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Endocrine Module > Women's Health Issues Associated with Menopause > Flashcards

Women's Health Issues Associated with Menopause Flashcards

1
Q

What are the basic steps of the ovarian function?

A
  1. Estradiol is produced by the dominant follicle
  2. Progesterone is produced by the corpus luteum
  3. The ovarian storm secretes androgens
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2
Q

Sex steroids are important to the function of what?

A

Bones, brain, skin, and reproductive/urogenital tracts

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3
Q

What is Perimenopause?

A

Menopause transition

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4
Q

What is Menopause?

A

The permeant cessation of menses following the loss of ovarian follicular activity

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5
Q

What is Natural vs Induced Menopause?

A

Natural = normal aging process
Induced = surgical menopause

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6
Q

What is Postmenopause?

A

The subsequent time after a woman has undergone menopause

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7
Q

How are estrogen and progesterone related to ovarian?

A

Ovaries do not secreted estrogen and progesterone without ovulation

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8
Q

What is the primary source of estrogen in postmenopausal women?

A

Estrone from extraglandular and adipose tissue

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9
Q

Are androgens affected in menopause?

A

Produced from ovary and adrenal gland so they do not decrease significantly

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10
Q

When is the most likely time a woman will seek medical attention?

A

Perimenopause

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11
Q

What are the Vasomotor Symptoms VMS?

A

Intense heat (hot flashes), subsequent cooling (skin flushing), perspiration, and chills

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12
Q

When are symptoms worse for vasomotor symptoms?

A

Worse in the early morning and evening

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13
Q

What are the Psychological Symptoms?

A

Insomnia, mood changes, memory loss, anxiety, and depression

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14
Q

What is urogenital atrophy caused by?

A

Estrogen loss

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15
Q

What is Hormone Therapy?

A

Estrogen with or without progestin

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16
Q

HERS Trials

A

Use of hormone therapy should not be recommended for the purpose of secondary prevention of CHD in postmenopausal women with established coronary disease

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17
Q

WHI Study

A

Overall risks exceeded benefits from use of combined estrogen plus progestin among health postmenopausal women

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18
Q

What are the NO longer recommended uses for hormone therapy?

A
  1. Mood and psychological well-being
  2. Treatment of urinary incontinence
  3. Prevention of heart disease
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19
Q

What are the therapeutic uses of estrogen?

A
  1. Vasomotor symptoms
  2. Urogenital atrophy
  3. Prevention of osteoporosis
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20
Q

Progestins do what for women with an intact uterus taking estrogen?

A

Decreases risk of endometrial hyperplasia and endometrial adenocarcinoma

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21
Q

What are the absolute contraindications for hormone therapy?

A
  1. Breast Cancer
  2. History of DVT/PE
  3. History of Stroke/MI
  4. Liver Dysfunction
  5. Undiagnosed abnormal genital bleeding
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22
Q

What are the relative contraindications for hormone therapy?

A
  1. Elevated BP
  2. Hypertriglyceridemia
  3. Hypothyroidism
  4. Fluid Retention
  5. Severe Hypocalcemia
  6. Ovarian Cancer
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23
Q

For Oral hormone therapy, Premarin and Estrace what are the pearls?

A

Commonly used route
CEE

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24
Q

What is CEE?

A

Conjugated equine estrogen

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25
Q

For Transdermal patch hormone therapy, vivelle-dot/estraderm/climara what are the pearls?

A

Commonly used route
Dosing frequency dependent on product

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26
Q

For Intra-Vaginal hormone therapy, Estrace cream/Estradiol Ring/Vagifem what are the pearls?

A

If used PRN for urogenital symptoms, will not prevent osteoporosis
Systemic absorption varies with products
Some vaginal preps require progestin co-administration

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27
Q

For Dermal hormone therapy, estradiol evamist what is the low dose and standard dose?

A

Low: 1 spray QD
Standard: 2-3 sprays QD
Spray on the Forearm

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28
Q

For patients with elevated triglycerides, what form of hormone therapy might be more beneficial?

A

Topical HT, avoids first pass metabolism becauses it bypasses the GI tract

29
Q

Why are low doses of CEE now recommended?

A

Due to long-term risks of standard doses

30
Q

What is the purpose of Progestins?

A

Progesterone decreases endometrial hyperplasia in women with an intact uterus

31
Q

What are the hormone therapy dosing regimens?

A
  1. Cyclic
  2. Continuous (preferred)
  3. Combination Products
  4. Low Dose Combination Hormonal Contraceptive
32
Q

What is the Annual Monitoring for HT?

A
  1. medical history
  2. physical exam including pelvic exam
  3. blood pressure management
  4. routine endometrial cancer surveillance
33
Q

Hormone Therapy continues to have a viable role in treatment, but in preventative therapy it has

A

Diminished

34
Q

Who are the most appropriate candidates for estrogen plus androgen therapy?

A

Women who have had their ovaries removed or with sexual dysfunction especially loss of libido

35
Q

What androgen is co-administered with estrogen with a/e of virilization, fluid retention, lipid effects?

A

Oral Methyltestosterone

36
Q

What are the CIs to oral methyltestosterone?

A

Mod/Severe Acne, Clinical Hirsutism, Androgenic Alopecia, and Androgen Dependent Neoplasia

37
Q

What are the bio identical hormone therapies and are they recommended?

A

NO, estrone, 17-B estradiol, estriol, progesterone, testosterone, and dehydroepiandrosterone

38
Q

What is the most effective therapy at relieving hot flashes?

A

Hormone Therapy

39
Q

What the considerations for mild symptoms of VMS?

A
  1. Start with lifestyle changes
  2. Next step, non-hormonal option. Generally SSRI/SNRI first line
40
Q

What are the considerations for moderate/severe symptoms of VMS?

A
  1. Risk vs. Benefit decision factoring in patients concurrent conditions/CIs
  2. HT may be considered
41
Q

What are the lifestyle changes for VMS?

A
  1. Wearing layered clothing
  2. Avoiding triggers
  3. Exercising
42
Q

What is Black Cohost, and how can it help VMS?

A

Not recommended cause of liver issues and inconsistent results

43
Q

What is Soy Protein, and how can it help VMS?

A

Not recommended and inconsistent results

44
Q

When should hormone therapy be stopped?

A

2-3 years, should be used in the lowest effective dose and for the shortest time period necessary

45
Q

What is Tissue Selective Estrogen Complex TSEC?

A

Combines selective estrogen receptor modulator SERM and estrogen, considered as ALTERNATIVE to HT

46
Q

What is the MOA of Gabapentinoids?

A

Modulation of calcium currents, thereby modifying adrenergic and serotonergic pathways of the pituitary hypothalamic region and impacting the thermoregulatory process

47
Q

What is MOA of SSRIs?

A

Increases the availability of serotonin in the central nervous system as well as reducing LH

48
Q

What are the urogenital symptoms?

A

Urogenital atrophy, vaginal dryness, and dyspareunia

49
Q

HT remains the primary treatment for what?

A

Moderate/Severe symptoms of vulvar and vaginal atrophy associated with menopause

50
Q

What is the therapy regimen of HT for urogenital symptoms?

A

When solely used for urogenital symptoms, vaginal HT should be considered for long-term use

51
Q

When should non-estrogen vaginal gels/creams be used?

A

Relief of vaginal dryness used alone or with HT

52
Q

When should SERM Osphen be used?

A

To improve mod/severe dyspareunia

53
Q

What should Synthetic Steroid Prasterone be used for?

A

To prove mod/severe dyspareunia, avoid in women w/breast cancer

54
Q

What are other urogenital symptoms?

A

Urinary Incontinence
Sexual Dysfunction
Decreased Libido

55
Q

What can improve urinary incontinence?

A

Estrogen does not improve urinary stress incontinence, but vaginal estrogen may improve urge incontinence and overactive bladder

56
Q

What do you give for decreased libido?

A

Androgen

57
Q

Does estrogen improve psychological symptoms?

A

NO

58
Q

When should initial follow up and maintenance follow up occur?

A

Initial = 6 wks
Maintenance = 1 year

59
Q

What is the dosing for CEE/Premarin?

A

0.3 -0.45 mg QD

60
Q

What is the dosing for Miconized 17B-Estradiol/Estrace?

A

1 mg QD

61
Q

What is the dosing for 17B-Estradiol/Estraderm/Climara/Vivelle-Dot?

A

0.025 mg/hr, applied 1-2x/week

62
Q

What is the dosing for 17B-Estradiol/Estrace Intravaginal?

A

1-3x/week

63
Q

What is the dosing for 17B-Estradiol/Estring Intravaginal?

A

Insert ring every 3 months

64
Q

What is the dosing for Estradiol Hemihydrate/Vagifem/Evamist Intravaginal/Dermal?

A

Insert tablet 2x/weel
1 spray to the forearm QD

65
Q

What is the dosing for Methyltestosterone?

A

1.25-2.5 mg QD

66
Q

What is Estrogen + Progestion PO Brand Name?

A

Prempro/Premphase

67
Q

What is Estrogen + Progestin Transdermal Brand Name?

A

CombiPatch

68
Q

What is Estrogen + Testosterone Brand Name?

A

Covaryx

Endocrine Module (16 decks)

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