Menopause

Question 1

Define perimenopause

Answer 1

The time period before menopause characterized by irregular menses and decreased fertility

Question 2

Average length of perimenopause?

Answer 2

4 years

Question 3

Define menopause

Answer 3

permanent cessation of menses

Question 4

How is menopause determined and what is the criteria?

Answer 4

retrospectively when there is a full year of amenorrhea

Question 5

What is premature ovarian insufficiency and how is it treated?

Answer 5

menopause before the age of 40. Treated with HRT until about age 51

Question 6

What is the etiology of menopause?

Answer 6

1. aging
2. surgery
3. medications (chemo)
4. pelvic irradiation

Question 7

What is the pathophysiology of menopause?

Answer 7

Ovarian follicles decrease with age due to follicular atresia. Ovaries no longer the primary site of estrogen and progesterone synthesis. FSH increases and inhibin B decreases. Oocytes don’t respond to gonadotropins

Question 8

Signs and symptoms of menopause

Answer 8

1. cycle irregularity
2. hot flashes
3. night sweats
4. depression
   5 . anxiety
5. mood swings
6. concentration problems
7. vaginal itching, burning
8. dyspareunia
9. sexual dysfunction
10. urinary incontinence
11. sleep disturbance
12. joint pain
13. headache
14. metabolic

Question 9

How do you diagnose menopause?

Answer 9

1. age
2. signs and symptoms
3. FSH
4. Anti-Mullerian hormone

Question 10

Normal level of FSH

Answer 10

4-10

Question 11

Perimenopause level of FSH

Answer 11

10-12

Question 12

Menopause level of FSH

Answer 12

> 40

Question 13

Menopause level of AMH

Answer 13

< 1

Question 14

What was the result of WHI 1991 study?

Answer 14

Black box warning for MI, stroke, breast cancer, and VTE on all estrogen products

Question 15

brand name: conjugated equine estrogen

Answer 15

Premarin

Question 16

brand name: micronized estradiol

Answer 16

Estrace

Question 17

brand name: estradiol acetate

Answer 17

Femtrace

Question 18

brand name: synthetic conjugated estrogen

Answer 18

Cenestin and Enjuvia

Question 19

brand name: esterified estrogens

Answer 19

Menest

Question 20

brand name: estropipate

Answer 20

Ogen

Question 21

What are the oral estrogen products metabolized into

Answer 21

estrone

Question 22

Which concentration of estrogen is higher in the transdermal patches?

Answer 22

estradiol

Question 23

What is a key difference in pharmacokinetics between the patches and the topical gels, sprays, and emulsions?

Answer 23

the patches release estradiol at a continuous rate unlike the gels, emulsions, and sprays

Question 24

What are the once weekly patches?

Answer 24

Climara, Climara Pro, and Menostar

Question 25

What are the twice weekly patches?

Answer 25

Alora, Minivelle, Vivelle, Vivelle Dot, and CombiPatch

Question 26

Site of application for Estrasorb topical emulsion

Answer 26

both thighs and calves

Question 27

Site of application for Estrogel topical gel

Answer 27

one arm from wrist to shoulder

Question 28

Site of application for Elestrin topical gel

Answer 28

one upper arm and shoulder area

Question 29

Site of application for Divigel topical gel

Answer 29

one upper thigh

Question 30

Site of application of Evamist topical spray

Answer 30

inner surface of the forearm starting near the elbow

Question 31

Why do we combine estrogen therapy with progestin?

Answer 31

to decrease the risk of endometrial hyperplasia and cancer

Question 32

Who should get progestin therapy?

Answer 32

all females who have not had a hysterectomy and are taking estrogen products

Question 33

What is the minimum day length required each month for progestin protection

Answer 33

12-14 days

Question 34

What is the benefit of micronized progesterone over synthetic?

Answer 34

better CV, BP, VTE, stroke, and breast cancer outcomes

Question 35

What is continuous cyclic (sequential) dosing?

Answer 35

estrogen daily with progestin coadministered for 12-14 days of cycle

Question 36

What is continuous combined dosing?

Answer 36

combined estrogen and progesin administration

Question 37

What is continuous long-cycle (cyclic withdrawal)?

Answer 37

estrogen given daily and progestin given 6 times per year (every other month) for 12-14 days

Question 38

What is intermittent combined?

Answer 38

3 days of estrogen therapy alone and then 3 days of combined estrogen and progestin

Question 39

What are the adverse effects of HRT?

Answer 39

1. cardiovascular 2. breast cancer 3. endometrial cancer 4. VTE 5. Nausea 6. Headache 7. Breast tenderness

Question 40

Contraindications for HRT?

Answer 40

1. unexplained vaginal bleeding 2. Hx of breast/endometrial cancer 3. Hx of VTE 4. CHD, stroke, dementia 5. severe liver disease

Question 41

Prescribing considerations

Answer 41

1. < 60 yo 2. within 10 years of menopause 3. PMH 4. FH 5. BP, lipid panel, liver function 6. mammogram, pap smear 7. smoking status