Reproductive system

Question 1

Lifestyle changes to minimize hot flash triggers

Answer 1

• Keep food diary to track triggers, eat in small amounts (spicy food, chocolate, etc)
• Restrict or avoid alcohol
• Control room temperature and humidity
• Dress in layers that can be removed and replaced (avoid tight, restrictive clothing)
• Smoking cessation
• Take cool showers or baths

Question 2

Prescription medications for menopausal symptoms

Answer 2

Hormone therapy to treat hot flashes (lowest dose that is effective)

• Oral conjugated estrogen, oral 17-estradiol, transdermal 17-estradiol
• Should take estrogen hormone therapy with progestin to minimize endometrial cancer risk

Question 3

Other medications available to treatment vasomotor symptoms (hot flashes) in perimenopausal women that isn’t hormone therapy

Answer 3

• Antidepressants
  
  • SSRIs → sertraline (zoloft), paroxetine (paxil)
  • SNRIs → venlafaxine (effexor)
• Gabapentin (neurontin)
• COCs (also good for cycle regulation)

Question 4

Absolute contraindications for postmenopausal estrogen therapy

Answer 4

• Unexplained vaginal bleeding
• Acute liver disease
• Chronic impaired liver function
• Thrombotic disease
• Neuro-ophthalmological vascular disease
• Endometrial cancer
• Breast cancer (past, current, suspected)