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
difference between cyclic and continuous
cyclic is a more regular bleed
continuous get breakthrough bleeds sporatic
what is estrogen + SERM for
prevents hyperplasia so there is no sig effects on CVD or breast cancer risk
but only have safety data for 2 years
if the last menstrual period is less than 1 year ago what is the recommended regimen
combined continuous estrogen with 14 days progestin
if the last menstrual period is greater than 1 yr prior what regimen should you use
continuous combined
if bleeding is heavy or erratic what should you do
increase dose of progestagen
advantage of transdermal over oral
avoid first past effect
decrease liver disease, lipid effect, gallbladder disease, VTE
consider transdermal/topical if …
current or history of VTE or gallbladder disease
CVD history
smoking
hypertension
diabetes
obestiy
* not automatic, consider all risk factors together
concerns with bioidentical compounded hormones
safety and efficacy not tested
quality control
expensive
bioidentical not an agreed upon definition
micronized estradiol 1mg is equal to how much conjugated equine est
0.625mg
difference between provera and prometrium
prometrium is more expensive considered more natural because from a plant
causes sedation
caution contains peanut oil
when should women on hormone therapy be reevaluated
annually
* use lowest dose for shortest period of time
should you taper hormone therapy
can be tough on the woman must taper off
what is vaginal atrophy
thinning drying and inflammation of the vaginal walls
cause of sexual pain
local options for vaginal atrophy
non hormonal lubricants
tablets
cream
ring
how do you start of therapy for vaginal atrophy
start with induction therapy of daily dosing for 1-2 weeks
then only a couple times a week
does low dose vaginal estrogen require a progestogen for women with a uterus
no
contraindications to vaginal estrogen
unexplained vaginal bleeding
insufficient data for breast cancer consider benefit vs risk
when and what should you monitor for vaginal estrogen
1-2 months
dryness, frequent uti, painful sex, bleeding
application difficulties, expulsion during urination or intercourse
sensing ring during intercourse
