Menopause

Question 1

When treating women for menopause associated hot flashes, who benefits more? Women who are just starting menopause or older women?

Answer 1

Women just starting menopause

Question 2

Which SSRIs and SNRIs are used in hot flashes

Answer 2

Paroxetine - FDA approved

Venlafaxine

Question 3

What treatments can you recommend for atrophic vaginitis

Answer 3

• vaginal moisturizers used once or more per week
• lubricant at time of coitus
• vaginal estrogen

Question 4

What is the preferred treatment for vaginal atrophy?

Answer 4

Vaginal estradiol ring (worn 90 days)

Question 5

Treatment option for women with vaginal atrophy who are unable to use a vaginal product?

Answer 5

Ospemifene (Osphena) PO product

SERM that acts as an estrogen agonist in vagina but seems to have no significant estrogenic effect in the endometrium or breast

can cause systemic side effects - hot flashes, VTE

reduces bone turnover

Question 6

Management of vaginal atrophy in women with breast cancer

Answer 6

• first line: libricants and moisturizers

- on aromatase inhibitors (stops estrogen production), avoid vaginal estrogen therapy