Pharmacotherapy of Menopause

Question 1

Define Menopause

Answer 1

Life Event
Loss of ovarian function and hormonal deficiency
Amenorrhea for 12 months
FSH>40

Question 2

Define Perimenopause

Answer 2

Period before menopause and 1 year after
Vasomotor and psycho symptoms
FSH fluctuates

Question 3

What are you checking in the complete medical history

Answer 3

FH of CVD, breast cancer and personal history of thromboembolism

Question 4

What are you looking at in the physical exam

Answer 4

CV, thyroid, breast and pelvic, mamogram and lipid panel

Question 5

HRT Indications

Answer 5

Moderate to severe vasomotor symptoms
Vulvovaginal atrophy
Prevention of postmenopausal osteopororsis

Question 6

Contraindication to HT

Answer 6

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

Question 7

Estrogen dose

Answer 7

Lowest effective dose for the shortest amount of time

Question 8

Non-pharmacologic treatment

Answer 8

Smoking cessation
Limited alcohol and caffeine
Limit hot beverages and spicy food
Dress in layers
Reduce stress
Increase exercise
Water based lubricants
Kegel exercise

Question 9

Intact uterus needs

Answer 9

Progestogen to prevent endometrial hyperplasia and cancer

Question 10

Continuous Cyclic HRT

Answer 10

Estrogen daily
Progestogen for 12-14 days
Withdrawal bleeding shorter and lighter

Question 11

Continuous Combined HRT

Answer 11

Estrogen and progesterone DAILY
No withdrawal bleeding
Breakthrough bleeding for 6-12 months so best for postmeno of 2 years

Question 12

Continuous Long Cycle HT

Answer 12

Estogen daily
Progestogen every other month for 12-14 days
6 periods per year that are longer and heavier

Question 13

Intermittent Combined HT

Answer 13

Estrogen alone for 3 days then combo for 3 days, repeat

Lower bleeding and better tolerated

Question 14

Premarin

Answer 14

Estrogen

Question 15

Cenestin

Answer 15

Estrogen

Question 16

Menest

Answer 16

Estrogen

Question 17

Estrace or Femtrace

Answer 17

Estradial

Question 18

Ogen

Answer 18

Estropipate

Question 19

Provera

Answer 19

MPA progesterone

Question 20

Prometrium

Answer 20

Progesterone

Question 21

Aygestin

Answer 21

NETA

Question 22

Prempro

Answer 22

CEE + MPA

Question 23

Angeliq

Answer 23

Estradial + drospirenone

Question 24

FemHRT

Answer 24

Estradiol + Norethindrone

Question 25

Activella

Answer 25

Estradiol + norethindrone

Question 26

Ortho-prefest

Answer 26

Estradiol + Norgestimate

Question 27

Low dose hormone therapy

Answer 27

Decrease hot flashes, improved vulvovaginal atrophy, increase bone mineral density and endometrial protection

Question 28

Androgen indication

Answer 28

Vasomotor symptom treatment | Not first line

Question 29

Estrogen Adverse Effects

Answer 29

``` Nausea Headache Bloating Breast tenderness Bleeding CHD Stroke VTE Cancer ```

Question 30

Progesterone Adverse Effects

Answer 30

``` Nausea Headache Weight gain Bleeding Irritability Depression VTE Decreased bone mineral density ```

Question 31

Manage AEs

Answer 31

Reduce dose Change preparation Change method of administration

Question 32

When do you begin transdermal patches?

Answer 32

1 week after last day of oral HT

Question 33

1 Patch weekly

Answer 33

Climara Menostar Climarapro (combo)

Question 34

1 patch twice weekly

Answer 34

Alora Estraderm Vivelle-Dot CombiPatch

Question 35

Divigel

Answer 35

Topical Gel Apply to clean, dry, unbroken skin Allow to completely dry before dressing FLAMMABLE

Question 36

Estrogel

Answer 36

Topical gel pump Apply to clean, dry, unbroken skin Allow to completely dry before dressing (5 minutes) FLAMMABLE

Question 37

Elestrin

Answer 37

``` 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 ```

Question 38

Estrasorb

Answer 38

``` 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 ```

Question 39

Evamist

Answer 39

Topical Spray on FOREARM Allow to completely dry before dressing (2 min) FLAMMABLE Wash with soap and water if a person comes into contact

Question 40

Estring

Answer 40

Vaginal Ring Replace after 90 days Systemic absorption

Question 41

Vagifem

Answer 41

Vaginal tablet New applicator each day 1 tablet daily for 2 weeks, 1 tablet twice weekly

Question 42

Estrace

Answer 42

Vaginal Cream | Squeeze to expel amount and put inside you

Question 43

Discontinuation

Answer 43

Vasomotor symptoms resolve in 4 years-ish | Reassess need for HRT and TAPER after 1 yr

Question 44

Bioidentical Hormone Therapy

Answer 44

Custom made HRT compound | Dose determined by salivary hormones