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
2
Q
What should all perimenopausal women be protected from?
A
- Pregnancy, use BC pill
- also good for menstrual problems
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
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
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
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
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
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