemo, toxins
What happens to ovaries as a woman ages?
less eggs and poorer quality= estrogen production stops and progesterone is not needed to antagonize estrogen
What hormones increase in menopause?
FSH and LH
Why can perimenopause take so long?
ovaries stop producing estrogen but periphery able to convert androgens to estrogen
What is the primary estrogen after menopause? What is it’s potency and where is it made?
estrone
1/3
in adipose
What are the VMS of menopause?
hot flashes, sweating, redness, anxiety, palpitations
Why do hot flashes happen in menopause?
narrowing of thermoregulatory system due to low E
Non pharm for hot flashes?
cooling methods, avoid triggers, exercise, lose weight, stop smoking
Is CBT good for hotflashed?
yes and for sleep :)
When is estrogen therapy alone fine for menopause?
hysterectomy
What is the most effective treatment for VMS?
E and P
Why must progesterone be onboard if on estrogen as well?
risk of cancer if P is on risk is no higher than normal women
Dosing of adding P to estrogen?
> 12-14 days a month and match dose to E
True or false: E and P patch is better than oral?
no more effective
all are equal
Issue with patches for MHT?
anecdotal increase in VTE
What progesterone product may have an issues with peanut or sunflower allergy?
Micronized progesterone
peanut= Tea
sunflower= PMS
Benefit of transdermal estrogen?
less nausea, headache, and effect on TG
What is a weird s/e of micronized progesterone when taken with food?
drowsy
Pro of micronized progesterone?
less ate and breast cancer
How does bazedoxifene work?
SERM, antagonist at endometrium and agonist at bone
Do you need progesterone if on a SERM? Benefits of bazedoxifene?
NO
Pros= no progesterone s/e such as boob soreness and bleeding
What is Bijuva?
combo of E and P for MHT
What is tibolone for? what hormone does it have?
- for VMS SHORT TERM
NO hormone
MOA of tibolone?
steroid analogue that is converted to a weak form of E and P
Which is better EPT or tibolone?
EPT
If contraception In perimenopause what are options?
Low dose CHC
estrogen + LNG-IUS
MHT- barrier
non-hormonal +POP
Why can’t we use contraception for menopausal sx?
E dose is WAYYYYY too high
When. can you stop OC in menopause?
> 50 stop and use non hormonal until no period for >1 year
58 stop and ur fine
Is compounded BHT worth it?
hormone testing unreliable so no point
can be under or overdosed easily
lack of safety and efficacy
Pros of continuous E and P? CONS?
easy
no withdrawal bleeding
least risk of cancer
CONS: irregular bleeding seen initial 6 months
CI of MHT?
active liver dx
Estrogen cancer
pregnant
active thombolic
untreated/uncontrolled CVD`
Pros of Continuous E and cyclic P?Cons?
Pros: less pills, no breakthrough bleeding
Cons: withdrawal bleeding
Typical E s/e?
nausea, headache, bloating boob sore
Typical P s/e?
irritable, boob sore, bloat, PMS
When to go with non oral E options of MHT?
migraine, CBD, DM, old
What did the women’s health initiative find?
if >60, and way past menopause end= risk»»»> benefits
What is another GOOD option for VMS?
SSRI/SNRI
Which is more effective SSRI or hormones?
hormones
What AD is good for VMS?
Paroxetine, citalopram, escitalopram, venlafaxine, desvenlafaxine
When to see effect of AD for VMS?
2-4 weeks
Is Veozah worth it?
for VMS but bad s/e of headache, LFTs, insomnia, and gi issues
What are the only herbal options with SOME evidence for VMS?
black cohosh, isoflavanoes= estrogen like effects
Other 3rd line options for VMS but s/e bad?
clonidine, oxybutinin, gabapentin, pregabalin
Are hormones indicated for osteoporosis treatment?
NOOOOO- only preventative
How does E effects lipids?
Lowers LDL and increases HDL increases TG
Who is at most risk of CVD event of MHT?
> 60 and longer times from menopause
Is the cancer risk high with MHT?
slight increase risk than general population, if had before= AVOID
Would estrogen replace AD for mood sx in menopausal women?
no but if other sx use MHT
Is MHT recommended to prevent cognitive decline?
No if >65 may even worsen
GSM sx in menopause?
itchy, dry, burning, painful sex, UTI
1st line for GSM?
lubricants- sex
moisturizers 2-3 x a week
2nd line for GSM?
if OTC fail
vaginal estrogen
Do you need P if vaginal estrogen for GSM?
NO
Are you at increased risk of E s/e if vaginal E for GSM?
NO
Dosing for Premarin?
0.5-2 g pv HS f2w then 1-3 x a week
s/e of vaginal estrogen?
irritation, burning, leakage
If CI to estrogen for GSM what is an option? What is weird with formulation?
Prasterone- in hard fat
If treatment of VMS with MHT, will it also help GSM?
YES
How does Ospemifene work? S/e?
SERM for GSM
hot flashes= do not administer with E
Is weight gain attributed to meds or menopause?
menopause
When should Abnormal uterine bleeding be investigated?
if ALOT, or happens 12 months after amenorrhea OR >6 months after hormonal treatment
Treatment for abnormal uterine bleeding?
low dose OCP (20 mcg EE), progestin
