Menopause and HRT 4

Question 1

What are the factors determining whether or not cardinal symptoms of menopause should be treated?

Answer 1

• Severity
• Quality of life
• Risk/benefit profile

Question 2

What should all perimenopausal women be protected from?

Answer 2

• Pregnancy, use BC pill
  
  • also good for menstrual problems

Question 3

What is the mainstay of therapy for symptomatic perimenopausal women?

Answer 3

• Estrogen - use lowest possible dose for shortest amount of time
  
  • treat POF until patient reaches age of spontaneous normal menopause
• If a woman has a uterus, treat with estrogen and progesterone
  
  • counters the increased risk of endometrial cancer with just estrogen alone
• Avoid starting systemic hormone therapy > 10 years after FMP and/or in women over 60
  
  • increased risk of aging

Question 4

What is the risk/benefit profile for using oral estrogen and progesterone for perimenopausal symptoms?

Answer 4

• Increased risk of:
  
  • MI
  • breast cancer
  • stroke
  • VTE
  • gall bladder disease
• Decreased risk of:
  
  • colon cancer
  • hip fracture

Question 5

What is the risk/benefit profile for using estrogen alone for treatment of perimenopausal symptoms?

Answer 5

• Increased risk of:
  
  • stroke
  • VTE
  • gall bladder disease
• Decreased risk of:
  
  • MI
  • breast cancer

Question 6

What are the main methods and alternative methods for treating VMS in perimenopausal women?

Answer 6

• Lifestyle
  
  • layer clothes
  • no tobacco
  • limite alcohol
  • paced respiration
  • lower thermostat
• Systemic therapy
  
  • ​transdermal estrogen and oral micronized progesterone presumed to be the safest delivery methods
• Women who can’t take ET or E+PT:
  
  • SSRI antidepressants such as paroxetine or escitalopram
  • SNRI antidepressants - venalfaxine
  • Gabapentin
  • Clonidine

Question 7

What is the accepted therapy for vulvovaginal atrophy in perimenopausal women?

Answer 7

• Vaginal lubricants and moisturizers
• Maintain coital activity
• Dilators prn
• Local vaginal estrogen as creams, pills, rings

Question 8

What is the accepted therapy for depressive symptoms in perimenopausal women?

Answer 8

• Clinical depresssion not greated with menopause HT
• Estrogen can be adjunctive therapy
  
  • Depressive symptoms may be responsive