Menopause Hormone Treatment Flashcards

1
Q

Besides the symptoms of menopause, what 2 other conditions are very prevalent for menopause women?

A
Bone effects (fractures, osteoporosis) 
Cardiovascular effects (ACS, MI, stroke, DVT)
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2
Q

What is the primary therapy for menopausal symptoms?

A

Only estrogen if the have no uterus

Estrogen and a progestin if they have a uterus

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3
Q

What is the big time estrogen effect we have to give progesterone for?

A

Endometrial proliferation

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4
Q

Estrogen therapy decreases production/activity of what 3 things?

A

Total and LDL cholesterol
AT3
Osteoclast activity

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5
Q

Estrogen therapy increases production/activity of what 5 things?

A
Tris and HDL
Clotting factors 
Platelet aggregation
Sodium/fluid retention
Thyroid binding globulin
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6
Q

7 harms of taking a estrogen/progesterone combo?

A
Breast cancer
CHD
Dementia
Gallbladder disease
Stroke
DVT
Urinary incontinence
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7
Q

What are the three benefits to taking the estrogen/progesterone combo?

A

Diabetes
All fractures
Colorectal cancer

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8
Q

What are the 5 harms to taking estrogen therapy alone?

A
Dementia
Gallbladder disease
Stroke
DVT
urinary incontinence
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9
Q

What are 3 benefits of taking estrogen alone therapy?

A

Breast cancer got better
All fractures
Diabetes

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10
Q

The women’s health initiative study summary message include MHT was very effective at minimizes/treating what 2 things?

A

Vasomotor symptoms and vaginal changes.

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11
Q

The first point for MHT treatment was for younger women, what was the recommendation?

A

MHT is an acceptable option for treating moderate to severe menopausal symptoms in relative young, up to 59, women.

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12
Q

The second point for MHT is for women with vaginal symptoms only, what is the recommendation?

A

Use low dose topical vaginal estrogen

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13
Q

Point number 3 for MHT was for a woman with uterus, what was it?

A

No uterus, estrogen only.

Have a uterus, need progesterone.

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14
Q

What was the 4th point for MHT and blood clots?

A

Both estrogen alone and combo therapy increase risk of clots.
However, risk is less in 50-59 age group.

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15
Q

5th point of MHT was with breast cancer, what was it?

A

If a woman has continuous combo therapy for 3-5 years, really more than 3 years, it increases the risk for breast cancer.

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16
Q

Two principles to MHT, what is the take home message?

A

Lowest dose possible for shortest duration of time.

17
Q

What does SERM and TSEC stand for?

A

Selective estrogen receptor modulator

Tissue selective estrogen complex

18
Q

MOA for SERM and TSEC?

A

SERM has pro estrogenic or agonist activity in certain tissues and antagonist activity in others
TSEC is basically a SERM with an estrogen

19
Q

Clinical indication for ospemifene?

A

Treatment of moderate to severe dyspareunia

20
Q

2 MOA for ospemifene?

A

Vaginal estrogen agonist and breast estrogen antagonist

21
Q

3 side effects of ospemifene?

A

Worsening of hot flashes
Increases coag effects like stroke/DVT
Endometrial hyperplasia

22
Q

3 contraindications for ospemifene?

A

Abnormal vaginal bleeding
Thromboembolic diseases
Estrogen related neoplasia

23
Q

What patient population do we need to exercise judgment in when prescribing ospemifene?

A

Smokers because of cardiac events

24
Q

2 clinical indications for bazedoxifene?

A

Treatment of moderate to severe vasomotor symptoms from menopause in women with a uterus
Prevention of post menopausal osteoporosis in women with a uterus

25
Q

MOA of bazedoxifene?

A

Anti estrogen in breast and endometrium

Agonist in bone

26
Q

What are the side effects and contraindications of bazedoxifene?

A

Same as estrogen because of the estrogen component

27
Q

What is the clinical indication for clomiphene?

A

Infertility in an anovulatory women

28
Q

What are the 3 conditions where a women would be anovulatory and be prescribed clomiphene?

A

Amenorrhea, PCOS, and dysfunctional bleeding

29
Q

What is the MOA of clomiphene?

A

Blocks inhibitory actins of estrogen of GnRH coming out of hypothalamus and gonadotropin coming out of pituitary

30
Q

4 side effects of clomiphene?

A

Multiple births
Ovarian cysts
Hot flashes
Luteal phase dysfunction