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825 > Menopause/Hormonal Contraception > Flashcards

Menopause/Hormonal Contraception Flashcards

1
Q

Premenopausal Phase

A
  • Reproductive phase
  • Cyclic
  • Predictabe hormones
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2
Q

Perimenopausal Phase

A
  • Includes menopause transition and ends at 12 months after FMP
  • Acyclic
  • Fluctuating hormones
  • Hot flashes increase as stages progress
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3
Q

Postmenopausal Phase

A
  • Phase following FMP
  • Ovarian cessation
  • Low hormones
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4
Q

Menopause Signs

A
  • Low estrogen levels
  • Vaginal wall thinning
  • Irregular menses
  • Decreased libido
  • Erratic levels of estrogen and progesterone
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5
Q

Menopause Symptoms

A
  • Vasomotor symptoms
  • Sleep disturbances
  • Mood changes
  • Problems with concentration/memory
  • Vaginal dryness and dyspareunia
  • Arthralgia
  • Cessation of menses
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6
Q

Vasomotor Symptoms

A
  • Hot flashes (hot flashes, night sweats)
  • 75-85% of women
  • Erythema and perspiration
  • Skin (face, head, neck) may become red/warm
  • Episodic flush (30 seconds to 5 minutes)
  • Chills
  • Night Sweats
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7
Q

Genitourinary Symptoms of Menopause (GSM) - Signs

A
  • Decreased labia size
  • Loss of elasticity with constriction
  • Thin vaginal epithelial lining
  • Petechiae, ulcerations, or tears
  • Recurrent UTI
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8
Q

GSM - Symptoms

A
  • Atrophy of vaginal mucosa
  • Genital dryness, burning, irritation
  • Impaired sexual function
  • Spotting/bleeding post intercourse
  • Urinary urgency
  • Dysuria
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9
Q

Menopause Lab Tests

A
  • Perimenopause: FSH on day 2/3 of menstrual cycle >10-12 IU/L (variable)
  • Menopause: FSH > 40 IU/L
  • Other relevant tests: thyroid function tests, iron stores, lipid profile
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10
Q

Goals of Menopause Therapy

A
  • Natural process, not a disease
  • Relieve symptoms and improve quality of life
  • Minimize adverse SE
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11
Q

Pharmacologic Algorithm

A
  1. Assess their symptoms
  2. Assess the severity of their symptoms
  3. Assess if estrogen therapy is CI
  4. Select appropriate therapy
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12
Q

Vasomotor Non-pharmacologic Therapy

A
  • Wearing layered clothing
  • Lowering room temperatures
  • Avoid triggers: spicy foods, caffeine, hot drinks
  • Weight management
  • Exercise
  • Avoid alcohol
  • Smoking cessation
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13
Q

GSM Non-pharmacologic Therapy

A
  • Moisturizers/lubricants
  • Kegel exercises
  • Oxybutynin or tolterodine for urge incontinence
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14
Q

Vasomotor Hormone Therapy

A

-Oral/transdermal estrogen therapy is the most effective

Intact Uterus Options:
-Combination of estrogen + progesterone
-Continuous cycle
-Continuous combined
-Continuous long cycle
-Intermittent combined
EX: Duavee (conjugated estrogen + bazedoxifene)
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15
Q

GSM Hormone Therapy

A
  • Low dose vaginal estrogen populations
  • EX: premarin vaginal cream, estring, vagifem
  • Non-estrogen Rx Therapies: Osphena
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16
Q

Hormone Replacement Therapy Uses

A
  • Systemic: moderate to severe vasomotor symtpoms

- Intravaginal: moderate to severe vulvar/vaginal atrophy (EX: vaginal dryness, dyspareunia, atrophic vaginitis)

17
Q

Absolute CI of MHT

A
  1. Undiagnosed vaginal bleeding
  2. Known or suspected pregnancy
  3. Estrogen dependent neoplasm
  4. History of breast cancer
  5. Active/history of DVT or PE
  6. Active/history of arterial thromboembolic disease (stroke/MI)
  7. Liver dysfunction
18
Q

Relative CI of MHT

A
  1. Elevated BP
  2. Hypertriglyceridemia
  3. Impaired liver function
  4. Hypothyroidism
  5. Fluid retention
  6. Severe hypocalcemia
  7. Ovarian cancer
  8. Diabetes
  9. Migraines with aura (oral estrogen therapy)
  10. Intermediate risk for breast cancer
19
Q

MHT Box Warning

A
  • Endometrial cancer
  • CV disease (increased risk of strokes/MI)
  • Venous thromboembolism
  • Breast Cancer
  • Risk v.s. Benefit: estrogen only should be used at the lowest doses for the shortest durations possible
20
Q

Duavee

A
  • Conjugated estrogen/bazedoxifene
  • Indication: women with intact uterus for menopause or prevention or post menopausal osteoporosis
  • AE: dizziness, muscle spasm, oropharyngeal pain
  • Agonst: Bone
  • Antagonist: Endometrium
  • Neutral: breast
21
Q

Estrogen AE

A
  • Nausea, headache, breast tenderness, heavy bleeding
  • Serious: increased risk for CHD, stroke, venous thromboemolism, breast cancer, gallbaldder disease
  • Elevation of TG
  • *Transdermal estrogen has lower incidence of breast tenderness, DVTs, and increased TG
22
Q

Progesterone AE

A
  • Irritability, weight gain, irritability, bloating, headache
  • Pre-menstual-like symptoms: mood changes, bloating, fluid retention, sleep disturbances
23
Q

Vaginal Products Risks

A
  • Not statistically acting
  • Inadequate relief for VM symptoms
  • Endometrial cancer with long term use
24
Q

Vaginal Products Benefits

A
  • Long acting
  • Restore blood flow
  • Improves thickness of walls (increases it)
  • Quicker response than systemic
25
Q

Paroxetine

A
  • Brisdelle
  • Alternative
  • Indication: moderate to severe VM symptoms with menopause
  • Dose: 7.5 mg
  • AE: headache, fatigue, N/V
26
Q

Other Non-Hormonal Options

A
  • Catapres
  • Effexor
  • Neurontin
27
Q

Black Cohost

A
  • NOT RECOMMENDED
  • Treat hot flashes and night sweats
  • Monitoring: liver function
  • Long term safety data is unknown
28
Q

Compounded Estrogen

A
  • Bioidentical
  • Compounded therapies
  • May combine multiple hormones: estradiol, estriol, estrone, DHEA, testosterone, progesterone
  • Untested, unapproved combinations or formulations
  • Prescribed or dosed on bases of salivary hormone testing (unreliable)
29
Q

Alternatives Durations

A
  • Estrogen: shortest duration possible
  • SSRI/SNRI: 8-24 weeks in most trials
  • Lack of long term use data
30
Q

Alternatives Monitoring

A
  • Resolution of symptoms
  • Specific AE
  • 6 mo. after initiation of therapy, followed by annually re-assessment of therapy
31
Q

Conclusion

A
  • Hormone therapy is most effective for VM and vaginal symptoms
  • Intact uterus: estrogen + progesterone
  • No Uterus: estrogen only
  • Treatment should be individualized based on benefits and risks and reevaluating when determining continuation of hormone therapy
  • In women <60 y.o. or are within 10 years of menopause that have no CI, hormone therapy is favorable

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