Menopause and HT Flashcards
Menopause definition
Permanent cessation of menses due to loss of follicular activity
Recognized after 12 months of amenorrhea with no obvious pathological cause
What are some things that can accelerate the loss of primordial follicles?
Smoking Chemotherapy Pelvic radiation Ovarian surgery Autoimmune disease potentially
Symptoms of menopause
Vasomotor sx Psychological disturbances Sexual dysfunction Somatic symptoms Stress incontinence Weight gain
What is the main reason women seek HT
Vasomotor symptoms
Peak within 2 years of menstrual cessation
3 goals of HT
Reduce estrogen deficiency symptoms
Treat urogenital atrophy
Prevent osteoporosis
Who should get HT
Women who are symptomatic
NOT for asymptomatic women (pre or post menopause)
Women whose sx are controlled on HT can continue on HT for 3-5 years
Where do host flushes come from
Hypothalamic origin with dysfunction of thermoregulatory center due to changes in estrogen level
May be due to rapid withdrawal of estrogen
3 pharmacological options for vasomotor symptoms other than hormones
Venlafaxine
SSRI
Gabapentin
What is the most potent naturally occurring estrogen
17B-estradiol
3 types of estrogen for HRT
Ethinyl estradiol
Estradiol
Conjugated estrogens
Why should we give progesterone as well?
Protect the endometrium from hyperplasia
3 classes of progestins
17alpha-hydroxyprogesterone derivatives
19-nortestosterone derivatives
Spironolactone derivative
6 contraindications to estrogen
Unexplained vaginal bleeding Stroke history Active VTE Estrogen dependent cancer Coronary heart disease Acute liver dysfunction
2 contraindications to progestins
Unexplained vaginal bleeding
Breast cancer
3 symptoms vaginal estrogen can be helpful for
Recurrent UTI
Urge symptoms
Vaginal atrophy
