Menopause and HRT Flashcards
Estrogens for HRT
Progestins for HRT
Menopause begins in
Preimenopause transitions from
fertility begins to
Menopause is complete when
typically occurs bw __ yrs
Can be induced ___ by bilateral removal of
CEE, 17B estradiol
MPA, Progesterone
repro to norepro yrs
dec
no period for 1 yr
45-55 yrs
surgically, ovaries
Menopause occurs due to failure of the
Dec in ___ and ___ of ovarian follicles
Ovaries appear ___
Pituitary secretes excess __ to stimulate maturation of ___ in older repro system
FSH levels __ afeer menopause, and is used for
ovaries
fxn, #
atrophied
FSH, existing follicles
rise, diagnosis
Sx of Perimenopause and Menopause
H\_\_\_ due to \_\_\_, contibute to \_\_\_ disturb_ Lack of E dec O U Mood \_\_, D \_\_, A M
hot flashes, vasomotor changes, insomnia Sleep serotonin osteoporosis uro-genital atrophy swings, depression, anxiety memory problems
Hormone therapies
For Perimenopasual pt, use ___ contraceptives
ideally less than __ug EE COCs
Fertility is dec but pt can
Inc rate of
Hormone regimens for menopause are not potent enough to ___
Menopausal pt, use ___
initiate __ or ___ menopause
Lower dose
35
get pregnant
unintended pregnancies
prevent pregnancy
MHT
at or soon after menopause
HRT can __ and __ sx of menopause
Inc __ dec ___ disturbances
Inc __ protects against CV disease by dec __ inc __
E reverses atrophyof V___, V___, u____, T____
E decreases ___
E dec freq of ___
E reestablishes feedback on hypothalamic control of ___, dec freq of ____
alleviate/prevent
Estrogen, sleep
estrogen, LDL/HDL
vulva, vagina, urethra, trigone of bladder
bone resorption
hip fracture
NE sec, hot flashes
Estrogen + Progestin Therapy (EPT)
___ assc w endometrial cancer
__ opposes proliferative effect of E and __ risk of cancer
Indicated for women w
Estrogen only (ET) indicated for women w
Unopposed E
P, dec
intact uterus
hysterectomy
HRT Oral therapy (take one)
C___
17___
given in ___ form of __ to minimize ___
Adv= positive effect on Disadv= high risk for
Transdermal patch w
Adv= lower risk of __ by reducing __ exposure
Disadv= less improvement in
Vaginal such as
Adv/Disadv
CEE
17B estradiol
micronized, natural hormone, hepatic 1st pass effect
lipid profile (inc HDL/dec LDL) clot
17B estradiol
clots, hepatic
lipid profile
Vaginal ring/cream/pill
Local effects
HRT Common progestin (use 1)
MPA considered longtime __
Disadv= opposes pos effect of E on
Micronized Progesterone (MP)
micronizing minimizes___
allows for therapy w ___ or __hormone
In contrast to MPA, natural hormone does not oppose ___ of estrogen on lipid profile
Typically combined w ___ to achieve EPT
standard therapy
lipid profile
hepatic 1st pass effect
bio identical/natural
beneficial effect
estrogen
Cyclic Regimen Estrogen
minimizes
Progestin
12 days of P regarded as sufficient to prevent
Continuous combined Regimen
Dosing, days, hormone free interval, comments
PO/TD, 1-24 of mnth, 3-6d
P exposure
PO, 10-24, 3-6d,
endometrial hyperplasia
E (PO/TD) and P (PO), daily, none,
Currently, advocation for
CEE dose reduced by __ or more
Lower CEE dose relieves __ and ___, preserves ___
use ___ estrogen dose to maintain sx, some females can still use ___
always use less than
lower than standard dose
1/2
hot flashes/ urogenital atrophy, bone
lowest, lower
OCP
NE plays a key role in
Estrogen def __ NE
Resets thermostat ___
women feel warmer at __
Triggers ___ (VD and perspiration)
Hot flashes also occur in
Women w ___ and tx w ___ for breast cancer
men tx w __ for prostate cancer
thermoregulation
inc
downward
lower ambient temps
heat loss mechs
oophorectomy. antiestrogen
anti-androgen
Mod/sevre Hot flashes are a __ for EPT/ET
can impact ___
Begins about __ yrs prior to cessation of menses
__ dec hot flashes
Non hormonal alternative
primary indication
QOL
2 yrs
Estrogen
Paroxetine
Urogenital atrophy
Declining E leads to __, __, Less ___ vaginal tissue
presents w __ __ __
Uncomfortable intercourse
Can have ___ changes too (urgency, freq, incont)
Sx __ and get __
Tx if urogenital sx are sole menopausal complaint
Helps to minimize ___ of EPT/ET
drier, thinner, less elastic
burning, itching pain
Dyspareunia
urinary tract
persist, worse
vaginal prep HT
systemic effects
EPT/ET is protective, not 1st line for
E ___ rather than restores ___
Major effect is to dec __ and __ of OC
HRT reduces ___, including hip ___
fastest rate of bone loss occurs in ___, optimal EPT/ET should be initiated ___
If HRT used for other indications, initiating therapy close to ___ has adv of
Greatest decline in bone loss in 1st __ yrs
___% bone loss per year
Osteoporosis
prevents, bone loss
number and activity
osteoporotic frac, hip frx
early menopaus, at this time
menopause, preventing bone loss
3-6yrs
2-3%
Vasomotor sx can resolve w/in
Nonhormonal therapies for vasomotor sx ___ vaginal sx
Incidence of athero dz in premenopausal women is __, __ after menopause
HRT cannot be used as ___ for heart disease
HRT may have some ___ effects
E only for greater than 10 yr inc risk of
__ is very important for HRT
a few years
wont help
low, higher
secondary intervention
cardioprotective
BC
timing, like at menopause
