Menopause Study Guide Flashcards
Goal of HRT
Reduce frequency & severity of moderate to severe vasomotor symptoms in women w/o risk factors for CHD or breast CA
Estrogen only therapy
Only appropriate for pts with hysterectomy; all others must use combined therapy
Need for combination therapy
Progestin potects against endometrial proliferation and possible endometrial atypia/CA
HRT Treatment Length
Less than 5 yrs; use lowest dose for shortest duration to decrease risk of CHD and Breast CA
HRT Benefits
Reduced vasomotor symptoms; Prevent vulvovaginal atrophy; Osteoporosis prevention; Reduced risk of colon CA
HRT Risks
CHD; Breast/Lung/Ovarian CA; Venous Thromboembolism
Methods of HRT Administration
Cyclic estrogen & progesteron; Continuous estrogen & progesterone
Drawback of Cyclic HRT Therapy
Return of menses
Oral Estrogen-only HRT
Premarin; Estrace
Oral Combo HRT
Prempro; Activella
Other HRT Formulations (aside from PO)
Transdermal; Topical Estrogen
What is the optimal estrogen dosing?
Minimum amt required to relieve s/sx
When are vaginal rings ideal HRT therapy?
Women with hx of hysterectomy presenting with hot flashes, vaginal s/sx, and preferring non-oral route.
What side effects may be seen with transdermal patches?
Skin rxn to adhesives
What form of therapy is required for women with a uterus receiving HRT?
Must be prescribed progestin with estrogen tx to prevent the increased risk of endometrial hyperplasia/cancer with unopposed systemic estrogen.
Is progestin therapy required with topical estrogen products?
No. Low dose vaginal estrogen limits systemic absorption & generally does not require the use of progesterone.
Common adverse effects unique to estrogen therapy
Bloating & Breast tenderness
Common adverse effects unique to progesterone therapy
Wt gain; Irritability; Depression
HRT Contraindications
Hx or active VTE/DVT/PE; Breast CA or estrogen-dependent neoplasm; Pregnancy; Liver dz; Undiagnosed vaginal bleeding
HRT Discontinuation Protocol
Should be tapered to reduce symptom recurrence; Dose taper or day taper are both acceptable mechanisms
When is androgen therapy considered for HRT?
To improve sexual desire in woman complaining of lack of desire or hypoarousal.
Non-HRT tx options for hot flashes
SSRIs (fluoxetine; paroxetine; sertraline); SNRI (Venlafaxine); Soy protein (avoid in estrogen dependent CA); Gabapentin; Clonidine
Non-HRT tx options for depression/anxiety
SSRIs (fluoxetine; paroxetine; sertraline); SNRI (Venlafaxine)
Herbal tx for menopause (little evidence)
Black Cohosh (limit to 6 mo); Evening primrose oil; Dong Quai
Preferred Antidepressant in Menopause
SNRI - Venlafaxine (Effexor XR)
Best tx option for patient with hot flashes & HTN
Clonidine (Catapress)
Drawback of Phytoestrogens (Soy proteins)
Unknown risks on Breast CA risk; limit tx to 5 yrs
