FSH level in menopause
> 40 mIU/mL
hormone therapy indications
- moderate to severe vasomotor symptoms (hot flashes, night sweats)
- vulvovaginal atrophy (vag dryness & dyspareunia-painful sex)
- prevention of postmenopausal osteoporosis
contraindications to HT
- active or history of thromboembolism
- CHD
- stroke or TIA
- history of breast cancer or estrogen dependent neoplasm
- prego
- active liver disease
- undiagnosed vaginal bleeding
HT black box warnings
- increase risk of breast cancer
- increase risk of dementia
- increase risk of endometrial cancer
- should not be used to prevent CHD
- should be used the shortest term possible
non-pharmacologic treatment
smoking cessation, limit alcohol & caffeine, limit hot beverages & spicy foods, dress in layers, reduce stress, increase exercise, deep slow breathing, water-based lubes, kegel exercises
Estrogen recommendation in menopause
LOWEST effective dose for SHORTEST amount of time possible
women taking estrogen with an INTACT uterus need
progesterone to prevent endometrial hyperplasia and endometrial cancer
topical products for women only experiencing
vulvovaginal atrophy
continuous cycle hormone therapy
- estrogen & progesterone for 12-14 days each month
- menses return for 1-2 days after last progesterone dose
- withdrawal bleeding shorter and lighter than typical menstrual cycle
- less spotting or break through bleeding
- if pt is menstruating, start estrogen on day 5 and continue for 3 weeks
continuous combined hormone therapy
- estrogen and progesterone administered daily
women do NOT experience withdrawal bleeding - may experience unpredictable break-through bleeding for 6-12 months
- best for women 2 years post-menopausal due to unpredictable bleeding
continuous long cycle hormone therapy
- aka cyclic withdrawal
- estrogen is given daily
- progesterone is given every other month for 12-14 days
- results in 6 periods per year
- bleeding may be longer and heavier than continuous cyclic
intermittent combined hormone therapy
- aka continuous-pulse of pulse-progesterone
- estrogen therapy alone for 3 days followed by combined estrogen & progesterone for 3 days. then repeat
- lower incidence of uterine bleeding
- may be better tolerated
estrogens
- premarin, cenestin. menest, estrace, femtrace, ogen
progesterones
- provera, prometrium, aygestin
combined products
- prempro, premphase, angeliq, femHRT, activella, ortho-prefest
low-dose hormone therapy
- decreases hot flashes, improved vulvovaginal atrophy, increased bone mineral density, and endometrial protection
low-dose hormone therapy drugs
CEE, synthetic equine estrogens, oral micronized 17 B-estradiol, transdermal 17 B-estradiol, esterfied estrogens, estropipate
androgen treatment indications
- treatment of moderate-to-severe vasomotor symptoms associated with menopause not improved by estrogens alone
- may improve issues with sexual function such as decrease libido and decreased pleasure
androgen therapy drugs
- covaryx HS- esterified estrogens 0.625mg and methyltestosterone
- covaryx- esterified estrogens 1.25mg and methyltestosterone 2.5mg
counseling points
- take oral products with food to minimize GI distress
- symptoms may improve in as early as a few days-weeks
estrogen ADE
- common: N, HA, bloating, breast tenderness, bleeding
- serious: CHD, stroke, VTE, breast cancer, gallbladder disease
progesterone ADE
- comon: N, HA, weight gain, bleeding, irritability, depression
- serious: VTE, decreased bone mineral density
Managing ADE
- reduce dose, change preparation, change administration- transdermal may have less ADE
application sites of transdermal patch
trunk, preferably abdomen
- rotate sites, wait at least 1 week before site is used again
