men's and women's health: HRT

Question 1

c/i to HT

Answer 1

breast or endometrial cancer, CVD, active liver disease, undiagnosed vaginal bleeding

Question 2

HT initiation recommended in

Answer 2

age<60yo and menopause onset within 10yr and low risk of breast cancer and cvd

Question 3

indications for HRT

Answer 3

• moderate to severe vasomotor symptoms: lowest effective dose
• moderate to severe GSM: local therapy may be preferred
• sexual sx, but HRT not recommended for treatment of diminished libido
• osteoporosis prevention

Question 4

start with ____(dose)___ of oral estradiol

Answer 4

0.5mg/d

Question 5

start with ____(dose)___ of transdermal estradiol

Answer 5

0.025mg twice weekly

Question 6

All women with an intact uterus need a ?? to be added to their systemic estrogen to prevent ??

Answer 6

progestin, endometrial hyperplasia

Question 7

dose of progesterone

Answer 7

200 mg/day for 12 days/month [ie, a cyclic regimen that is designed to mimic the normal luteal phase of premenopausal women] or 100 mg daily [continuous regimen]

Question 8

advise to take progesterone when?

Answer 8

bedtime. some of its metabolites are associated with somnolence

Question 9

c/i to MHT

Answer 9

history of breast cancer, CHD, a previous venous thromboembolic (VTE) event or stroke, active liver disease, unexplained vaginal bleeding, high-risk endometrial cancer, or transient ischemic attack

Question 10

adv of cyclic vs continuous progestin regimen?

Answer 10

amenorrhea, though irregular bleeding can persist for many months

Question 11

OCs should be avoided in obese perimenopausal women because

Answer 11

they are at greater risk for thromboembolism

Question 12

Hot flash relief often occurs within

Answer 12

first 3-4 weeks of therapy
- if persistent, incr estrogen dose

Question 13

ddi

Answer 13

• anticonvusant meds (phenytoin, cbz) incr hepatic clearance of estrogen: transdermal may be btr than oral since it avoids the first-pass hepatic metabolism
• thyroid hormone replacement: oral estrogen decr T4
• alcohol intake: concurrent ingestion can incr serum estradiol conc by slowing metabolism of estradiol

Question 14

f/u and monitoring

Answer 14

dose adj
endometrial monitoring
mammography

Question 15

The standard recommendation for duration of menopausal hormone therapy (MHT) use has been

Answer 15

five years (and not beyond age 60 years)