Menopause Study Guide

Question 1

Goal of HRT

Answer 1

Reduce frequency & severity of moderate to severe vasomotor symptoms in women w/o risk factors for CHD or breast CA

Question 2

Estrogen only therapy

Answer 2

Only appropriate for pts with hysterectomy; all others must use combined therapy

Question 3

Need for combination therapy

Answer 3

Progestin potects against endometrial proliferation and possible endometrial atypia/CA

Question 4

HRT Treatment Length

Answer 4

Less than 5 yrs; use lowest dose for shortest duration to decrease risk of CHD and Breast CA

Question 5

HRT Benefits

Answer 5

Reduced vasomotor symptoms; Prevent vulvovaginal atrophy; Osteoporosis prevention; Reduced risk of colon CA

Question 6

HRT Risks

Answer 6

CHD; Breast/Lung/Ovarian CA; Venous Thromboembolism

Question 7

Methods of HRT Administration

Answer 7

Cyclic estrogen & progesteron; Continuous estrogen & progesterone

Question 8

Drawback of Cyclic HRT Therapy

Answer 8

Return of menses

Question 9

Oral Estrogen-only HRT

Answer 9

Premarin; Estrace

Question 10

Oral Combo HRT

Answer 10

Prempro; Activella

Question 11

Other HRT Formulations (aside from PO)

Answer 11

Transdermal; Topical Estrogen

Question 12

What is the optimal estrogen dosing?

Answer 12

Minimum amt required to relieve s/sx

Question 13

When are vaginal rings ideal HRT therapy?

Answer 13

Women with hx of hysterectomy presenting with hot flashes, vaginal s/sx, and preferring non-oral route.

Question 14

What side effects may be seen with transdermal patches?

Answer 14

Skin rxn to adhesives

Question 15

What form of therapy is required for women with a uterus receiving HRT?

Answer 15

Must be prescribed progestin with estrogen tx to prevent the increased risk of endometrial hyperplasia/cancer with unopposed systemic estrogen.

Question 16

Is progestin therapy required with topical estrogen products?

Answer 16

No. Low dose vaginal estrogen limits systemic absorption & generally does not require the use of progesterone.

Question 17

Common adverse effects unique to estrogen therapy

Answer 17

Bloating & Breast tenderness

Question 18

Common adverse effects unique to progesterone therapy

Answer 18

Wt gain; Irritability; Depression

Question 19

HRT Contraindications

Answer 19

Hx or active VTE/DVT/PE; Breast CA or estrogen-dependent neoplasm; Pregnancy; Liver dz; Undiagnosed vaginal bleeding

Question 20

HRT Discontinuation Protocol

Answer 20

Should be tapered to reduce symptom recurrence; Dose taper or day taper are both acceptable mechanisms

Question 21

When is androgen therapy considered for HRT?

Answer 21

To improve sexual desire in woman complaining of lack of desire or hypoarousal.

Question 22

Non-HRT tx options for hot flashes

Answer 22

SSRIs (fluoxetine; paroxetine; sertraline); SNRI (Venlafaxine); Soy protein (avoid in estrogen dependent CA); Gabapentin; Clonidine

Question 23

Non-HRT tx options for depression/anxiety

Answer 23

SSRIs (fluoxetine; paroxetine; sertraline); SNRI (Venlafaxine)

Question 24

Herbal tx for menopause (little evidence)

Answer 24

Black Cohosh (limit to 6 mo); Evening primrose oil; Dong Quai

Question 25

Preferred Antidepressant in Menopause

Answer 25

SNRI - Venlafaxine (Effexor XR)

Question 26

Best tx option for patient with hot flashes & HTN

Answer 26

Clonidine (Catapress)

Question 27

Drawback of Phytoestrogens (Soy proteins)

Answer 27

Unknown risks on Breast CA risk; limit tx to 5 yrs