Meds

Question 1

Goals of hormone replacement therapy (ex. menopause)

Answer 1

~ reduce estrogen withdrawal symptoms (hot flashes, lack of sleep, cognitive symptoms, vaginal discomfort)
~ reduce chances of osteoporosis
~ treat urogenital atrophy (common post menopause - ex. prolapse, stress incontinence, etc)

Question 2

What is premature ovarian insufficiency = failure? Should it be treated like menopause?

Answer 2

menopause = ave age 51
POF = <age 40
iatrogenic (surgery, chemo, radiation; infection; autoimmune)

POF is NOT menopause - lower risk of breast cancer but earlier onset CHF and osteoporosis. Hormone RT is recommended at least until at least normal age of onset of menopause (NA menopause society), but findings of menopause studies cannot be generalized here

Question 3

What are biggest health risks of menopause?

Answer 3

Osteoporosis

CV disease is leading cause of death post-menopause

Question 4

What are risks associated with combined hormone therapy? (estrogen + progesterone)

Answer 4

• breast cancer (combined but not with estrogen, think opposite endometrial cancers)
  IMPORTANT: breast cancer risk increases after 5 years of hormone therapy, no changes if 1-4 years of therapy only; risk does not increase with estrogen alone. also remember that biggest predictor of breast cancer is family history, everything else pails in comparison significantly
• cardiovascular disease
• dementia (some studies)
• stroke (transdermal estrogen alone does not increase risk, but oral estrogen does!)
• DVT (transdermal estrogen does not increase risk, but oral estrogen does)
• smaller studies showed that estrogen does not directly increase CV disease - if taken pre menopause or during menopause - arterial health good, but if taken post menopause, say > 55-65 years old, it can increase mural thrombi - timing (KEEPS study)
• PE
• very slight 1:1000 incr. in ovarian cancer
  primarily based on women’s health initiative study

Question 5

what are benefits of combined hormone therapy?

Answer 5

• reduction in osteoporosis
• reduction in endometrial cancers
• reduction in colon cancers
• reduction in estrogen withdrawal symptoms (vasomotor = think hot flashes, etc)

Question 6

What are specific risks of combined therapy?

Answer 6

biggest is breast cancer if used beyond 5 years, but benefit of colon cancer

Question 7

Absolute counterindications to hormone therapy?

Answer 7

think similar to birth control:
~ Live Dreamily (DVT) in BC, Canada (bleeds,  CV, Cancer) = think lots of retirees post menopausal
~ ACUTE Liver Disease (makes worse)
~ undiagnosed vaginal BLEEDS
~ CARDIOVASCULAR disease
~ vascular thrombosis (DVT)
~ uterine and breast cancer

Question 8

Side effects of hormone therapy?

Answer 8

abnormal uterine bleeding
breast tenderness
edema, heartburn, nausea
mood changes (progesterone)

Question 9

Main principles of pharmacotherapy?

high/low doses, short/long duration

Answer 9

doses low, duration short <5 years b/c of breast cancer risk

Question 10

would you give progesterone to women with no uterus?

Answer 10

no point - mainly used to prevent endometrial hypertrophy, if no endometrium, has no added benefit and increased risk of breast cancer