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IPFC 1 Final > Menopause Therapeutics > Flashcards

Menopause Therapeutics Flashcards

1
Q

What is systemic and local estrogen for?

A

Systemic (oral, transdermal): vasomotor symptoms

Local: for vulvovaginal atrophy

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2
Q

What are risks of using the first pass effect in systemic estrogen (oral pill instead of transdermal)

A

Increases:
- HDL cholesterol
- Triglycerides
- Coagulation factors

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3
Q

When are transdermal products used?

A

When at risk of:
- Hypertriglyceridemia
- High risk of VTE
- Malabsorption
- Obese women with metabolic syndrome
- Smokers
- history of gallstones

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4
Q

What are contraindications to estrogen therapy

A
  • unexplained vaginal bleeding after 1 year of amenorrhea
  • liver disease
  • history of thromboembolic disease
  • Estrogen-dependent cancer
  • Pregnancy
  • Coronary heart disease
  • Previous stroke
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5
Q

When is follow up for estrogen

A

4-6 weeks

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6
Q

When is progestogen HT indicated?

A

Women with a uterus taking systemic ET
- prevents endometrial hyperplasia
- hyperplasia occurs within 6 months of ET if they do not take progesterone

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7
Q

What are CI of progestogens

A
  • unexplained vaginal bleeding
  • breast cancer
  • pregnancy
  • peanut allergy
  • soy allergy
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8
Q

When do we give progestogen IUD

A

Estrogen + levonorgestrel

  • if patients experiencing s/e to oral progestogen
  • if they want contraception
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9
Q

What is the dosing like when using progestogen?

A

Cyclic for 5 years pre-menopause and 2 years post-menopause
- 2 weeks on, 2 weeks off
- to prevent BTB - although common

After 2 years post-menopause: continuous dosing

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10
Q

When are combo products used?

A

When patients are stabilized on a dose
- more difficult to taper
- daily pills

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11
Q

When to use COC in menopause?

A

Perimenopausal women if
- they need contraception
- useful when needing to control irregular or heavy bleeding

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12
Q

When is vaginal estrogen used?

A

For symptoms of vulvovaginal atrophy
- including dyspareunia
- urinary urge incontinence
- Recurrent UTIs

Must try systemic first

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13
Q

What are the CI of vaginal estrogen?

A

Not CI in women with CI to oral

  • avoid in women with breast cancer and aromatase inhibitors
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14
Q

Which therapies are more risker for side effects
EPT vs ET
Oral vs transdermal

A

Risks:
EPT > ET
Oral > transdermal

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15
Q

When to treat or avoid HT in breast cancer? When does risk of breast cancer decrease?

A

Treat: risk of breast cancer
AVOID: if they had breast cancer

Risk decreases 3 years after stopping HRT

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16
Q

What to give if patient has GSM symptoms but no vasomotor symptoms?

A

Use vaginal lubricants/moisturizers

If inadequate response
- start low dose vaginal estrogen

17
Q

When do you avoid HT if patient has vasomotor symptoms?

A
  • 10+ years of menopause
  • CVD risk over 10%
18
Q

When to choose transdermal patches if patient has vasomotor symptoms?

A

If patient has moderate risk of CVD 5-10%

19
Q

Explain what tibolone is an alternative for?
Activity?
Who should use?
Efficacy?
When to start?

A

Tibolone: alternate therapy for vasomotor symtpoms

Activity:
- all 3 types: estrogenic, progestogenic, androgen

Who should use
- patients with uterus
- patients who don’t tolerate EPT

Efficacy
- more effective than EPT at improving vaginal symptoms
- Less effective in reducing vasomotor symptoms

When to start?
- wait at least 1 year after LMP to avoid worsening BTB

20
Q

What is bazedoxifine used for (symptoms)?
Drug class?
Benefit?

A

Class: SERM

Used for vasomotor symptoms, vulvovaginal symptoms, osteoporosis

Benefit
- does not require a progestogen
- less bleeding, less breast tenderness

21
Q

What symptoms are antidepressants used for?
Who should use it?

A

For vasomotor symptoms

Who should use:
- EPT is CI
- if pt has anxiety/depression symptoms

22
Q

What are some lifestyle changes to offer relief of vasomotor symptoms?

A

Reduce core temp
Regular exercise
Weight management
Smoking cessation
Avoiding hot drinks, alcohol
Cognitive behavioural therapy

23
Q

What symptom is ospemifene used for?
Drug class?
Who should use?
Efficacy?
Benefit?
Side effects?

A

Used for genitourinary syndrome symptoms

Only SERM with agonist on vaginal epithelium

Who should use
- 2nd line for atrophic vagina symptoms

Efficacy: similar to ET

Benefit: no need for progesterone

Side effects
- increases vasomotor symptoms

24
Q

What symptoms are dehydroepiandrosterone used for?
MOA

A

GSM symptoms
- insert vaginally

MOA: inactive sex hormone that is converted to estrogen + androgen in vaginal cells

25
Q

What are non-drug alternative for GSM symptoms?

A

Vaginal dryness
- Vaginal moisturizers 2x/week
- Lubricants: PRN for sex

For stress incontinence
- pelvic floor physio

26
Q

Which decreases the HDL benefit of CE? Estrogen or Micronized progesterone or MPA

A

MPA

IPFC 1 Final (13 decks)

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