Menopause, HRT, PCOS, Breast CA meds

Question 1

General Info about Menopause

Answer 1

• Natural loss of ovarian follicular activity
  
  • not enough estradiol production
  • menses stop
• Age of onset: 40-58yo (avg 52yo)
• Early Menopause causes:
  
  • hysterectomy with bilateral salpingo-oophrectomy
  • low body weight
  • increased menstural cycle length
  • nulliparity (never having given birth to a child)
  • smoking
    
    • → on avg onset of menopause earlier than non-smokers by 2 years
• Prior to Menopause:
  
  • Perimenopause (climacteric) period
    
    • changes in hormone levels
    • occurs 2-8 yrs before menopause
      
      • results in irregular menstrual cycles
      • increased intervals between cycles
      • decreased cycle length
      • may experience physical sxs of menopause

Question 2

S/sxs of Menopause

Answer 2

• vasomotor sxs
  
  • hot flashes
  • night sweats
• irregular menses
• episodic amenorrhea
• sleep disturbances
• mood swings
• migraine, irritability
• vaginal dryness, dyspareunia (painful sex)
• fatigue, myalgias, decreased libido

Question 3

Tx of Menopause: goals, general approach, non-pharm therapy

Answer 3

Question 4

Guidelines for hormone replacement therapy in Menopause

Answer 4

Question 5

Risk Breast Cancer Development and Menopausal Hormone Therapy

Answer 5

• Risk category > 5 = AVOID MHT (menopause hormone therapy)

Question 6

When to use Hormone Therapy? (Algorithm)

Answer 6

Question 7

How to Administer Hormone Replacement Therapy

Answer 7

Question 8

Benefits & Risks of Hormone Replacement Therapy

Answer 8

• Benefits:
  
  1. effective for vasomotor sxs
  2. relief of vulvovaginal atrophy
  3. osteoporosis prevention
  4. lower rate of colorectal cancer (???)

Question 9

Polycystic Ovarian Syndrome (PCOS): general info and clinical presentation

Answer 9

• Syndrome:
  
  • irregular menstrual cycle
  • excess of androgens
  • metabolic syndromes & cardiovascular risks
  • polycystic ovaries
• Clinical presentation:
  
  • Menstrual dysfunction
  • hyperandrogenism

Question 10

PCOS: Clinical Presentation

Answer 10

Question 11

PCOS Tx goals & non-pharm tx

Answer 11

Question 12

PCOS: Pharm Tx overview

Answer 12

Question 13

Tx of PCOS Menstrual Dysfunction

Answer 13

• 1st line = combined oral Contraception: 20mcg EE + progestin with low androgenicity
• Alternatives:
  
  • Cyclic progestin tx:
    
    • Medroxyprogesterone 5-10mg x 10-14days q 1-2 months
    • Micronized progesterone (Prometrium) 200-400mg QHS x 10-14d Q4 weeks
      
      • Contraindicated in ppl with peanut allergy
    • induces regular uterine bleeding & reduces risk of endometrial hyperplasia
  • Continuous progestin (progestin only OC, minipill)
    
    • Norethindrone 0.35mg Qday
  • Progestin release IUD
    
    • provides contraception & reduces risk of endometrial hyperplasia

Question 14

PCOS Tx: Androgen Excess

Answer 14

Question 15

PCOS tx: Infertility

Answer 15

Question 16

Breast Cancer: Epidemiology & Risks

Answer 16

Question 17

Breast Cancer: Overview of Tx

Answer 17

• Prevention & Early Detection
• Non-Pharm:
  
  • radical mastectomy
  • radiation therapy
• Pharmacologic systemic adjuvant tx
  
  • chemo
  • biologic therapy
  • endocrine therapy

Question 18

Breast Cancer Tx: Adjuvant/Neoadjuvant Endocrine Therapy Overview

Answer 18

Question 19

Breast Cancer: SERMs

Answer 19

Question 20

Breast Cancer: SERDs

Answer 20

Question 21

Breast Cancer: Aromatase Inhibitors

Answer 21

Question 22

Breast Cancer: LHRH Agonists

Answer 22