Women's Health - MHT Flashcards
MHT gets graded D for ___ of disease
prevention
MHT is composed of…
(3)
- estrogen only
- estrogen and progestin
- estrogen and SERM
Indications for MHT
- ___ symptoms
- ____ atrophy
- ___ prevention (not a main reason for MHT)
- Vasomotor
- Vulvovaginal
- Osteoporosis
Absolute Contraindications to MHT
- Unexplained ___ bleeding
- Pregnancy
- Endometrial and ___ cancer
- ___ and thromboembolic
disorders (or prior history) - Active ___ disease
- vaginal
- breast
- stroke
- liver
Estrogen Monotherapy Oral Products
- Premarin® (___ estrogens)
- Menest® (___ estrogen)
- Estrace® generics (___ estradiol)
- conjuagted
- esterified
- micronized
Estrogen Monotherapy Oral Transdermal Products
- Alora®
- Climara®
- Menostar®
- Minivelle®
- Vivelle®
- Vivelle-dot®
Other Estrogen Monotherapy Topical Products
- topical gel (Estrogel, Divigel, Elestrin)
- topical spray (Evamist)
Estrogen Monotherapy Intramuscular Injections
- Estradiol cypionate (___)
- Estradiol valerate (___ )
- Depo-Estradiol
- Delestrogen
Estrogen Monotherapy Intravaginal Products
- vaginal cream (___ , ___)
- vaginal insert (___)
- vaginal tablet (___, ___)
- vagnial ring (___, ___)
- Premarin, Estrace
- Imvexxy
- Vagifem, Yuvafem
- Estring, Femring
Femring needs a progestin (highly absorbed systemically)
Critical factors in determining whether hormone therapy reduces or increases risk of ___:
___ and ___
CHD
* time since menopause
* age of initiation
(E+P) Women with intact uterus was significantly associated with a ___ risk of breast cancer.
(Mono E) Women with prior hysterectomy had significantly ___ risk of breast cancer
- higher
- lower
Menopausal Hormone Therapy: Current Recommendations
Initiation of treatment should be limited to women Age < ___ OR Within ___ years of last period
60
10
Methods of Administration: Combined Estrogen and Progestin
(4)
- continuous cyclic
- continuous combined
- continuous long cycle
- intermittent combined
Continuous Cyclic Therapy
- AKA ___
- Estrogen administered ___
- Progesterone administered at least ___ days out of a 28 day cycle
- scheduled ___ bleeding (90%)
- preferred in ___ menopausal women
- Sequential treatment
- daily
- 12-14
- withdrawal
- recently
Continuous Cyclic Therapy Example 1/2
Premphase
Route: ___
Estrogen Component: ___
Progestin Component: ___
- oral
- conjugated estrogens
- medroxyprogesterone acetate
Continuous Cyclic Therapy Example 2/2
Combipatch
Route: ___
Estrogen Component: ___
Progestin Component: ___
- transdermal
- estradiol
- norethindrone acetate
Continuous Long Cycle
- Rare
- AKA ___
- Estrogen administered ___
- Progesterone administered at least 12-14 days every other ___
- results in ___ scheduled bleeding times per year
- unclear endometerial safety data
- “cyclic withdrawal
- daily
- month
- 6
Continuous Combined
- ___ estrogen and progesterone
- Results in endometrial ___ and absence of vaginal bleeding
- Initial ___ spotting or bleeding which usually resolves within ___months
- Recommended for women ___ years post-final menstrual period
- ___ long-term endometrial protection
- daily
- atrophy
- unpredictable, 6-12
- > 2
- BEST
Continuous Combined Oral Examples 1/5
Prempro
Estrogen Component:
Progestin Component:
- conjugated estrogens
- medroxyprogesterone acetate
Intermittent Combined Example
Prefest
Route:
Estrogen Component:
Progestin Component:
- oral
- estradiol
- norgestimate
Treatment of Moderate-Severe Dyspareunia
Ospemifene (Osphena®)
* SERM
* agonist: ___, uterus
* Black Box Warning: ___ cancer, stroke, VTE
* ___ mg once daily in postmenopausal women
* take with ___
* SE: discharge, endometrial hyperplasia, and ___
- vagina
- endometrial
- 60 mg
- food
- hot flashes
Similar precautions to estrogen therapies
Treatment of Moderate-Severe Dyspareunia
Prasterone (Intrarosa)
* Inactive ___ converted to active estrogen and androgen
* ___mg qd qhs in postmenopausal women
* no black box warning
* Contraindications: ___ vaginal bleeding
* Avoid if history of ___ cancer
* SE: vaginal ___
- DHEA
- 6.5mg
- undiagnosed
- breast
- discharge
Estrogen-based regimen remain the first line for vulvovaginal atrophy
