Untitled Deck Flashcards
What is the primary pharmacologic treatment for managing menopausal symptoms?
Hormone Therapy (HT) is the first-line treatment, especially for hot flashes and vasomotor symptoms.
When is estrogen-alone therapy (ET) recommended?
ET is recommended for women without a uterus.
What type of hormone therapy is used for women with an intact uterus?
Estrogen-Progestogen Therapy (EPT) is used to prevent endometrial complications.
Why is progestogen necessary in hormone therapy for women with a uterus?
Progestogen prevents endometrial hyperplasia or cancer by counteracting estrogen’s stimulatory effects on the uterine lining.
What are some commonly used progestins in hormone therapy?
Medroxyprogesterone acetate (MPA), norethindrone acetate, and native progesterone are commonly used.
When is local (topical) estrogen therapy indicated?
Local estrogen therapy is indicated for vaginal dryness as the primary symptom.
Why doesn’t local estrogen therapy require progestogen?
Low-dose local estrogen does not raise systemic estrogen levels enough to stimulate the uterine lining.
What is the role of Bazedoxifene in hormone therapy?
Bazedoxifene, combined with conjugated estrogens (CEE), provides endometrial protection without needing additional progestogen.
How does systemic estrogen therapy benefit menopausal women?
Systemic estrogen therapy alleviates broader symptoms, such as hot flashes and vasomotor symptoms, by raising blood estrogen levels.
Why is estrogen-progestogen therapy necessary for systemic HT in women with a uterus?
It prevents estrogen-induced risks of endometrial hyperplasia or cancer.
How does local estrogen therapy benefit vaginal dryness?
Local estrogen directly addresses vaginal dryness without systemic effects or the need for progestogen.
What is the primary benefit of using Bazedoxifene with conjugated estrogens?
It combines estrogen benefits with endometrial safety, eliminating the need for additional progestogen.
What are the benefits of customizing hormone therapy for menopausal symptoms?
Systemic HT addresses widespread symptoms like hot flashes, while local estrogen targets specific symptoms like vaginal dryness without systemic effects.
When is systemic unopposed estrogen therapy indicated?
Systemic unopposed estrogen is prescribed for women who do not have a uterus.
What is the purpose of local estrogen therapy?
Local estrogen therapy is used to treat vaginal symptoms like vaginal atrophy and dryness, regardless of uterine status.
Why is local estrogen therapy considered safe for all women?
Local estrogen does not raise systemic estrogen levels significantly, eliminating the need for additional progestogen.
Why is progestogen added to estrogen therapy in women with an intact uterus?
Progestogen prevents endometrial hyperplasia and reduces the risk of endometrial cancer caused by unopposed estrogen.
What is the role of Estrogen-Progestogen Therapy (EPT)?
EPT provides the benefits of estrogen while ensuring endometrial protection for women with an intact uterus.
What happens if unopposed estrogen is given to women with a uterus?
It can stimulate the uterine lining, increasing the risk of endometrial hyperplasia and cancer.
Why is systemic unopposed estrogen therapy unsuitable for women with a uterus?
Without progestogen, it increases the risk of endometrial cancer due to estrogen stimulation of the uterine lining.
What symptoms does local estrogen therapy specifically target?
Local estrogen therapy targets vaginal atrophy and dryness.
How does EPT balance the effects of estrogen?
EPT allows the benefits of estrogen while reducing its risks by protecting the endometrium in women with a uterus.
What is the primary benefit of using progestogen in EPT?
Progestogen prevents adverse effects of unopposed estrogen, such as endometrial hyperplasia and cancer.
What is the first-line therapy for managing vasomotor symptoms (VMS) in menopausal women?
Hormone Replacement Therapy (HRT) is the first-line therapy for managing hot flashes and other vasomotor symptoms.
How does HRT help prevent osteoporosis?
HRT prevents bone loss and reduces fracture risk, making it beneficial for women at risk of osteoporosis.
When is HRT indicated for women with premature ovarian insufficiency (POI) or early surgical menopause?
HRT is used to manage symptoms and protect long-term health in these cases.
What is the recommended therapy for genitourinary symptoms of menopause (GSM)?
Local estrogen therapy, such as estradiol vaginal tablets or estriol cream, is recommended for GSM.
What are common side effects of HRT?
Side effects include breast tenderness, vaginal bleeding, nausea, headaches, weight changes, skin reactions, and cholecystitis.
What systemic HRT options are available for women with an intact uterus?
Options include: CEE (Premarin) or Estradiol Valerate (Progynova) taken daily; Combination therapy with CEE or Estradiol Valerate plus Medroxyprogesterone Acetate (MPA); Estradiol Hemihydrate + Drosperinone (Angeliq).
What systemic HRT options are available for women without a uterus?
CEE (Premarin) or Estradiol Valerate (Progynova) can be taken daily without the need for progestogen.
What is the regimen for Estradiol Vaginal Tablets (Vagifem) for GSM?
Insert 10 mg daily for 2 weeks, followed by 1 tablet twice weekly for maintenance.
How is Estriol Cream (Ovestin) used for GSM?
Apply 0.5 mg daily for 21 days, followed by a 7-day break.
Why do women with an intact uterus require progestogen in HRT?
Progestogen prevents endometrial hyperplasia and reduces the risk of endometrial cancer caused by unopposed estrogen.
What differentiates local from systemic HRT?
Systemic HRT addresses broader symptoms like VMS, while local HRT targets GSM with minimal systemic exposure and fewer side effects.
How does combination HRT with progestogen work for women with a uterus?
Progestogen is added to systemic estrogen therapy to protect the uterus and balance the effects of estrogen.
Why is CEE or Estradiol Valerate used without progestogen for women without a uterus?
Women without a uterus don’t need progestogen because there’s no risk of endometrial hyperplasia or cancer.
What are the absolute contraindications to MHT?
Absolute contraindications include: History of breast or endometrial cancer, Porphyria, History of thromboembolic disease, Unexplained vaginal bleeding, Active liver disease, Acute cardiovascular disease, Stroke, TIA, MI, PE, or VTE, Immobilization, Atypical ductal hyperplasia of the breast, Uncontrolled hypertension, Active gallbladder disease, Migraine with aura.
Why is MHT contraindicated in women with a history of breast or endometrial cancer?
Hormones may worsen or stimulate the growth of these cancers.
Why is MHT avoided in thromboembolic disease?
MHT increases the risk of blood clots, worsening thromboembolic conditions.
Why is unexplained vaginal bleeding a contraindication for MHT?
It requires evaluation for potential malignancies, as MHT may exacerbate these conditions.
Why should MHT not be used in active liver disease?
Estrogen is metabolized by the liver, and active liver disease may interfere with MHT processing.
Why is MHT contraindicated in acute cardiovascular conditions?
Hormones may aggravate existing cardiovascular diseases like MI, PE, or stroke.
Why is immobilization a contraindication for MHT?
Immobilization increases the risk of thromboembolism, which can be worsened by MHT.
Why should MHT be used cautiously in women with diabetes?
MHT may affect glucose metabolism and cardiovascular health, requiring careful monitoring.
Why is hypertriglyceridemia a precaution for MHT use?
It increases the risk of thrombosis when combined with MHT.
Why is MHT risky for women with migraine with aura?
MHT raises the risk of stroke in these women.
What precautions should be taken for women at increased risk of breast cancer or cardiovascular disease?
MHT should be carefully considered and monitored, as it may raise the risks of these conditions.
Why is an individualized approach important for MHT?
Assessing a patient’s health history ensures safe and effective therapy while minimizing adverse effects.
What factors should be considered when selecting an HRT preparation?
Factors include increased triglycerides, diabetes mellitus, breast cancer risks, mammographic density, and family history of VTE.
How can the first-pass effect be avoided in HRT?
Transdermal Estradiol bypasses the liver, reducing metabolic impact and clotting risk.
What are strategies for safer HRT use?
Use transdermal estradiol, progestins with safer metabolic profiles, and ultra-low-dose preparations.
How is endometrial protection ensured for women with a uterus on systemic estrogen?
Combine systemic estradiol with progesterone or conjugated estrogens (CEE) with Bazedoxifene to protect against endometrial hyperplasia and cancer.
Is progesterone required for low-dose vaginal estrogen therapy?
No, progesterone is typically unnecessary unless unusual vaginal bleeding occurs.
When should endometrial evaluation be performed during low-dose vaginal ET?
If vaginal bleeding occurs, evaluation is needed to rule out endometrial pathology.
What are the indications for osteoporosis drug therapy in postmenopausal women?
Indications include a history of vertebral or hip fractures or a T-score < -2.5 at the lumbar spine, femoral neck, or total hip.
What are the osteoporosis risk thresholds for moderate-risk postmenopausal women?
A T-score between -1.0 and -2.5 with a 10-year FRAX risk of major osteoporotic fracture ≥ 20% or hip fracture risk ≥ 3%.
How does drug therapy benefit osteoporosis management?
It reduces osteoporosis progression and lowers the risk of osteoporotic fractures.
Why is personalized HRT selection important?
It ensures symptom relief while minimizing adverse effects by accounting for individual cardiovascular, metabolic, and cancer risks.
What is the role of Bazedoxifene in systemic estrogen therapy?
Bazedoxifene provides endometrial protection when combined with conjugated estrogens (CEE).
Why is osteoporosis risk assessment critical in postmenopausal women?
It identifies women at high risk for fractures and guides drug therapy to prevent bone loss and fractures.
What are examples of Selective Estrogen Receptor Modulators (SERMs)?
Raloxifene, Droloxifene, and Tamoxifen are examples of SERMs.
What is the function of SERMs in bone health?
SERMs decrease bone resorption by mimicking estrogen’s effects on bone without stimulating breast or uterine tissues.
What is Tibolone, and how does it function?
Tibolone is an effective treatment for osteoporosis with mixed estrogenic, antiestrogenic, androgenic, and progestogenic effects.
Why is Tibolone not strictly classified as a SERM?
Tibolone has complex effects beyond SERM-like properties, including androgenic and progestogenic effects.
What are examples of bisphosphonates?
Examples include Etidronate, Alendronate, Risedronate, Ibandronate, and Zoledronic acid.
What is the primary effect of bisphosphonates?
Bisphosphonates inhibit bone resorption and are used to manage osteoporosis.
What are potential side effects of long-term bisphosphonate use?
Long-term use can cause osteoporosis of the jaw and long bone fractures, such as femur fractures.
What is the dosage and function of calcitonin in osteoporosis treatment?
Calcitonin is given as 50 IU subcutaneously daily or 200 IU intranasally and inhibits bone resorption to maintain bone density.
How does fluoride help in bone health?
Fluoride increases bone density and prevents vertebral fractures when given as 50 mcg of slow-releasing sodium fluoride daily.
What is the role of Teriparatide (parathyroid hormone) in osteoporosis treatment?
Teriparatide increases bone mass in women with significant osteoporosis when given as 20 mcg subcutaneously daily for up to 18 months.
What are the recommended daily doses of calcium and vitamin D for bone health?
Calcium: 1500 mg daily; Vitamin D: 400–800 IU daily.
How does combined calcium and vitamin D benefit bone health?
Combined calcium and vitamin D increase bone density in older adults but do not fully prevent bone loss in younger menopausal women.
Why is exercise important for osteoporosis prevention?
Exercise builds muscle and bone mass and reduces the risk of falls.
What are the treatment staging recommendations for osteoporosis?
Early menopause: Hormone therapy (HT). Osteopenia: SERMs. Osteoporosis: Bisphosphonates. Advanced cases/post-fracture: Teriparatide.
Why are calcium, vitamin D, and exercise considered adjunctive measures?
These measures support bone health but are not sufficient alone for treating or preventing osteoporosis in high-risk individuals.
What is the primary treatment for hot flashes in early menopause (ages 50-55)?
Hormone Therapy (HT) is used to manage vasomotor symptoms such as hot flashes.
How does HT benefit bone health in early menopause?
HT helps prevent bone loss and reduces the risk of osteoporosis in women with T-scores between -1 and -2.5.
At what stage is the bone density (BMD) in early menopause?
BMD is higher than osteoporotic levels but trending downward, indicating a risk for osteopenia.
What are hot flashes in early menopause (ages 50-55)?
Hormone Therapy (HT) is used to manage vasomotor symptoms such as hot flashes.
What treatments are recommended in the post-vasomotor, pre-fracture stage (ages 55-75)?
SERMs (e.g., Raloxifene) and Bisphosphonates (e.g., Alendronate, Risedronate) are recommended.
What is the function of SERMs during the post-vasomotor, pre-fracture stage?
SERMs prevent further bone loss and maintain bone density without stimulating breast or endometrial tissue.
How do bisphosphonates help in the post-vasomotor stage?
Bisphosphonates inhibit bone resorption and help increase bone density.
At what stage is the bone density (BMD) in the post-vasomotor, pre-fracture stage?
BMD is lower, with an increased risk of fractures, marking the transition to osteoporosis.
What treatments are recommended in the post-fracture stage (ages 75+)?
Teriparatide for bone formation and bisphosphonates to maintain bone density and reduce fracture risk.
What is the role of Teriparatide in severe osteoporosis?
Teriparatide stimulates bone formation and is used in patients with multiple fractures or high hip fracture risk.
How is Teriparatide administered?
Teriparatide is injected subcutaneously daily, usually for up to 18 months.
At what stage is the bone density (BMD) in the post-fracture stage?
BMD is at its lowest, with a very high risk of fractures, indicating severe osteoporosis.
What is the recommended treatment during early menopause (ages 50-55)?
HT is recommended for managing vasomotor symptoms and preventing osteoporosis.
What treatments are suggested for postmenopausal women with osteopenia or osteoporosis risk (ages 55-75)?
SERMs and bisphosphonates are recommended to manage bone density and prevent fractures.
How is osteoporosis managed in advanced cases (ages 75+)?
Teriparatide is used for bone building in severe cases, and bisphosphonates continue to maintain bone density.
Why is osteoporosis treatment tailored based on age and stage?
Tailored treatments address specific risks, such as prevention in early menopause, maintenance in middle-age, and active treatment for advanced osteoporosis.
Which antidepressants are used off-label for menopausal symptoms?
SSRIs (Fluoxetine, Paroxetine, Escitalopram) and SNRIs (Venlafaxine, Desvenlafaxine) help reduce hot flashes and mood symptoms.
What hypnotic medication can assist with menopausal sleep issues?
Eszopiclone can help with menopause-related sleep disturbances.
Which anticonvulsant is effective for nighttime hot flashes?
Gabapentin is effective for reducing nighttime hot flashes.
What antihypertensive drug is used off-label for hot flashes?
Clonidine can reduce hot flashes but may cause side effects like dizziness or dry mouth.
How can Pregabalin help menopausal women?
Pregabalin may help with neuropathic pain and hot flashes.
What are soy isoflavones, and how do they help menopause?
Soy isoflavones are plant-based compounds with estrogen-like properties that may reduce hot flashes.
What herbs are commonly used for menopausal symptoms?
Black Cohosh (hot flashes), Cranberry (urinary health), St. John’s Wort (mood), Valerian (relaxation/sleep), Vitex (hormonal balance).
How does melatonin benefit menopausal women?
Melatonin helps with sleep disturbances and supports circadian rhythm regulation.
What are examples of relaxation techniques for managing menopausal symptoms?
Yoga and meditation reduce stress and improve mood, helping with anxiety and hot flashes.
What dietary changes can help reduce menopausal symptoms?
A balanced diet and avoiding triggers like caffeine, alcohol, and spicy foods can reduce hot flashes.
What cooling strategies are recommended for hot flashes?
Dress in layers, sleep in a cool room, and drink cold beverages for immediate relief.
How can vaginal dryness be managed during menopause?
Moisturizers and lubricants enhance comfort and sensitivity during sexual activity.
What are the limitations of over-the-counter hormones like topical progesterone?
Effectiveness varies, and they should be used cautiously under healthcare provider guidance.
How does Black Cohosh benefit menopausal women?
Black Cohosh is commonly used to reduce hot flashes.
Why should complementary and alternative medicines be discussed with a healthcare provider?
Effectiveness varies, and potential interactions with other medications need to be considered.
Why are lifestyle adjustments critical in managing menopausal symptoms?
Healthy habits, relaxation, and cooling strategies provide significant relief from hot flashes, improve sleep, and enhance comfort.
What is the standard dose for vaginal estrogen cream (CEE) for GSM?
0.5 g, applied 2-3 times per week.
What is the dose for vaginal estriol cream for GSM?
1 mg, applied 2-3 times per week.
How is vaginal estradiol tablet dosed for GSM?
10 μg, used twice weekly.
What is the function of Ospemifene in GSM treatment?
Ospemifene (60 mg orally) treats vaginal dryness and atrophy.
What is the standard dose for oral conjugated equine estrogen (CEE)?
0.65 mg daily.
What is the low dose for oral estradiol valerate?
1 mg daily.
What is the ultra-low dose for transdermal estrogen?
0.014 mg/day.
What is a common combination of estrogen and progestogen for women with an intact uterus?
CEE + Medroxyprogesterone Acetate (MPA).
What is Tibolone, and what are its properties?
Tibolone is a synthetic steroid with estrogenic, progestogenic, and androgenic properties, used for menopausal symptoms and osteoporosis.
What is the role of TSEC (Tissue-Selective Estrogen Complex) in hormone therapy?
TSEC, such as CEE + Bazedoxifene, provides endometrial protection without requiring progestogen.
What is the use of testosterone in menopausal hormone therapy?
Testosterone is sometimes added to manage symptoms of low libido in postmenopausal women.
Why are localized therapies like vaginal estrogen and SERMs preferred for GSM?
They avoid systemic effects and are suitable for isolated symptoms like vaginal dryness and atrophy.
What are the benefits of systemic therapies like CEE and Estradiol Valerate?
They target broader menopausal symptoms, such as hot flashes and bone health.
Why must women with an intact uterus use combination estrogen-progestogen therapy?
To prevent endometrial hyperplasia or cancer caused by unopposed estrogen.
What is the role of Bazedoxifene in TSEC therapy?
Bazedoxifene provides endometrial protection, eliminating the need for progestogen.
How is GSM treated with vaginal estriol combined with lactobacillus?
A tablet containing 30 μg of estriol and lactobacillus is used.
What is the dosing regimen for vaginal estradiol rings in GSM treatment?
The vaginal ring provides localized estrogen and is replaced as directed, typically every 3 months.
What forms of vaginal estrogen are available for GSM?
Cream, tablet, or ring formulations.
Why are dose customizations important in hormone therapy?
Customizing doses (standard, low, ultra-low) tailors treatment to symptom severity and patient needs.
What is the role of ultra-low-dose estradiol + dydrogesterone therapy?
It provides symptom relief with minimal side effects, suitable for sensitive patients.
What causes a hot flash during menopause?
A hot flash occurs when the hypothalamus mistakenly perceives an elevated body temperature and triggers cooling mechanisms, often due to hormonal changes.
Which brain region regulates core body temperature during a hot flash?
The hypothalamus regulates core body temperature and is responsible for the false overheating signal during a hot flash.
What happens to blood vessels during a hot flash?
Blood vessels near the skin dilate, increasing blood flow to promote heat dissipation, causing redness and warmth.
Which body areas typically feel hot during a hot flash?
The chest, neck, and face often feel hot as blood flow increases to these areas.
What role do sweat glands play during a hot flash?
Sweat glands release perspiration to cool the body through evaporation.
How long does a typical hot flash episode last?
A hot flash usually lasts 2-5 minutes before the body temperature normalizes.
What is the thermoneutral zone, and how does it change in menopausal women?
The thermoneutral zone is the temperature range where the body neither sweats nor shivers. In menopausal women, this range narrows, making them more sensitive to slight temperature changes.
What hormone disruption is associated with hot flashes?
Declining estrogen levels during menopause disrupt the hypothalamus’s regulation of body temperature.
How can hot flashes impact quality of life?
Hot flashes can disrupt daily activities and sleep, causing fatigue and irritability.
What lifestyle changes can help manage hot flashes?
Wearing breathable clothing, keeping rooms cool, and avoiding triggers like caffeine, alcohol, and spicy foods can help manage hot flashes.
What medical treatments are available for hot flashes?
Hormone therapy (HT) and non-hormonal treatments like SSRIs or SNRIs can reduce the frequency and severity of hot flashes.
Why does the skin flush during a hot flash?
The skin flushes as blood vessels dilate to release heat, causing redness and warmth in the upper body.
What occurs during the cooling phase of a hot flash?
The brain corrects its error, core body temperature normalizes, and the episode ends, often leaving the individual feeling damp or sweaty.
How does declining estrogen affect the hypothalamus during menopause?
Declining estrogen disrupts the hypothalamus’s temperature regulation, leading to false overheating signals.
