Menopause Flashcards
Recommended dose of Vitamin D in
< 50 yo and no RF
> 50 yo or RF
RF= osteoporosis, multiple #, malabsorption
< 50 yo: 400 - 1000 U daily
> 50 yo: 800 - 1000 daily
What is the recommended daily dose of Calcium
Age: 19 - 50: 1000 mg daily
Age over 50: 1200 mg daily
What are the values of LDL at which you need to treat?
Low risk, treat if LDL >/= 5.0 mmol/L
Intermediate risk, treat if LDL >/= 3.5 mmol/L
High risk, treat regardless of cholesterol level but AIM to have cholesterol = 2.0 mmol/L or a decrease > 50%
What is the highest normals waist circumference in women
88 cm
What are the parameters of metabolic syndrome (
Over 3 of the following criteria:
Obesity
HTN
Glucose status
HDL
Triglycerides
With regards to ER/PR and HER2, do they have a positive or negative impact
ER/PR : improved survical
HER-2 : negative impact
What is the most potent naturally occuring etrogen?
And # 2, #3?
1: 17-Beta estradiol
What is the objective of “micronized” estrogen / progesterone?
Enhances oral bioavailability (absorption) and prevents degradation
What are the estrogens preparation for HRT (3)?
Conjugagted estrogen (Premarin)
17-beta-estradiol (Estrace)
Esterified estrogens (Estragyn)
In HRT, what is the minimum dose of estrogen required for vasomotor symptom relief and bone benefit?
5 ug
N.B. Much lower than the 20-30 ug in OCP (hence reason why continuous OCP is not an ideal option)
In which women should HRT be provided by transdermal route (4 +3) ?
High risk of VTE **
Malabsorption **
Hypertriglyceridemia (spontaneous or estrogen induced)**
Obese with metabolic syndrome **
Smokers
HTN
Sexual dysfunction
** Evidence for adverse effects vs advantage of transdermal
How do you follow a patient only on estrogen therapy?
Yearly endometrial biopsy
If progesterone added, continue yearly endometrial biopsies as effect of estrogen does not dissapear right away
OR use a SERM
Through which mecanisms are obese women exposed to excess estrogen (2)?
Peripheral convertion of androstenedione → estrone in adipose tissue (aromatase)
Reduced serum concentration of SHBG → increase free estrogen
What are the progesterone preparations for HRT (2 x 3 + 1)?
17-alpha-hydroxyprogesterone derivatives
- MPA
- Megestrol (Megace)
- Micronised progesterone (Prometrium)
19-nortestosterone derivatives
- Norethindrone
- Norethindrone acetate
- Levonorgestrel – Only as mirena
Spironolactone derivative
- Drospirenone – Only in combination with estradiol
What is the name of the SERM approved for HRT?
Bazedoxifene
To be used with conjugated estrogen only
What is the effect of menopause (natural and surgical) on estradiol and testosterone levels?
Natural
- Estradiol decreases by > 80 %
- Testosterone decreases by 25 %
Surgical
Testosterone decreases by 40 - 50 %
Name the contraindications to estrogen replacement therapy (6)
Previous stroke
Coronary heart disease
Active thromboembolic disease
Acute liver dysfunction
Unexplained vaginal bleeding
Estrogen dependant cancer (endometrial/ breast)
What are the contra-indications to progesterone therapy (2+1)?
Breast cancer
Unexplained vaginal bleeding
Peanut allergy ? (micronized progesterone)
What are the non-hormonal Rx to treat VMS and which one is the most effective?
SSRI (Venlafaxine, paroxetine, fluoxetine)
Gabapentin
Clonidine
Bellergal
SSRI most effective
What is the most common complain of post menopausal women?
Vasomotor symptoms
Sleep disturbance
What is the most effective way of reducing cardiovascular risk in post menopausal patients?
Reduction of modifiable RF
DM
HTN
Abdominal obesity
Smoking
Psychological stress
With regars to HRT and VTE
What factors increase the risk of VTE beyound the baseline risk (4)?
Oral route (vs transdermal)
Estrogen-Progesterone therapy (vs estrogen alone)
Older
Obese
With regards to HRT and cardiovacular health
Which factors increase the risk of CVD (2)?
HRT initiated > 10 y post menopause
Combined estrogen-progesterone therapy (vs estrogen alone)
Does HRT increase the risk of stroke and in which population?
Standard doses : YES
Low dose: low to absent risk
If a cardiovascular event would happen to women on HRT, when is it moore likely to happen?
Within the first years of use
What is pre-menopause surgical oophorectomy associated with?
↑ Risk of CAD
↑ Risk of stroke
What are the metabolic effect of HRT in women without DM?
HRT reduces …. In women without DM
Abdominal obesity
Insulin resistance
New onset DM
Lipid levels
Blood pressure
What are the metabolic effect of HRT in women with DM?
HRT reduces….in women with DM
Insulin resistance
Fasting glucose
List the risk factors for DVT in post-menopausal women (4)
What is the best way to administer HRT?
Age
Obesity
Factor V Lieden
Hx of prior DVT
Use TRANSDERMAL therapy
