Week 6 Menopause, Breast Changes, & Osteoporosis Flashcards
In postmenopausal women, estrogen levels increase with decreasing weight. True or False?
False
Which of these is NOT listed as a recommended dosing option for estrogen/progesterone therapy? Continuous Monophasic Sequential
Monophasic
Provera is an option for transdermal hormone therapy. True or false
False
Alendronate (Fosamax) and riserdronate (Actonel) are examples of calcitonin. True or false
false
Galactorrhea can persist for months or years after breastfeeding. True or False
True
Which of these procedures allows clinicians to distinguish between invasive and noninvasive cancer?
core needle biopsy
Mammograms help differentiate among malignant, benign, or cystic fibroids. true or false
false
Which of these screening procedures is reserved for those at very high risk for cancer?
MRI
Women with a parent, sibling. or child with BRCA-1 or BRCA-2 mutation should have an MRI and a mammogram every other year. True or false
false
Bisphosphonates
- Aldronate (Fosamax)
- Risedronate (Actonel, Atelvia)
- Ibandronate (Boniva)
Indication
MOA
Contraindication
1st line osteoporosis
MOA: inhibit bone resorption by reducing osteoclast #
Contraindication
- Upper GI disease
- Hypocalcemia
- Renal disease
- MUST TAKE WITH WATER
Zoledronic acid (Reclast)
Indication
Contraindication
osteoporisis
IV
Contraindication: Hypocalcemia
Raloxifine (Evista)
Indication
MOA
side effect
Contraindication
Indication: Osteoporosis (spine)
MOA: selective estrogen receptor modulator (SERM)
Side Effect
- Hot flashes
Contraindication:
- not recommended if on estrogen therapy or EPT
- Hx VTE
Calcitonin
Indication
Caution
Contraindication
Indication
- Not first line for osteoporosis
- Analgesic effect on osteoporotic fractures
Caution:
- Consider malignancy risk
- admin = nasal spray
- Use <6 months
Contraindication
- Allergy to calcitonin- salmon
What increases a patient’s modifiable risks for osteoporosis?
- BMI <21
- Hypogonadal states (anorexia, turner & kleinfelters)
- Nulliparity
- Lifestyle (smoking, sedentary)
- Medications (thyroid, steroids, PPIs, SSRI)
- Chronic disease
What are the non modifiable risk factors for developing osteoporosis?
- Age
- Female
- Race (white)
- Family history
- history fracture as adult
- 1st degree relative
- Genetic disease
- Hematologic disorder
- Autoimmune
What are the diagnostic criteria for osteoporosis?
Bone mineral density score
T score -2.5 or higher = osteoporosis
What are the physiological changes that occur with menopause? What questions should you be asking your patients?
Follicles less responsive to FSH
Ovaries produce less estradiol, progesterone, and androgens
Describe
Estradiol (E2)
Estriol (E3)
Estrone (E1)
Estradiol (E2)
- most potent
- Main estrogen in reproductive years
- low post menopausal
Estriol (E3)
- by product of estradiol and estrone
Estrone (E1)
- Weak
- Primary estrogen in post menopausal women
- Produced by adipose
What are non hormonal treatment options for vasomotor symptoms? 3 and their side effects
Clonidine: weekly patch
- Side Effect dizzy, dry mouth
Gabapentin:
- Side Effect: anorgasmia
SSRI (Venlafaxine or Fluoxetine)
- SE: sexual dysfunction
What are the only FDA approved prescription for treating hot flashes in women with high risk breast cancer or people who have had breast cancer?
Paroxetine
When will vasomotor symptoms resolve within _____ after initiation of hormone therapy but return in _____ % of women
2 to 6 weeks
50%
how long do vasomotor symptoms last?
up to five years and sometimes up to 10 years
What is the diagnostic criteria for Female Sexual Arousal Disorder
Complete lack or reduction in sexual interest/arousal associated with 3+ below for 6 months
Absence or reduction in
- interest
- erotic thoughts
- desire to initiate sex
- sense of excitemnt during sex
- response to sexual cues
- decreased sensation during sex
Medications for sexual arousal disorder
Flibanserin
Bremelanotide
Brupopion
Testoserone
Flibanserin
MOA
Side effect
For sexual arousal disorder
MOA: dopamine activation “female viagra”
Side Effect: Syncope esp with ETOH
Bremelanotide
Side Effect
Sexual arousal disorder PRN autoinjector
Side Effect: Nausea
What is the breast cancer screening recommendations for the average women without risk factors?
45 to 74
What is the USPSTF screening recommendations for average risk women breast cancer?
Mammography Q 2 years
Ages 50 to 74
What does the american cancer society recommend for breast cancer screening for women with high risk
MRI and mammogram yearly starting at 30
What does the ACOG recommend for higher risk breast cancer individuals
MRI yearly starting at 25
Mammogram yearly starting at 30
When would you order an ultrasound?
Benefits of US
- When radiation is to be avoided if aged <30
- pregnant
- Dense breasts
- palpable breast lumps
As an adjunct to mammography!!!
Benefits
- Differentiate cysts v solid mass
- guide fine needle aspiration of breast cysts
**cannot differentiate between malignant or benign solid masses
Management for breast lump <30
>30
<30 = Ultrasound alone
>30 = US & Mammogram
Causes of galactorrhea
- Hyperprolactinemia
- Pituitary prolactin secreting tumors - adenoma
- Medications (COC, antidepressant)
- Hypothyroidism
- Neurologic disorder
- Stress
What diagnostics do you check for galactorrhea?
Pregnancy
Prolactin in AM before breast stimulation ( + = CT pituitary)
TSH
Mammogram if >30
US
What are the screening recommendations for osteoporosis?
All women >65 years
Women <65 with risk factors
Men >70
Men <50 if previous broken bone
How do you screen for osteoporosis?
DEXA scan Q2 years
osteoporosis = T score of -2.5 SD or lower
Osteopenia = t shore -1.1 to -2.4 SD
Z-score -2 or less
What is the FRAX tool?
determines 10 year risk for fracture
What are the benefits of Raloxifene (Evista)
Disadvantages?
Selective Estrogen Receptor Modulator (SERM)
- Decreases bone resorption
- Increases BMD at spine only/reduce risk vertebral fx
- Protection against breast cancer
Disadvantages
- May cause hot flashes
- Increased risk DVT
- Lose bone immediately after stopping
When would you stop Bisphosphonates after 5 years?
When would you continue meds over 5 years?
- No fracture hx or low risk for fracture
- hip BMD >-2.5 = drug holiday reassess in 2 to 3 years
Continue if
- Hx fracture before or during treatment
- BMD is -2.5 or less or at high risk fracture
Reassess every 2 to 3 years
Raloxifene (Evista)
Who is this for?
BBW
Who: Postmenopausal women at risk for breast cancer; people with bisphosphonate contraindications
BBW:
DVT, endometrial/uterine cancer, increased risk of stroke death
