Menopause

Question 1

Menopause

Answer 1

Transition lasts about 7 years, can go to 15
Treatment: Hormone replacement
Vaginal Dryness: Vaginal estrogen formula
Hot flashes: SSRIs, Gabapentin, Clonidine
Osteoporosis prevention and treatment

Question 2

Menopause Hormone Therapy Hx

Answer 2

Increased risk of CV events led to a big decrease in prescriptions.
Then better data came out and it is more balanced now

Question 3

Menopausal Hormone Therapy

Answer 3

Estrogen replacement: Controls Menopause s/s
Progestin: Counterbalances estrogen-mediated stimulation of the endometrium to prevent endometrial hyperplasia/cancer. NO clinical use in post-hysterectomy patients! (no endometrium). DO increase risk of breast cancer and CV events.
Cream/gel/topical patch/tablet: systemic. Vaginal ring: Local effects

Question 4

HT Uses

Answer 4

Treat moderate to severe vasomotor s/s (sweating, hot flashes, etc) constantly re-evaluate and use lowest possible dose.
Treat Mod-severe vulvar and vaginal atrophy. Topical ONLY
Prevent postmenopausal Osteoporosis. Reserved for women with high risk and who can’t have non-estrogen therapy

Question 5

D/c Menopause HT

Answer 5

High likelihood of return of vasomotor s/s
Immediate: Abrupt d/c
Dose tapering: Gradually reducing daily dose
Day tapering: Gradually spacing out number of days b/w dosing

Question 6

Estradiol

Answer 6

IND: Hypoestrogenism from ovarian failure, hypogonadism, osteoporosis prevention, prostate cancer, vasomotor s/s, metastatic breast cancer
MOA: Simulates estrogen
BOX: Endometrial cancer, CV dz, breast cancer, not for dementia prevention
CON: Thromboembolic disorders, UnDx bleeding breast cancer, hepatic impairment/dz, pregnancy,
ADR: Edema, vaginal bleeding, breast tenderness, dysmenorrhea

Question 7

Conjugated Estrogen

Answer 7

IND: Hypoestrogenism, Contraception, HMB, Menopause (vaginal atrophy), Vasomotor s/s, Osteoporosis, Metastatic Breast Cancer
MOA: Estrogen
BOX: Endometrial cancer
Breast cancer
CV dz
No prevention of dementia
CON: Thromboembolic disorders, undx bleeding, breast cancer, pregnancy, hepatics
ADR: Vaginal bleeding, m/s pain, breast pain, edema

Question 8

Medroxyprogesterone

Answer 8

IND: Amenorrhea
MOA: Progestin
BOX: CV dz
Breast cancer
not for dementia
CON: 5
ADR: 3

Question 9

Norethindrone

Answer 9

IND: AUB and Contraception. 5mg and .35mg
MOA: Progestin
BOX:
CON: 5
ADR: 3

Question 10

Progesterone

Answer 10

IND: AUB
MOA: Progestin. 10-12 days/month with estrogen
BOX: Not to prevent CV dz
Breast cancer
Not for dementia
CON: 5 and peanuts
ADR: Breakthru bleeding, galactorrhea, weights

Question 11

Combination Drugs

Answer 11

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