Women’s Health Issues Associated with Menopause Exam 3 Flashcards
Perimenopause
- period immediately prior to menopause
- inconsistent production of mature follicles
- ovaries become resistant to FSH, LH
Menopause
permanent cessation of menses following the loss of ovarian follicular activity
Natural menopause
- normal aging process and occurs as a result of ovarian follicle depletion
- 12 consecutive months of amenorrhea in the absence of any other physiological cause
- 45-55 yo
Induced menopause
- surgical menopause
- hysterectomy +/- bilateral oophorectomy
- ovarian damage from other medical means
Postmenopause
time after a woman has undergone menopause
Hormone changes associated with menopause: Estrogen and progesterone
- no longer secreted by ovaries
- source of estrogen comes from other glands and adipose tissue
Hormone changes associated with menopause: Androgen
- ovarian stroma may become fibrotic and a poor source of sex steroids
- do not decrease as rapid as estrogen since it’s produced by adrenal gland
Hormone changes associated with menopause: FSH levels
- Perimenopause: FSH on day 2 or 3 of menstrual cycle > 10-12 IU/L.
- At menopause or postmenopause, FSH increased to > 40 IU/L and estradiol concentrations decreased by >90% .
Clinical characteristics: Vasomotor symptoms (VMS)
- perception of intense heat (hot flash) and subsequent cooling by cutaneous vasodilation (skin flushing), perspiration, and chills
- can affect activities of daily living
- occur first two years of menopause
Clinical characteristics: Psychological symptoms
- insomnia
- mood changes
- memory loss
- anxiety
- depression
- symptoms of PMS can worsen during periM but improve postM
Clinical characteristics: Atrophic vaginitis / genitourinary symptoms
- Urogenital atrophy
- dryness, burning, dyspareunia, loss of vaginal secretions, and vulvar pruritus
- urethral discomfort, frequency, dysuria, stress incontinence, and increased UTIs
Clinical characteristics: Osteoporosis
low bone mass and increased fracture risk
Clinical Evidence for uses of Hormone Therapy
- benefits for osteoporosis and heart disease
- long term conjugated estrogen with or without medroxyprogesterone found a reduction in fracture, but an increase in breast cancer, CHD (during the first year), stroke, and DVT/PE.
Hormone Therapy: Estrogen
- Treatment of vasomotor symptoms
- Treatment of urogenital atrophy
- Prevention of osteoporosis
- Clearest benefit in healthy women < 60 years of age or within 10 years of menopause
Hormone Therapy: Progestins
- Decreases risk of endometrial hyperplasia and endometrial adenocarcinoma in women with an intact uterus taking estrogen.
- May also result in further reduction in vasomotor symptoms.
Hormone Therapy Contraindications
- Breast cancer
- History of venous thromboembolism (DVT/PE)
- History of arterial thromboembolism (stroke, MI)
- Liver dysfunction
- Undiagnosed abnormal genital bleeding
Hormone Therapy RELATIVE Contraindications
- Elevated blood pressure (uncontrolled)
- Hypertriglyceridemia (uncontrolled)
- Hypothyroidism
- Fluid retention
- Severe hypocalcemia
- Ovarian cancer (also endometrial and cervical)
Hormone Therapy uses
- Treatment of moderate to severe vasomotor symptoms
- Treatment of moderate to severe urogenital atrophy
- Prevention of osteoporosis
Androgen uses
- improved libido and bone mass in perimenopausal and postmenopausal women with androgen deficiency
- used for women who have had their ovaries removed
- used for women with sexual dysfunction
Lifestyle modifications for Vasomotor Symptoms
- Wearing layered clothing
- Avoiding triggers
- Exercising for as little as 1-2 hours/week has shown benefit.
- If only mild symptoms are present, symptoms will often be alleviated by lifestyle modifications.
Nonprescription Therapies for Vasomotor Symptoms
- Black cohosh
- Soy protein
Prescription Therapies for Vasomotor Symptoms
- Bazedoxifene / conjugated estrogens (Duavee®)
- Gabapentin (Neurontin®)
- Medroxyprogesterone (Provera ®)
- Serotonin (and Norepinephine) Reuptake Inhibitors
Prescription Therapies for Vasomotor Symptoms: Duavee®
- used for vasomotor symptoms
- Bazedoxifene / conjugated estrogens
- Should be considered as an alternative to HT (estrogen / progestin)
Prescription Therapies for Vasomotor Symptoms: Serotonin (and Norepinephine) Reuptake Inhibitors
- Paroxetine (Paxil®)
- Fluoxetine (Prozac®)
- Venlafaxine (Effexor®)
- Desvenlafaxine (Prestiq®)
VMS Treatment Approach
- Mild symptoms: start with lifestyle changes, SSRI/SNRI are first line for pharmacological therapy
- Moderate to severe symptoms: Risk vs benefit decision factoring in patients concurrent conditions and contraindications, may start hormone therapy
Pharmacological therapy for Urogenital Symptoms
- Replens
- Selective estrogen receptor modulator SERM
- Synthetic Steroid
Urogenital Symptoms
- Urogenital atrophy
- vaginal dryness
- dyspareunia
- Urinary incontinence
- Sexual dysfunction and decreased libido
Pharmacological therapy for Urogenital Symptoms: Replens
- Some relief of vaginal dryness can be achieved
- They can be used alone or in conjunction with HT
Pharmacological therapy for Urogenital Symptoms: Selective estrogen receptor modulator SERM
- Ospemifene (Osphena®)
- Improves moderate to severe dyspareunia associated with urogenital atrophy
Pharmacological therapy for Urogenital Symptoms: Synthetic Steroid
- Prasterone (Intrarosa®)
- Use with caution in women with h/o breast cancer
- Improves moderate to severe dyspareunia associated with urogenital atrophy
