Pharmacotherapy of Menopause Flashcards
Define Menopause
Life Event
Loss of ovarian function and hormonal deficiency
Amenorrhea for 12 months
FSH>40
Define Perimenopause
Period before menopause and 1 year after
Vasomotor and psycho symptoms
FSH fluctuates
What are you checking in the complete medical history
FH of CVD, breast cancer and personal history of thromboembolism
What are you looking at in the physical exam
CV, thyroid, breast and pelvic, mamogram and lipid panel
HRT Indications
Moderate to severe vasomotor symptoms
Vulvovaginal atrophy
Prevention of postmenopausal osteopororsis
Contraindication to HT
Active or history of thromboembolism Coronary heart disease Stroke or transient ischemic attack History of breast cancer Pregnancy Active liver disease Un-diagnosed vaginal bleeding
Estrogen dose
Lowest effective dose for the shortest amount of time
Non-pharmacologic treatment
Smoking cessation Limited alcohol and caffeine Limit hot beverages and spicy food Dress in layers Reduce stress Increase exercise Water based lubricants Kegel exercise
Intact uterus needs
Progestogen to prevent endometrial hyperplasia and cancer
Continuous Cyclic HRT
Estrogen daily
Progestogen for 12-14 days
Withdrawal bleeding shorter and lighter
Continuous Combined HRT
Estrogen and progesterone DAILY
No withdrawal bleeding
Breakthrough bleeding for 6-12 months so best for postmeno of 2 years
Continuous Long Cycle HT
Estogen daily
Progestogen every other month for 12-14 days
6 periods per year that are longer and heavier
Intermittent Combined HT
Estrogen alone for 3 days then combo for 3 days, repeat
Lower bleeding and better tolerated
Premarin
Estrogen
Cenestin
Estrogen
Menest
Estrogen
Estrace or Femtrace
Estradial
Ogen
Estropipate
Provera
MPA progesterone
Prometrium
Progesterone
Aygestin
NETA
Prempro
CEE + MPA
Angeliq
Estradial + drospirenone
FemHRT
Estradiol + Norethindrone
Activella
Estradiol + norethindrone
Ortho-prefest
Estradiol + Norgestimate
Low dose hormone therapy
Decrease hot flashes, improved vulvovaginal atrophy, increase bone mineral density and endometrial protection
Androgen indication
Vasomotor symptom treatment
Not first line
Estrogen Adverse Effects
Nausea Headache Bloating Breast tenderness Bleeding CHD Stroke VTE Cancer
Progesterone Adverse Effects
Nausea Headache Weight gain Bleeding Irritability Depression VTE Decreased bone mineral density
Manage AEs
Reduce dose
Change preparation
Change method of administration
When do you begin transdermal patches?
1 week after last day of oral HT
1 Patch weekly
Climara
Menostar
Climarapro (combo)
1 patch twice weekly
Alora
Estraderm
Vivelle-Dot
CombiPatch
Divigel
Topical Gel
Apply to clean, dry, unbroken skin
Allow to completely dry before dressing
FLAMMABLE
Estrogel
Topical gel pump
Apply to clean, dry, unbroken skin
Allow to completely dry before dressing (5 minutes)
FLAMMABLE
Elestrin
Topical gel pump Apply to clean, dry, unbroken skin Allow to completely dry before dressing FLAMMABLE DO NOT APPLY SUNSCREEN FOR AT LEAST 25 MINUTES OR 7 DAYS IN A ROW
Estrasorb
Skin Emulsion Apply to clean, dry, unbroken skin Allow to completely dry before dressing Do not apply sunscreen at same time Left over onto butt
Evamist
Topical Spray on FOREARM
Allow to completely dry before dressing (2 min)
FLAMMABLE
Wash with soap and water if a person comes into contact
Estring
Vaginal Ring
Replace after 90 days
Systemic absorption
Vagifem
Vaginal tablet
New applicator each day
1 tablet daily for 2 weeks, 1 tablet twice weekly
Estrace
Vaginal Cream
Squeeze to expel amount and put inside you
Discontinuation
Vasomotor symptoms resolve in 4 years-ish
Reassess need for HRT and TAPER after 1 yr
Bioidentical Hormone Therapy
Custom made HRT compound
Dose determined by salivary hormones
