211 - Menopause and HRT Flashcards Preview

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Flashcards in 211 - Menopause and HRT Deck (14)
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Who should be treated with hormone replacement therapy?
(In the context of menopause)

People with...

  • Moderate to severe vasomotor symtpoms that affect their quality of life
  • NO contraindications
    • Cannot have hormone-sensitive breast cancer, CHD, VTE, Liver disease, unexplained vaginal bleeding
  • LMP less than 10 years ago



If estrogen hormone replacement therapy is only indiated for perimenopausal people with vasomotor symtoms, what treatments are avilable for patients experiencing vulvovaginal symptoms?


  • Topical estrogen 
  • Lubricant, moisturizer, dilator
  • SERM

Don't start systemic therapy if sx are only local



  • FSH is elevated post-menopause
  • In the transition period, it will fluctuate; not super helpful to measure

Changes in menstrual bleeding patterns = better predictor of menopausal stage than serum FSH during transition

Heavy periods -> lighter/spaced out -> no more periods


List 3 new health problems that are more likely to arise after menopasue

  • Depression
  • Osteoporosis
    • Associated with estrogen deficiency
    • Associated with estrogen decline


But estrogen hormone therapy is currently not indicated to prevent CHD (useful in preventing osteoporosis)



  • Estrogen contraindicated in patients with hx of breast cancer
  • SSRIs contraindicated in pts on tamoxifen



Describe the hormonal changes that occur in perimenopause

  • Initially, decreased inhibin B
  • -> loss of feedback inhibition, resulting in increased FSH 
  • -> Temporarily increases estrogen from ovary
    • ​-> heavy menstrual periods
  • -> Follicle continues to deplete
  • -> Can no longer respond to increasing FSH
  • -> estrogen falls


Also - Anti-mullerian hormone diminishes during perimenopause


Thank you @Frank!


Describe the vasomotor symptoms associated with menopause

  • Flushing
  • Increased HR/palpitations
  • Sweating followed by chills
  • Hot flashes

The menopasue FISH!


Which cancer drug is an absolute contraindication for SSRIs?


Typical pt: Hx of breast cancer, on tamoxifen

Cannot give estrogen therapy or SSRI; use SNRI (venlafaxine)


What hormones should be used for hormone replacement therapy?

Estrogen is the hormone that will treat vasomotor sx

  • If the pt has a uterus, estrogen + progestin
    • Unopposed estrogen -> endometrial cancer
  • If the patient does not have a uterus, can use estrogen only





List the contraindications to hormone replacement therapy (7)

  • Vaginal bleeding (unexplained)
  • Liver disease (active)
  • VTE or PE (previous)
  • Thrombophilia
  • HTN (untreated)
  • Estrogen-dependent neoplasia
  • Hx of CHD, Stroke, TIA




B: Topical estroen

  • Safe in pts with hx of breast cancer
  • Don't need systemic therapy if sx are only local
  • Offer vaginal moisturizer if pt wantst to avoid estrogen





  • B is post-menopausal (>1 year since LMP)
  • C has primary ovarian insufficiency



What changes in menstrual cycles are likely to occur during perimenopause?

  • At first, periods become heavier
    • As ovarian estrogen is upregulated in response to increasing FSH
  • Then, they become lighter and mose spaced out
    • Follicle is depleted, can no longer respond to increasing FSH
  • Finally, they stop completely



Which gonadotropin is most reliably elevated in a post-menopausal female?


(But may fluctuate wildly during transition!)