Menopause/Hormone therapy

Question 1

Describe the difference between hormone therapy and hormone replacement therapy.

Answer 1

none

Question 2

At what severity level is hormone therapy indicated for vasomotor symptoms?

Answer 2

moderate to severe

Question 3

A woman with an intact uterus will be starting systemic hormone therapy for severe vasomotor symptoms. Which product would you select for the patient and why?

Answer 3

Estrogen + progestogen tx, estrogen only products should only be used in women w/hx of hysterectomy

Question 4

What are 2 benefits of topical hormone therapy over oral?

Answer 4

1. avoids first pass effect in the liver
2. little effect on hemostatic factors- decreased risk for VTE

Question 5

What is the difference between Femring and Estring?

Answer 5

Femring achieves systemic concentrations while Estring does not

Question 6

A 60-year-old woman decides to discontinue use of the Climara ProPatch she has used for the last 10 years to control hot flashes and night sweats. How should the medication be discontinued?

Answer 6

tapered over 3-6 months via day, dose, or combination taper

Question 7

You attempt to prescribe vaginal estrogen therapy to a menopausal woman to treat vaginal atrophy but the cost is prohibitive. What alternative could you offer to the patient?

Answer 7

OTC Replens

Question 8

What is the “Women’s Health Initiative Trial” and how did it impact prescribing of hormone therapy?

Answer 8

Study performed to determine benefits and risks of taking HRT for chronic condition. HRT should NOT be prescribed for prevention of chronic conditions as it increases risk for cardiovascular adverse effects

Question 9

True or False. Custom compounded bioidentical hormone therapy is safer than commercially available hormone therapy.

Answer 9

True

Question 10

List 3 non-hormonal medications from different drug classes that have shown benefit in reducing hot flashes.

Answer 10

1. antidepressant - Paroxetine
2. gabapentin
3. clonidine

Question 11

Fill in the blanks. As compared to the treatment of depression, the benefit of antidepressants in treating vasomotor symptoms occurs at _______________ doses and takes ____________ to see a benefit.

Answer 11

low,1-2 weeks

Question 12

What is the safety concern for using black cohosh?

Answer 12

wide variation in product formulations.
risk for hepatotoxicity