Menopause and HRT 4 Flashcards

Describe indications for treatment of perimenopausal symptoms and basic treatment principles for prescribing hormone therapy.

1
Q

What are the factors determining whether or not cardinal symptoms of menopause should be treated?

A
  • Severity
  • Quality of life
  • Risk/benefit profile
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2
Q

What should all perimenopausal women be protected from?

A
  • Pregnancy, use BC pill
    • also good for menstrual problems
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3
Q

What is the mainstay of therapy for symptomatic perimenopausal women?

A
  • Estrogen - use lowest possible dose for shortest amount of time
    • treat POF until patient reaches age of spontaneous normal menopause
  • If a woman has a uterus, treat with estrogen and progesterone
    • counters the increased risk of endometrial cancer with just estrogen alone
  • Avoid starting systemic hormone therapy > 10 years after FMP and/or in women over 60
    • increased risk of aging
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4
Q

What is the risk/benefit profile for using oral estrogen and progesterone for perimenopausal symptoms?

A
  • Increased risk of:
    • MI
    • breast cancer
    • stroke
    • VTE
    • gall bladder disease
  • Decreased risk of:
    • colon cancer
    • hip fracture
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5
Q

What is the risk/benefit profile for using estrogen alone for treatment of perimenopausal symptoms?

A
  • Increased risk of:
    • stroke
    • VTE
    • gall bladder disease
  • Decreased risk of:
    • MI
    • breast cancer
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6
Q

What are the main methods and alternative methods for treating VMS in perimenopausal women?

A
  • Lifestyle
    • layer clothes
    • no tobacco
    • limite alcohol
    • paced respiration
    • lower thermostat
  • Systemic therapy
    • transdermal estrogen and oral micronized progesterone presumed to be the safest delivery methods
  • Women who can’t take ET or E+PT:
    • SSRI antidepressants such as paroxetine or escitalopram
    • SNRI antidepressants - venalfaxine
    • Gabapentin
    • Clonidine
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7
Q

What is the accepted therapy for vulvovaginal atrophy in perimenopausal women?

A
  • Vaginal lubricants and moisturizers
  • Maintain coital activity
  • Dilators prn
  • Local vaginal estrogen as creams, pills, rings
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8
Q

What is the accepted therapy for depressive symptoms in perimenopausal women?

A
  • Clinical depresssion not greated with menopause HT
  • Estrogen can be adjunctive therapy
    • Depressive symptoms may be responsive
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