Menopause Flashcards
What is perimenopause, menopause, and postmenopause
Perimenopoouase: 2-8 year period proir to menopause AND the 1 year following menopause
Menopuase: The last menstrual period
Postmenopause: Time after the last menses
When dose menopuase usually occur in women
Ages 40-60 years old ( Average in America = 51)
What is the most common vasomotor symptom of menopause, how is characterized, when dose it usually begin, rhythm and length of episode
Hot flashes, sudden feeling of warmth with increased sweating/flushing, years before last menstrual period, episodes last 5-12 minutes while mostly occurring at night
T/F: The average duration of hot flashes in menopause is 7.5 years
True
What is the vaginal symptom of menopause, characteristics
Vaginal Dryness/ irritation, discomfort, painful sex
T/F: Just like hot flashes, vaginal atrophy decreases with time since menopause
False: Vaginal atrophy does NOT wane with time since menopause
T/F: Women with menopause can have breast atrophy as well
True
What are risks that women with menopause must now be aware of
Osteoprorisis and Cardivascular disease
What hormone is increased during menopause
FSH ( Greater than 40 pg/mcl)
What are possible triggers for hot flashes in menopausle women
Hot beverages, spicy foods, alcohol, warm environment, emotional stress
What type of exercises can be done for menopausle women and what would they help these women with
Aeorbic exercise (cardiovascular protection), weight-bearing (bone protection)
What are diet suggestions in menopausle women
adequate dietary calcium intake, adequate vitamin D, heart healthy diet
What are the hormone therapy options to give menopausle women
Estrogen +/- progestin, Tissue selective estrogen complex (TSEC), SERM
What are non hormone therapy options to give menopausle women
Seritonergic agents, antiepileptic drugs, antihypertensives, local (vaginal) therapies, herbals
What are the types of estrogen only hormone therapies
Systemic estrogen (oral, transdermal, high dose vaginal), localized estrogen (low-dose vaginal)
T/F: Estrogen plus Progesterone can be given oral, transdermal or high-dose vaginal
True
What is SYSTEMIC estrogen monotherapy indicated for , what is the most important rule and why
Vasomotor symptoms, ONLY used in women with NO UTERUS, could increase risk of endometrial cancer in women with a uterus
What hormone therapy can be used for vasomotor symptoms in women who still have a uterus
SYSTEMIC estrogen/PROGESTIN therapy
What TSEC is used in menopausle women, what is the indication, what women should avoid this drug
Estrogen plus Bazedoxifene (Duavee)/ moderate to severe vasomotor symptoms, prevention of postemenopausal osteoporosis/ those with renal or hepatic disease
T/F: Women who Duavee are still at high risk of endometrial cancer
False: Estrogen plus Bazedoxifene has estrogenic effects on bone BUT antiestrogenic effects on the uterus/breast
What hormone therapy would be used for vaginal atrophy, changes if they have a uterus
Low dose vaginal estrogen, Can be used in women who have uterus because the estrogen does not have significant systemic absorption
What is the most effective therapies for vasomotor symptoms, vaginal atrophy
Both estrogen AND estrogen/progestin therapies, systemic and vaginal routes
What are the estrablished benefits of using hormone therapy
Controlled vasomotor symptoms, less osteoporisis, less vaginal atrophy
What are the established risks of hormone therapy
Thromboembolic disease, breast cancer. cardiovascular disease, endometrial cancer, ischemic stroke. gallbladder disease, hypertriglyceridemia
What are the ABSOLUTE CONTRAINDICATIONS of using hormone therapy
Undiagnosed vaginal bleeding, severe active liver disease, active venous thrombosis, history of hormone related thrombosis, history of ischemic stroke and/or TIA, history of dementia, migraine WITH aura, pregnancy, current tobacco use, histroy of estrogen dependent cancer
What are the RELATIVE CONTRAINDICATIONS of using hormone therapy
Enometriosis, gallbladder or moderate liver disease, hypertriglyceridemia, Migraine WITHOUT aura, uncontrolled DM or HTN, obese, strong family history of breast cancer
Why would a transdermal patch be preffered over an oral route
Patient has a high risk of thromboembolic disease, gallbladder disease, HTN, hypertriglycerdiemia
Side effects from using hormone therapy
nausea, breast tenderness, headaches, increased blood pressure, leg crams, decreased libido, skin irritation (transdemal)`
What are key concepts for using hormone therapy
Use lowest effective dose, use less than 5 years, can use vaginval ET long term as long as it isn’t systemic
What serotonergic antidepressant is also FDA approved for menopause (vasomotor), other antidepressants
Paroxetine mesylate, citalopram, duloxetine,fluoxetine, sertraline,mitrazapine,venalfaxine
What AED and NSAID can be used for vasomotor symptoms of menopause, hypertension med
Gabapentin (900mg/day), pregablin, clonidine
What vaginal lubricant can be used extended relief of symptoms
Vaginal moistrurizer (Replens)
What SERM therapy is okay for vaginal symptoms and ok for bone, contraindications
Osphena (estrogenic in vaginal mucosa/bone while agonist in uterus) 60 QD/ active or history of thromboembolic disease, breast cancer
What are adverse effects of ospemifene
hot flashes, muscle cramps, vaginal discharge, sweating, concurrent use of CYP3A4 and/or 2C9 inhibitors/induces
What intravaginal DHEA is indicated for pain during sex
Prasterone
