Pharm of Menopause Flashcards
Menopause
amenorrhea for 12 months
FSH >40mIU/mL
loss of ovarian function and hormonal deficiency
hormone therapy indications
mod-severe vasomotor symptoms
vaginal atrophy
prevention of postmenopausal osteoporosis
Non-pharmacologic treatment
limit alcohol and spicy foods and caffeine, smoking cessation, dress in layers, reduce stress, increase exercise, deep slow breathing, water-based lubricants, Kegel exercises
Continuous cyclic HT
estrogen daily and progestogen for 12-14 days each month
menses returns 1-2 days after progestogen
less spotting and breakthrough bleeding
Continuous combined HT
estrogen AND progestogen administered daily
NO withdrawal bleeding
**best for women 2 years postmenopause due to unpredictable breakthrough bleeding
Continuous long-cycle HT
AKA cyclic withdrawal
estrogen given daily and progestogen given every other month for 12-14 days
results in 6 periods per year
bleeding may be longer and heavier than continuous cyclic
Intermittent combined HT
AKA continuous-pulsed or pulsed-progestogen
estrogen alone for 3 days then combined estrogen + progestogen for 3 days then repeat
lower incidence of uterine bleeding and may be better tolerated
When should pts be switched to transdermal products?
lower incidence of VTE
Use when unable to take PO products due to: ADR’s, high TG’s, liver function abnormalities, gallbladder disease
What should you counsel pt if transdermal patch falls off?
Apply same patch to diff area OR start a new patch
MAINTAIN THE ORIGINAL SCHEDULE
special considerations for transdermal patches
may be worn during bathing
avoid prolonged exposure to sunlight
begin patch 1 week after taking last oral HT
Bioidentical hormone therapy (BHT)
“custom made” HT made for an individual using salivary hormone testing
When are antidepressants first line for menopause?
When C/I for HT
Gabapentin
reduced frequency and severity of hot flashes
