Menopause: It and HRT for It

Question 1

Replacement of estrogen in perimenopausal women will improve which symptoms of menopause?

Answer 1

1. vasomotor symptoms
2. vaginal dryness
3. mood and sleep deterioration

Question 2

Based on the results of major HRT studies, what is the current thinking regarding HRT?

Answer 2

Basically: good for symptoms, bad for disease

• HT is appropriate for managing moderate-to-severe symptoms in early menopause
• but current evidence does not support the use of either EPT or ET alone for long-term chronic disease prevention

Question 3

Describe the role of ET in the treatment of osteoporosis.

Answer 3

• ET is approved for prevention of OP, not treatment

- it’s recommended that tx be limited to women of high risk fracture

Question 4

Describe the differences in risk/benefit analysis of CEE+MPA vs. CEE alone

Answer 4

• CEE alone has more balanced risks/benefits, dec. risk of BrCa
• CEE+MPA has dec. risk of hip fractures, DM, and vasomotor sx, but inc. risk of CHD, BrCa, stroke, PE, gallbladder dz, dementia, and urinary incontinence

Question 5

Describe the patient who is appropriate for HT.

Answer 5

1. moderate to severe menopausal sx
2. no inc. risk of stroke by FSS, and no CI’s to HT
3. very low, low, or moderate risk of CHD
4. ≤10yr since last period
   * Reassess each criterion at least q6-12mo while HT still desired

Question 6

Best treatment for a perimenopausal women with only vaginal symptoms (dryness or dyspareunia)

Answer 6

low doses of vaginal estrogen

no need for progestins

Question 7

Define menopause.

Answer 7

1 yr without menses
FSH > 30
With less estrogen produced, FSH levels rise.

Question 8

Most common symptom of menopause:

Name some others.

Answer 8

Hot flashes (aka vasomotor symptoms). Sweating.
At night, can cause sleep disturbances.

Vaginal atrophy, dryness, painful intercourse, depression, decr. libido, “going crazy”

Question 9

We treat symptoms of menopause with:

Answer 9

Estrogen +/- progesterone (depending on circumstances)

Question 10

Women who still have their uterus need to take a _______ along with estrogen to prevent uterine cancer.

Answer 10

Progesterone (or similar product)

Those w/ hysterectomy can have estrogen alone.

Question 11

Women w/ only vaginal dryness/painful intercourse can have this tx only.

Answer 11

Vaginally administered estrogen

Question 12

Is estrogen approved for prevention or tx or both of osteoporosis?

Answer 12

Prevention, only

Question 13

Early loss of endogenous estrogen is associated with CVD. How does it do this?

Answer 13

Incr. smooth muscle proliferation, lowers cholesterol, and improves vascular tone.

Question 14

Estrogen replacement therapy has these CVD protective effects if administered before the vascular damage has already occured:

Answer 14

Positive effects on vascular remodeling of age
Decr. intimal thickening
Decr. incidence of plaques

Question 15

Why is initiation of estrogen tx not recommended after the age of 65?

Answer 15

Plaques already formed.

Estrogen is prothrombotic

Question 16

Estrogen/progestin therapy increases the risk of breast cancer beyond ____ yrs of use.
How about estrogen only?

Answer 16

beyond 5 yrs

Estrogen only, no enhanced risk