Hormones

Question 1

How is menopause defined?

Answer 1

12 months without a menstrual period

Question 2

What is the average age of menopause?

Answer 2

51 years old

Question 3

What is the 10-15 year time span from early symptoms of menopause until menopause is complete called?

Answer 3

Perimenopause

Question 4

What are the symptoms associated with altered levels of estrogen and progestin and androgens?

Answer 4

Hot flashes, vaginal atrophy, dryness, dyspareunia, and urinary incontinence

Question 5

What is the difference in HRT and ERT?

Answer 5

ERT is estrogen only hormone replacement therapy

Question 6

What type of estrogen is the most common to be produced in young women?

Answer 6

17-B estradiol

Question 7

What are the two major estrogen receptors?

Answer 7

A and B

Question 8

Where are alpha estrogen receptors mostly found

Answer 8

Breast, endometrium, and ovaries

Question 9

Where are the beta estrogen receptors more commonly found?

Answer 9

Bone, lung, and kidneys

Question 10

How does estrogen affect bone health?

Answer 10

They maintain bone density

Question 11

What are the three uses for exogenous estrogen?

Answer 11

Oral contraception, female hypogonadism, and hormone therapy for menopause

Question 12

What are the routes available for exogenous estrogen therapy

Answer 12

Oral, transdermal, intravaginal, and parenteral

Question 13

What is an advantage of using a non oral form of estrogen?

Answer 13

They bypass the first pass effect and therefore decrease adverse events like clotting and inflammation

Question 14

What are the adverse risks of estrogen therapy?

Answer 14

Endometrial hyperplasia and carcinoma, breast cancer, and ovarian cancer.

Question 15

What organs produce progestins ?

Answer 15

Ovaries and placenta

Question 16

What affect does progestin have on the reproductive body organs?

Answer 16

It thickens the endometrial lining, prepares the uterus for pregnancy, thickens cervical mucus, and breast development

Question 17

What affect does progestin have on non reproductive hormones?

Answer 17

Increases fat deposition m, increases basal insulin levels, increases body temp

Question 18

What are the adverse effects of progestin therapy?

Answer 18

Teratogenic effects, breast cancer, breast tenderness, depression

Question 19

What are the different types of hormone therapy used?

Answer 19

Estrogen alone, combo of estrogen and progesterone, SERMs, and progestogen alone.

Question 20

What are bioidenticals?

Answer 20

Hormones that have the same structure as the bodies naturally produced hormones

Question 21

What should you educate patients on requesting custom compounded hormones?

Answer 21

They are not tested for safety or efficacy, and may not contain the amount of hormone listed in the packaging.

Question 22

What are the symptom indications for hormone therapy?

Answer 22

To relieve or prevent symptoms like vasomotor symptoms, urogenital symptoms, and prevention of osteoporosis

Question 23

When is hormone therapy contraindicated?

Answer 23

History of breast it endometrial cancer, liver disease, hypertriglyceridemia, clotting disorders, vaginal bleeding, endometriosis, and fibroids

Question 24

How long after starting hormone therapy are you at risk for breast cancer?

Answer 24

5 years after continuous tx

Question 25

What should you asses patients for that are treating with HRT?

Answer 25

Physical exam, CBC, UA, lipid profile, CMP, HGA1C, mammogram, Pap smear, and a biannual pelvic exam

Question 26

What test should you do if post menopausal bleeding occurs on HRT?

Answer 26

A transvaginal ultrasound or endometrial biopsy

Question 27

What are the guidelines for prescribing hormone therapy?

Answer 27

Lowest dose and shortest time frame, monitor annually for risk profile and AEs, only start at menopause.

Question 28

A progestin is included in regimens for HRT to prevent what adverse effect?

Answer 28

Endometrial cancer

Question 29

What did the women’s health initiative find in there study?

Answer 29

Estrogen + progestin resulted in increased MI, CVA, DVT, breast cancer. But a reduced rain for CRC and less fractures. Estrogen alone- increased risk for CVA, DVT, and reduced CRC

Question 30

What are the recommendations from WHI in prescribing HRT?

Answer 30

HT should not be prescribed to prevent heart disease, consider risk vs benefit for initiating HT in osteoporosis, consider alternative therapies like calcium + vit D, weight bearing excersize, bisposphonates, and SERMs

Question 31

What are the recommendations for osteoporosis prevention?

Answer 31

Weight bearing/muscle strengthening exercise, adequate dietary and supplement intake of Vit d and calcium (women 12,00mg calcium a day or 800-10000 IU vit D).

Question 32

Which three groups of people are pharmacological in treatment of osteoporosis indicated in?

Answer 32

Anyone 50+ with hip or vertebral fracture, anyone who’s T score on DEXA scans are < 2.5 at femoral neck, hip, or lumbar spine, and post menopausal women 50+ with osteoporosis by DXA and a 10 y/o hip fracture risk of >3%

Question 33

What are the pharmacological options for osteoporosis?

Answer 33

Biophosphonates, calcitonin, SERM, estrogens, parathyroid hormone analog, monoclonal antibody

Question 34

What is the bisphosphonate used for osteoporosis

Answer 34

Alendronate

Question 35

What is the SERMs used for osteoporosis?

Answer 35

Raloxifene, bazedoxifene

Question 36

What is the parathyroid hormone analog used in osteoporosis treatment?

Answer 36

Teriparatide-forteo

Question 37

What is the mab used for osteoporosis treatment?

Answer 37

Denosumab

Question 38

T or F natural estrogens are more hazardous than synthetic estrogens

Answer 38

F there is no proof that they are more or less hazardous

Question 39

T or F bioidentical means custom compounded hormones

Answer 39

F

Question 40

T or F you can use estrogen in pregnancy

Answer 40

F

Question 41

Which states have the highest the lowest unintended pregnancy rates?

Answer 41

Mississippi and Massachusetts

Question 42

What is the main synthetic estrogen?

Answer 42

Ethinyl estradiol

Question 43

How does estrogen prevent ovulation?

Answer 43

It suppresses LH and FSH

Question 44

What are the adverse effects of oral contraceptive estrogen?

Answer 44

Nausea, increased breast size and tenderness, fluid retention, leukorrhea, headaches, early breakthrough bleeding.

Question 45

What is the common reason for discontinuation of low dose estrogen oral contraceptives?

Answer 45

Bleeding pattern disruptions

Question 46

What increases the risk of VTE on oral estrogen therapy?

Answer 46

Obesity and older age

Question 47

Which group of women should never be prescribed oral estrogen contraceptives

Answer 47

Women over the age of 35 who smoke

Question 48

What biliary disorders are associated with oral estrogen contraceptives?

Answer 48

Hepatic adenomas and gallstones

Question 49

How does progestin affect fertility?

Answer 49

It supresses the endometrium, thickens cervical mucus, and inhibits ovulation

Question 50

What are the adverse effects of progestin oral contraceptives?

Answer 50

Irregular bleeding, follicular cysts, acne, breast tenderness, melasma

Question 51

What are the two phases of a cycle?

Answer 51

Follicular phase: onset of menses to the LH surge Luteal phase: behind the day of LH surge and ends at the onset of the next menses

Question 52

When are serum estradiol and progesterone concentrations low in a natural cycle?

Answer 52

Early follicular phase

Question 53

Which hormone rises during the follicular phase to support the development of endometrium?

Answer 53

Estrogen

Question 54

Which two hormones are secreted by the ovaries

Answer 54

Estrogen and inhibin

Question 55

What are the four major subgroups of combo oral contraceptive pills?

Answer 55

Monophasic, biphasic, triphasic, and quad/four phasic

Question 56

When are POP contraceptives preferred?

Answer 56

Women are breastfeeding or an older reproductive age.

Question 57

When is extended cycle oral contraceptives used?

Answer 57

Endometriosis, PMS, hyperandrogen conditions, PCOS, or just for conscience of not having a period.

Question 58

What are the pros to treating with a progesterone and estrogen combo oral contraceptive?

Answer 58

Decreased riskfor some types of cancer, suppression of PMS, treatment of acne and hirsutism, improvement bleeding fibroids in endometriosis

Question 59

Which type of cancer does the combo oral contraceptive put you at a higher risk for

Answer 59

Cervical cancer and maybe breast (conflicting)

Question 60

When is the combo oral contraceptive pill absolutely contraindicated?

Answer 60

History of 🫶🏻 disease, thrombogenic mutations, smoking, DM, HTN, a Fib, bacterial endocarditis, breast cancer, lupus, cirrhosis or HCC, anyone less than 6 weeks postpartum, migraines with aura

Question 61

What drugs decrease effectiveness of combo oral contraceptives?

Answer 61

Anticonvulsants (except valproic acid), rifampin, griseofulvin, protease inhibitors, and St. John’s wart

Question 62

What can increase the effect of oral contraceptives?

Answer 62

Fluconazole and grapefruit juice

Question 63

How do anti microbials affect oral contraceptives?

Answer 63

They decrease flora and can result in lower drug serums. (PCN and tetracyclines)

Question 64

What are the options for non oral contraceptives

Answer 64

Transdermal patch, intravaginal, progestin injections, progestin implants, intra uterine devices

Question 65

What is the transdermal patch made of?

Answer 65

3 layers: an outer protective layers, a middle layer with the two hormones ethinyl estradiol and norelgestromin or levonorgestrel, and an inner layer that is removed prior to applying to the skin.

Question 66

How are the contraceptive patches used?

Answer 66

They are worn once a week for three weeks and then then a 1 week break.

Question 67

What are the advantages of using a transdermal contraceptive patch?

Answer 67

No daily fluctuations in hormone levels, no first pass metabolism, lower dose required, improved adherence, and immediate cessation of drug with removal of the patch

Question 68

What are the disadvantages of the transdermal patch?

Answer 68

Higher risk of VTE, more breakthrough bleeding in the first 2 months, and less effective more women with a BMI over 30

Question 69

What should you do if a vaginal ring falls out?

Answer 69

Rinse with cool water and reinsert within 3 hours.

Question 70

T or F the vaginal ring is associated with less breakthrough bleeding

Answer 70

T

Question 71

What are some contraindications or the vaginal ring?

Answer 71

Undiagnosed abnormal genital bleeding

Question 72

What is the box warning for all estrogen containing contraceptives?

Answer 72

Cigarette smoking increases CV risk

Question 73

What are the progestin only non oral birth control methods?

Answer 73

Depo-provera shot, IUD, and etonigestrel subdermal implant

Question 74

What are the two major downsides or progestin only therapy ?

Answer 74

They decrease fertility to several months after stopping, and they have an increased risk for bone density loss

Question 75

What do the plan b contraceptives contain?

Answer 75

Progestin only

Question 76

What is one way you can use regular BC as emergency contraception?

Answer 76

Take 4-5 tabs every 12 hours for two doses

Question 77

How long after sex can emergency contraceptives be taken?

Answer 77

Up to 120 hours

Question 78

At what BMI is emergency contraceptives less effective?

Answer 78

30

Question 79

Up to how soon after vomitting should you repeat emergency contraceptive use?

Answer 79

3 hours

Question 80

When should you start the depo shot?

Answer 80

Within 5 days of onset of menses or 6 weeks postpartum if breastfeeding