Women's Health Review

Question 1

What is the brand name and dose of Paroxetine approved to treat menopause?

Answer 1

Brisdelle 7.5 mg

Question 2

Which symptoms of menopause does Brisdelle treat?

Answer 2

Vasomotor symptoms (hot flashes)

Question 3

What adverse effects have been seen with Brisdelle?

Answer 3

Headache, fatigue, nausea/vomiting

Question 4

Which 4 specific drugs are mentioned as interactions with Brisdelle in the article?

Answer 4

Codeine (decreased analgesic effect), Tamoxifen (decreases efficacy of tamoxifen in pts being treated for breast cancer), Metoprolol (INCREASED serum concentrations). MAOI (wait 14 days)

Question 5

What are the primary symptoms of menopause?

Answer 5

Vasomotor (hot flashes) and genitourinary (thin, dry vaginal lining)

Question 6

Why should a woman with a uterus not take an estrogen only product?

Answer 6

Endometrial hyperplasia and adenocarcinoma

Question 7

What are the serious potential adverse effects of taking an estrogen + progestin product?

Answer 7

Coronary heart disease, stroke, venus thromboembolism and breast cancer.

Question 8

Based on the article for class, should we recommend bioidentical hormone products?

Answer 8

No, there is “no acceptable evidence” that these products are effective OR safe, and the potency can vary.

Question 9

Which of the CAM options mentioned in the article have strong evidence for use in menopause? (Soy, black cohosh etc)

Answer 9

None of them are recommended by the article. “No acceptable evidence”

Question 10

What are the options for a menopausal women who cannot take hormonal therapies?

Answer 10

Anti-depressants and vaginal lubricants

Question 11

A woman presents with only vaginal menopausal symptoms, what is your first recommendation?

Answer 11

A vaginal estrogen formulation (such as estrace or premarin cream)

Question 12

Which anti-convulsant has been reported to reduce hot flashes? (It’s not FDA approved for this use)

Answer 12

Gabapentin

Question 13

Which contraceptives are the most effective?

Answer 13

IUD, progestin implant and sterilization

Question 14

Which contraceptive methods have the highest rate of failure?

Answer 14

barrier and fertility methods

Question 15

What is the problem with oral contraceptives with < 20 mcg of ethinyl estradiol?

Answer 15

higher risk of failure and changes in bleeding patterns.

Question 16

What is the difference between monophasic and multiphasic oral contraception?

Answer 16

Monophasic contains fixed doses in each active pill. Multiphasic vary the dose in one or both hormones in each active pill.

Question 17

What is the proposed benefit of multiphasic oral contraception?

Answer 17

Many multiphasic packs have a lower total hormone dose per cycle BUT there is no convincing evidence that they cause fewer adverse effects or improve cycle control.

Question 18

Which low dose contraceptive is taken for 365 days with no pill free or placebo interval?

Answer 18

Lybrel

Question 19

What are the benefits of shorter or fewer hormone free intervals?

Answer 19

Theoretically might decrease the risk of ovulation and unintended pregnancy but clinical data is lacking. Studies suggest they result in fewer menstrual symptoms such as headache, bloating and pain.

Question 20

Why was Levomefolate added to Beyaz?

Answer 20

To decrease the risk of neural tube defects in babies conceived during or shortly after use of oral contraceptives.

Question 21

Women on the pill have a reduced risk of which types of cancer?

Answer 21

epithelial ovarian and endometrial cancer