Hormonal Replacement Therapy: Phillips Flashcards Preview

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Flashcards in Hormonal Replacement Therapy: Phillips Deck (48):
1

What is menopause definition?

One year without menses
FSH >30

2

What is perimenopause?

Symptoms as we get close, 45-55

3

What is the average age of menopause?

51 or 52

4

What causes earlier menopause?

smoking!

5

What is post menopause?

>55
or after menopause

6

What was the avg age of menopause/death 1932?

meno: 51
death: 52

7

What is the avg age of meno/death today?

Meno: 51
death: 87
Women spend 1/3 their life in menopause

8

When does reproductive life usually end?

43, earlier or later

9

What rises hormonally? lowers?

Rises: FSH
Lower: Estrogen

10

Why do women start HRT?

Symptoms
Osteoporosis
CV disease
Anxiety and depression

11

MC Sx?

Hot flash: gonadotrpin spikes as much as estrogen deficiency
skin and vasodilation makes heat

12

When do hot flashes happen?

Night... then cooling effect: 5 times a night, sleep disturbance

13

What race is most likely to have hot flashes?

Black>white>chinese>hispanic

14

Tx for HRT?

Estrogen with
Progestin: prevents endometrial cancer

15

What is true for drugs in terms of placebo effect?

Just about anything helps... due to placebo effect

16

What % of people will have tried self treatment before seeing doctor?

40%

17

Soy products relate how to placebo?

Same as placebo... but there is a huge placebo effect

18

If a woman has had a hysterectomy, what is notable about HRT?

No PROGESTIN... no endometrium to prevent cancer in

19

What happens to vagina in menopause?

Vaginal atrophy

20

What sexual symptoms are not associated with menopause?

Depression
Lack of sex interest
Going crazy

21

What is dyspareunia?

Pain with intercourse

22

What tx for vaginal pain?

Vaginal Estrogen... no need for progestins since not systemic.
Local or systemic.

23

What medical illnesses are associated with menopause?

Osteoporosis
Heart disease
Cancer

24

Bone mass peaks at what age?

18-31

25

Estrogen therapy has been approved for prevention but not treatment?

osteoporosis

26

When do bone density scans begin?

65 unless risk factors

27

HRT decreases what risk?

Fracture risk

28

What is the WHI?

Women's Health Initiative

29

What were WHI questions?

CVD reduced with HRT?
Breast cancer caused by HRT?

30

What are the top 3 killers of older women?

CV disease

31

What is notable about CV in hormones?

Women were protected until menopause
it gets worse after menopause
estrogen: increases good vascular changes

32

When do CV complications show up, meet mens stats?

age 65

33

What is the major problem with observational studies?

BIAS in introduced

34

What did observational studies show for HRT?

CV protection

35

What is the gold standard trial?

Double blind
placebo
randomized
control trial

36

What were WHI results in 2002?

Women are MORE likely to have CV heart attacks!

37

If you are before menopause HRT does what?

Positive: vascular remodeling
Decreased intimal thickening
Decreased plaques

38

If you are after menopause HRT causes what?

Over 65 HRT: Plaques are already formed...
Estrogen is thrombogenic: cuts off artery
Adverse effect was in first year!

39

When did women have heart attacks in HRT WHI study?

within 1 year

40

What correlates to risk of MI with HRT?

Years since menopause... >20 years increased risk 66%

41

When does breast cancer risk increase in HRT?

With use beyond 5 years

42

What is absolute risk in WHI for breast cancer?

4-6 additional invasive cancers/10,000 women/yers with use of HRT for >5 years

43

Progestin causes risk for what? Estrogen causes cancer risk for what?

Progestin: breast
Estrogen: endometrial

44

What is sum of breast cancer risk in HRT?

Increase risk of breast cancer is seen in 3-5 years of continuous EPT therapy

Progestin adds to the risk

The risk is small

45

What happens to BC risk after HRT is terminated?

Returns to baseline

46

Who should be really worried about HRT?

Breast cancer family history

47

What is key to deciding HRT?

Individualization
Have a convesation
Weigh osteoporosis risk and CV risk

48

Patch decreases what in estrogen? How?

Clotting risk: avoids first pass through liver and those effects