Module 2 lecture 1 Flashcards
define pre menopausal, perimenopausal and post menopausal
Pre menopausal- time period of endocrine changes before cessation of menstruation
perimenopausal- The period of endocrine changes surrounding menopause
postmenopausal- The time period of endocrine changes surrounding menopause
What are some clinical representations of menopause
Hot flashes
Night sweats
sleep disturbances
vaginal dryness
mood changes
Absolute contraindications to menopausal hormone therapy
pregnancy
Endometrial or breast cancer
stroke
Active thromboembolic disorders
active liver disease
Estrogen monotherapy principle
estrogen monotherapy is only for women without a uterus
Why is estrogen monotherapy used in women without uteruses
They do not have to worry about endometrial cancer
Name 4 estrogen monotherapy drug ROA
Oral
topical
transdermal
Intravaginal
Intramuscular
Name 3 oral estrogen monotherapy drugs
Premarin, estraca and menest
Why do oral estrogen monotherapy drugs have more sideeffects
1st pass metabollism
Name estrogen monotherapy transdermal products
Vivelle-dot, vivelle, Alora, climara, menostar, minivelle
Why are transdermal products favored?
Less side effects, less risk of stroke and thromboembolism
What are some characteristics of intravaginal products for estrogen monotherapy
minimal systemic absorption (except for 1 exception)
helps vaginal dryness
What is the only intravaginal estrogen monotherapy that is systemically absorbed
Femring.
can we give women with uterus intact intravaginal products? Why?
What intravaginal product will require us to give her progesterone
We can usually give wome with uterus intact intravaginal products. This is due to their minimal systemic absorption in the body. The exception to this ofcourse is femring. We will need to give progesterone along with that product.
Name IM estrogen monotherapy drugs
Estradiol cypionate
Estradiol Valerate
Which drugs should be prescribed for women experiencing vaginal dryness
Topical vaginal products
Women with uterus intact should be prescribed a __________ in addition to estrogen to decrease risk of endometrial cancer
progestin
Estrogen is more favorabe the earlier you take it T/F
True
T/F women with uterus intact had a significantly higher chance of breast cancer compared to women with hysterectomy
True
Estrogen + progesterone increases the risk of
CHD (stroke, heart attack, venous thromboembolism) and breast cancer
Women below 60 y/o within 10 years of menopause have no evidence of CHD in estrogen only treatment. T/F
True
4 methods of administering combined estrogen and progestin
Continuous cyclic therapy
continuous long cycle
continuous combined
intermittent combined
which method mimics natural menstrual cycle
Continuous cyclic
how often is progesterone administered in continuous cyclic treatment
atleast 12-14 days in a 28 day cycle
Which method is preferred in recently menopausal women
continuous cyclic
Name 2 continuous cyclic drugs and ROA
Premphase- oral
combipatch- transdermal
What is the difference between continuous cycle and continuous long cycle
continuous long has less bleeding. This is because progesterone is administered every other month resulting in 6 bleedings per year.
How do we administer continuous combined therapy
daily estrogen + progesterone
Which treatment has the best long term protection for endometrial cancer
continuous combined
How does continuous combined affect endometrium?
atrophy of endometrium. Less bleeding. Best protection for endometrius.
continuous combined drugs
Prempro, fyavolv, jinteli, angeliq, activella, amabelz, climara pro
How is intermittent combined administered
3 days of estrogen and 3 days estrogen + progesterone (pulsed progesterone)
Why do we pulse progesterone in intermittent combined therapy
pulsing prevents downregulation of progesterone receptors
Drug for intermittent combined therapy
prefest
What are some oral progestins for endometrial protection
medroxyprogesterone
norethindrone acetate
micronized progestins
What is so special about the micronized progestins
resemble invivo progesterone
What is an estrogen & SERM drug
Duavee
Is estrogen & SERM hormonal?
what does it treat?
Side effects?
effect on endometrial cancer?
It is Non- hormonal
Treats menopausal symptoms and prevents bone less in women with intact uterus
side effects include GI disorders and muscle spasms
WHat are some SSRI/SNRI drugs
paroxetine, citalopram, escitalopram
WHat are SSRIs and SNRIs mainly used for
Hot flashes non hormonal
What is one treatment of moderate to severe dyspareunia (painful intercourse)
Ospemifene (SERM)
Black box warning for ospemifene
Endometrial cancer
stroke
VTE
