3 - Menopause Flashcards Preview

Year 3 - Clinical (Winter) > 3 - Menopause > Flashcards

Flashcards in 3 - Menopause Deck (17)
Loading flashcards...
1
Q

Define menopause, peri-menopause, and post-menopause

A
  • Menopause = permanent cessation of menses for 12 consecutive months due to the loss of ovarian function
  • Perimenopause = transition into menopause (beginning of sx; usually 2 years before menopause)
  • Post-menopause = 1 year after menopause & beyond
    • Women now spend 1/3 of their lives in post-menopause
2
Q

Sx of menopause

A
  • Vasomotor (“hot flashes”) – most common
  • Genitourinary
  • Mood changes
  • Sleep disturbance
  • Sexual function
  • Skin wrinkles
  • Hair thinning/loss
  • Joint pain; increased risk of osteoporosis
3
Q

Describe the vasomotor sx of menopause

A
  • Hot flashes or flushes, night sweats
  • Average duration of sx = 7-8 years
    • 60% have < 7 years; 15% persist > 15 years
  • ~80% perimenopausal women & ~40% postmenopausal women have hot flashes 3+ times/day
4
Q

Genitourinary syndrome of menopause

A
  • Associated w/ decreased estrogen, & will generally persist or worsen w/ aging
  • Vaginal atrophy doesn’t improve overtime (unlike hot flashes)
  • Genital – dryness, burning, itching, discharge, irritation
  • Urinary – loss of bladder control, recurrent UTIs
  • Sexual – lack of lubrication, discomfort/pain, impaired function
5
Q

Menopause quick 6 screen

A
  • Any changes in your periods? *
  • Are you having any hot flashes? *
  • Any vaginal dryness or pain or sexual concerns?*
  • Any bladder issues or incontinence? *
  • How is your sleep?
  • How is your mood?
  • If yes to any of the first 4 questions = may be a candidate for tx
6
Q

Goals of therapy for menopause

A
  • Relieve sx (vasomotor, urogenital, mood-related changes)
  • Improve QOL & well-being during & after this transition period
  • Minimize adverse effects of therapy (endometrial/breast cancer, MI, stroke, VTE)
7
Q

What are the pharm options for menopause?

A
  • Hormone tx (estrogen, combination estrogen & progestogen)
  • Non-hormone tx (SSRI, SNRI, gabapentinoids, clonidine)
8
Q

Who should get hormone therapy for menopause?

A
  • Unremitting sx affecting QoL
  • No absolute contraindications
  • Other non-drug options not effective
  • Risks and benefits discussed
  • Agree to limited duration of tx
9
Q

What are the contraindications to hormone therapy use in menopause?

A
  • Unexplained vaginal bleeding
  • Acute liver dysfunction
  • Estrogen-dependent cancer (endometrial & breast cancer)
  • Coronary heart disease, previous stroke, active thromboembolic disease
10
Q

Does hormone therapy work for menopause?

A

Most effective tx option for moderate to severe vasomotor sx

11
Q

What are the risks associated w/ hormone therapy use?

A
  • Increased risks of breast cancer, coronary heart disease, thromboembolic events, stroke
  • Continuing HT w/ the lowest effective dose beyond age 60 w/ clinical supervision may be considered in some circumstances
  • Women should be advised of the increased risks; HT should be individualized & not stopped solely based on age
  • Highest risk for breast cancer after 4-5 years of combo HT; ovarian cancer after 4 years; CV disease after 4 years in those age > 60, > 10 years after menopause
12
Q

What are the available formulations of hormone therapy? When should one be used over the other?

A
  • Systemic (combined vs. estrogen only; cyclic (sequential) vs. continuous; oral vs. transdermal)
  • Local (cream, ring, tablets)
  • If LMP < 1 year -> recommend cyclic timed to endogenous cycle; minimizes risk of breakthrough bleeding
  • If LMP > 1 year -> consider continuous to avoid monthly withdrawal bleed
  • Breakthrough bleeding generally resolves < 3-6 months (longer than this = referral)
  • Consider topical/ transdermal if increased CVD risk, HTN, DM, smoking, obesity, gallstones
  • Consider vaginal estrogen for urogenital sx b/c less systemic effect; ok even if breast cancer hx if failed non-hormonal tx
  • Low-dose vaginal estrogen (0.5 g twice/week) doesn’t necessitate a progestogen for women w/ a uterus
13
Q

What are the non-hormonal tx options for vasomotor sx?

A
  • SSRI (off-label)
  • SNRI (off-label)
  • Gabapentinoids (off-label)
  • Clonidine 0.05 mg BID (4-6 week trial)
  • Rule of thumb – low doses are often effective; start low & titrate up if necessary to minimize SEs; allow 2-4 weeks for effect
14
Q

Which NHPs are marketed for menopause? Do they work?

A
  • In general, these appear ineffective, but evidence is limited
  • Watch for DI’s & CI’s
  • Purity of compounds a concern
  • Soy/isoflavones – phytoestrogen w/ estrogenic effects? – may or may not be more effective than placebo
  • Black cohosh – modulation of 5-HT pathways? Estrogenic activity? – Cochrane review = no different than placebo
  • Dong quai, fennel, evening primrose oil – likely no better than placebo
15
Q

Describe some non-pharms for menopause

A
  • Useful – vaginal moisturizers (alternative to vaginal estrogen) for urogenital sx (vaginal dryness, dyspareunia)
    • Apply HS 3 times/week
  • Some evidence to support – weight loss, clinical hypnosis, cognitive behavioural therapy
  • Reasonable to try, but limited evidence – smoking cessation, healthy diet, cooling techniques, exercise, yoga, avoidance of triggers
  • Limited or no evidence, but potential harm/cost – NHPs, acupuncture
16
Q

Monitoring for menopause

A
  • Symptoms
  • When lower doses are used, the delay before adequate relief may by up to 6 weeks -> advise women to be prepared to wait 6-8 weeks before modifying the regimen
  • Side effects -> if secondary to progestin (ex: mood swings, bloating) may decrease dose by ½ or decrease duration by 7-10 days
  • Bleeding -> if bleeding heavy or erratic on sequential regimen, consider increasing progestin dose (ex: x2)
  • Women receiving MHT (menopausal hormone therapy) must be evaluated annually, w/ the risk-benefit profile as well as the woman’s expectations reviewed
  • Always use the lowest dose that adequately addresses sx & use for the shortest period of time
17
Q

Describe tapering of hormone therapy

A
  • Varying data about abrupt d/c vs. taper
  • Abrupt d/c may worsen VMS in first 3 months
  • Tapering methods:
    • Alternate doses of oral meds then reduce to lower dose
    • Drop 1 pill/week every couple of weeks