Menopause Flashcards
define menopause
permanent cessation of menses following the loss of ovarian follicular activity
12 consecutive months have passed without a menstrual period
age of onset of menopause
52
symptoms of menopause
vasomotor - hot flushes change in mood worsened sleep sexual libido urogenital symptoms (dryness, discharge, bleeding, UTI, loss of bladder control) arthralgia decreased bone density
goals of therapy
relieve symptoms
improve quality of life
min adverse effects
non drug measures
avoid triggers dress in laters yoga drink water fan eat beans cut out coffee
evidence for non drug measures
some limited but prob still good for you
some evidence for weight loss, CBT, hypnosis
examples of herbal remedies
soy, isoflavones, black cohosh, dong quai, fennel, evening primrose oil
general recommendation for herbal remedies
not good evidence, limited safety data
not recommended
all have potential for various drug interactions
non hormonal drugs used for vasomotor symptoms
SSRI - paroxetine
SNRI - venlafaxine
anticonvuslant - gabapentin
clonidine
antidepressants decrease vasomotor symptoms by how much
symptoms 25-69% but placebo is 30%
doses for antidepressants
start low and titrate up to min side effects
allow 2-4 weeks for effect
what are the benefits of hormone therapy
decrease vasomotor symptoms, sleep problems, mood or anxiety problems, aches and pains
osteoporosis prevention
reversal of vulvar and vaginal atrophy
who should receive hormone therapy
unremitting symptoms affecting QOL no absolute CI other non drug options not effective risk and benefit discussed agree to limited duration of treatment
what are some day to day adverse effects of hormone therapy
breast tenderness bleeding bloating mood change similar to oral contraceptives
risks with combined continuous
coronary events stroke DVT breast cancer lung cancer death gallbladder disease
risks with estrogen only
stroke
DVT
gallbladder
less significant risks than combined
when does the CVD, breast cancer, ovarian cancer risk increase
4-5 yrs
does breast cancer risk normalize
yes after 2 years of discontinuation
contraindications to hormone therapy
unexplained vaginal bleeding acute liver dysfunction estrogen dependent cancer (endometrial,breast) coronary heart disease previous stroke active thromboembolic disease
other risk factors for breast cancer
first degree family history
previous oral contraceptive use
smoking
what is the risk if only one first degree family member is diagnosed after age 50
no increase in risk compared to general population
who would you be more concerned with in a history of breast cancer
if more than 1 or diagnosed before 50
why do they figure that hormonal exposure does not increase overal risk of breast cancer
genetic factors so large and overshadows the increase from hormonal therapy
why do you always add a progestin to estrogen unless theres no uterus
estrogen unopposed causes endometrial hyperplasia which predisposes to dysplasia and endometrial cancer
