Women's Health Issues Associated with Menopause Flashcards
What are the basic steps of the ovarian function?
- Estradiol is produced by the dominant follicle
- Progesterone is produced by the corpus luteum
- The ovarian storm secretes androgens
Sex steroids are important to the function of what?
Bones, brain, skin, and reproductive/urogenital tracts
What is Perimenopause?
Menopause transition
What is Menopause?
The permeant cessation of menses following the loss of ovarian follicular activity
What is Natural vs Induced Menopause?
Natural = normal aging process
Induced = surgical menopause
What is Postmenopause?
The subsequent time after a woman has undergone menopause
How are estrogen and progesterone related to ovarian?
Ovaries do not secreted estrogen and progesterone without ovulation
What is the primary source of estrogen in postmenopausal women?
Estrone from extraglandular and adipose tissue
Are androgens affected in menopause?
Produced from ovary and adrenal gland so they do not decrease significantly
When is the most likely time a woman will seek medical attention?
Perimenopause
What are the Vasomotor Symptoms VMS?
Intense heat (hot flashes), subsequent cooling (skin flushing), perspiration, and chills
When are symptoms worse for vasomotor symptoms?
Worse in the early morning and evening
What are the Psychological Symptoms?
Insomnia, mood changes, memory loss, anxiety, and depression
What is urogenital atrophy caused by?
Estrogen loss
What is Hormone Therapy?
Estrogen with or without progestin
HERS Trials
Use of hormone therapy should not be recommended for the purpose of secondary prevention of CHD in postmenopausal women with established coronary disease
WHI Study
Overall risks exceeded benefits from use of combined estrogen plus progestin among health postmenopausal women
What are the NO longer recommended uses for hormone therapy?
- Mood and psychological well-being
- Treatment of urinary incontinence
- Prevention of heart disease
What are the therapeutic uses of estrogen?
- Vasomotor symptoms
- Urogenital atrophy
- Prevention of osteoporosis
Progestins do what for women with an intact uterus taking estrogen?
Decreases risk of endometrial hyperplasia and endometrial adenocarcinoma
What are the absolute contraindications for hormone therapy?
- Breast Cancer
- History of DVT/PE
- History of Stroke/MI
- Liver Dysfunction
- Undiagnosed abnormal genital bleeding
What are the relative contraindications for hormone therapy?
- Elevated BP
- Hypertriglyceridemia
- Hypothyroidism
- Fluid Retention
- Severe Hypocalcemia
- Ovarian Cancer
For Oral hormone therapy, Premarin and Estrace what are the pearls?
Commonly used route
CEE
What is CEE?
Conjugated equine estrogen
For Transdermal patch hormone therapy, vivelle-dot/estraderm/climara what are the pearls?
Commonly used route
Dosing frequency dependent on product
For Intra-Vaginal hormone therapy, Estrace cream/Estradiol Ring/Vagifem what are the pearls?
If used PRN for urogenital symptoms, will not prevent osteoporosis
Systemic absorption varies with products
Some vaginal preps require progestin co-administration
For Dermal hormone therapy, estradiol evamist what is the low dose and standard dose?
Low: 1 spray QD
Standard: 2-3 sprays QD
Spray on the Forearm
For patients with elevated triglycerides, what form of hormone therapy might be more beneficial?
Topical HT, avoids first pass metabolism becauses it bypasses the GI tract
Why are low doses of CEE now recommended?
Due to long-term risks of standard doses
What is the purpose of Progestins?
Progesterone decreases endometrial hyperplasia in women with an intact uterus
What are the hormone therapy dosing regimens?
- Cyclic
- Continuous (preferred)
- Combination Products
- Low Dose Combination Hormonal Contraceptive
What is the Annual Monitoring for HT?
- medical history
- physical exam including pelvic exam
- blood pressure management
- routine endometrial cancer surveillance
Hormone Therapy continues to have a viable role in treatment, but in preventative therapy it has
Diminished
Who are the most appropriate candidates for estrogen plus androgen therapy?
Women who have had their ovaries removed or with sexual dysfunction especially loss of libido
What androgen is co-administered with estrogen with a/e of virilization, fluid retention, lipid effects?
Oral Methyltestosterone
What are the CIs to oral methyltestosterone?
Mod/Severe Acne, Clinical Hirsutism, Androgenic Alopecia, and Androgen Dependent Neoplasia
What are the bio identical hormone therapies and are they recommended?
NO, estrone, 17-B estradiol, estriol, progesterone, testosterone, and dehydroepiandrosterone
What is the most effective therapy at relieving hot flashes?
Hormone Therapy
What the considerations for mild symptoms of VMS?
- Start with lifestyle changes
- Next step, non-hormonal option. Generally SSRI/SNRI first line
What are the considerations for moderate/severe symptoms of VMS?
- Risk vs. Benefit decision factoring in patients concurrent conditions/CIs
- HT may be considered
What are the lifestyle changes for VMS?
- Wearing layered clothing
- Avoiding triggers
- Exercising
What is Black Cohost, and how can it help VMS?
Not recommended cause of liver issues and inconsistent results
What is Soy Protein, and how can it help VMS?
Not recommended and inconsistent results
When should hormone therapy be stopped?
2-3 years, should be used in the lowest effective dose and for the shortest time period necessary
What is Tissue Selective Estrogen Complex TSEC?
Combines selective estrogen receptor modulator SERM and estrogen, considered as ALTERNATIVE to HT
What is the MOA of Gabapentinoids?
Modulation of calcium currents, thereby modifying adrenergic and serotonergic pathways of the pituitary hypothalamic region and impacting the thermoregulatory process
What is MOA of SSRIs?
Increases the availability of serotonin in the central nervous system as well as reducing LH
What are the urogenital symptoms?
Urogenital atrophy, vaginal dryness, and dyspareunia
HT remains the primary treatment for what?
Moderate/Severe symptoms of vulvar and vaginal atrophy associated with menopause
What is the therapy regimen of HT for urogenital symptoms?
When solely used for urogenital symptoms, vaginal HT should be considered for long-term use
When should non-estrogen vaginal gels/creams be used?
Relief of vaginal dryness used alone or with HT
When should SERM Osphen be used?
To improve mod/severe dyspareunia
What should Synthetic Steroid Prasterone be used for?
To prove mod/severe dyspareunia, avoid in women w/breast cancer
What are other urogenital symptoms?
Urinary Incontinence
Sexual Dysfunction
Decreased Libido
What can improve urinary incontinence?
Estrogen does not improve urinary stress incontinence, but vaginal estrogen may improve urge incontinence and overactive bladder
What do you give for decreased libido?
Androgen
Does estrogen improve psychological symptoms?
NO
When should initial follow up and maintenance follow up occur?
Initial = 6 wks
Maintenance = 1 year
What is the dosing for CEE/Premarin?
0.3 -0.45 mg QD
What is the dosing for Miconized 17B-Estradiol/Estrace?
1 mg QD
What is the dosing for 17B-Estradiol/Estraderm/Climara/Vivelle-Dot?
0.025 mg/hr, applied 1-2x/week
What is the dosing for 17B-Estradiol/Estrace Intravaginal?
1-3x/week
What is the dosing for 17B-Estradiol/Estring Intravaginal?
Insert ring every 3 months
What is the dosing for Estradiol Hemihydrate/Vagifem/Evamist Intravaginal/Dermal?
Insert tablet 2x/weel
1 spray to the forearm QD
What is the dosing for Methyltestosterone?
1.25-2.5 mg QD
What is Estrogen + Progestion PO Brand Name?
Prempro/Premphase
What is Estrogen + Progestin Transdermal Brand Name?
CombiPatch
What is Estrogen + Testosterone Brand Name?
Covaryx
