HRT Flashcards
Perimenopausal cycles are associated with
Elevated and irregular follicle-stimulating hormone
Decreased inhibin
Normal luteinizing hormone
Slightly elevated estradiol levels
Menopause is considered to have occurred when there is no menses for
12 months
The average age of menopause is
51 years of age (95% between ages of 45 and 55 years).
Vasomotor symptoms are caused by
fluctuations in estrogen levels
Vaginal changes are caused by
low estrogen levels
Primary goal of MHT
relieve hot flashes but can help with sleep disturbances, mood lability/depression, and in some cases, joint aches and pains
Hot flashes require
systemic estrogen, GU syndrome of menopause (GSM) – treat with low-dose vaginal estrogen
Exogenous estrogens work like endogenous estrogens - Examples
Estradiol
Equine estrogen
Esterified and micronized estrogen
Exogenous progestins work like endogenous progestins - Examples
Medroxyprogesterone
Norethindrome
Micronized progesterone
HRT: Goals of Treatment
Provide relief from symptoms associated with menopause. Prevent or reduce vasomotor symptoms. Prevent or reduce vaginal atrophy. Reduce risk for osteoporosis. Ensure benefits of HRT outweigh risks.
Guidelines for indvidual approach
Based upon calculating women’s baseline CV and baseline risk prior to initializing therapy
Menopausal hormonal therapy (MHT) indicated for management of menopausal symptoms but not the prevention of CVD, osteoporosis, or dementia
Benefits outweigh risk for most symptomatic women who are either under age 60 y.o. or less than 10 years from menopause
Cardiac disease:
HRT not recommended
Breast cancer:
HRT may promote it; inconclusive evidence in younger women, but definite in older adults
Colon cancer:
HRT decreases risk
Osteoporosis:
HRT reduces risk but is not primary reason
Vasomotor symptoms and vaginal atrophy
HRT improves symptoms
Cognitive performance, sleep disturbances, and skin changes - HRT
inconsistent data
HRT: Rational Drug Selection
Use lowest dose that relieves symptoms for shortest time (up to 5 years in menopause; longer with surgical menopause).
Extended use of MHT should be individualized and not based solely on age (North American Menopause Society and the American college of Obstetrics and Gynecology).
Individualize the drug choice and dose based on patient’s risk profile.
Monitor patient annually.
Tapering versus abrupt stopping
Estrogen Therapy - Relief of
Relief of peri-menopausal/post-menopausal symptoms
Estrogen Therapy all types of
All types of estrogen are effective for relieving hot flashes
Estrogen Therapy - Route
Route – oral, transdermal, topical gels and lotions, and vaginal rings
Estrogen Therapy started on
Started on lowest dose (typically oral or transdermal).
Lower doses are associated with less vaginal bleeding, breast tenderness, fewer effects on coagulation and inflammatory markers, and a possible lower risk of stroke and VTE than standard-dose therapy
Estrogen Therapy NO
NO unopposed estrogen to women with intact uterus
Estrogen Therapy avoid in women with
Avoid in women with hypertriglyceridemia, active gallbladder disease, or known thrombophilia
