Menopause Hormone Treatment Flashcards
Besides the symptoms of menopause, what 2 other conditions are very prevalent for menopause women?
Bone effects (fractures, osteoporosis) Cardiovascular effects (ACS, MI, stroke, DVT)
What is the primary therapy for menopausal symptoms?
Only estrogen if the have no uterus
Estrogen and a progestin if they have a uterus
What is the big time estrogen effect we have to give progesterone for?
Endometrial proliferation
Estrogen therapy decreases production/activity of what 3 things?
Total and LDL cholesterol
AT3
Osteoclast activity
Estrogen therapy increases production/activity of what 5 things?
Tris and HDL Clotting factors Platelet aggregation Sodium/fluid retention Thyroid binding globulin
7 harms of taking a estrogen/progesterone combo?
Breast cancer CHD Dementia Gallbladder disease Stroke DVT Urinary incontinence
What are the three benefits to taking the estrogen/progesterone combo?
Diabetes
All fractures
Colorectal cancer
What are the 5 harms to taking estrogen therapy alone?
Dementia Gallbladder disease Stroke DVT urinary incontinence
What are 3 benefits of taking estrogen alone therapy?
Breast cancer got better
All fractures
Diabetes
The women’s health initiative study summary message include MHT was very effective at minimizes/treating what 2 things?
Vasomotor symptoms and vaginal changes.
The first point for MHT treatment was for younger women, what was the recommendation?
MHT is an acceptable option for treating moderate to severe menopausal symptoms in relative young, up to 59, women.
The second point for MHT is for women with vaginal symptoms only, what is the recommendation?
Use low dose topical vaginal estrogen
Point number 3 for MHT was for a woman with uterus, what was it?
No uterus, estrogen only.
Have a uterus, need progesterone.
What was the 4th point for MHT and blood clots?
Both estrogen alone and combo therapy increase risk of clots.
However, risk is less in 50-59 age group.
5th point of MHT was with breast cancer, what was it?
If a woman has continuous combo therapy for 3-5 years, really more than 3 years, it increases the risk for breast cancer.
Two principles to MHT, what is the take home message?
Lowest dose possible for shortest duration of time.
What does SERM and TSEC stand for?
Selective estrogen receptor modulator
Tissue selective estrogen complex
MOA for SERM and TSEC?
SERM has pro estrogenic or agonist activity in certain tissues and antagonist activity in others
TSEC is basically a SERM with an estrogen
Clinical indication for ospemifene?
Treatment of moderate to severe dyspareunia
2 MOA for ospemifene?
Vaginal estrogen agonist and breast estrogen antagonist
3 side effects of ospemifene?
Worsening of hot flashes
Increases coag effects like stroke/DVT
Endometrial hyperplasia
3 contraindications for ospemifene?
Abnormal vaginal bleeding
Thromboembolic diseases
Estrogen related neoplasia
What patient population do we need to exercise judgment in when prescribing ospemifene?
Smokers because of cardiac events
2 clinical indications for bazedoxifene?
Treatment of moderate to severe vasomotor symptoms from menopause in women with a uterus
Prevention of post menopausal osteoporosis in women with a uterus
