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Clinical 2.0 winter > Menopause > Flashcards

Menopause Flashcards

1
Q

define menopause

A

permanent cessation of menses following the loss of ovarian follicular activity
12 consecutive months have passed without a menstrual period

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2
Q

age of onset of menopause

A

52

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3
Q

symptoms of menopause

A 
vasomotor - hot flushes 
change in mood 
worsened sleep 
sexual libido 
urogenital symptoms (dryness, discharge, bleeding, UTI, loss of bladder control) 
arthralgia 
decreased bone density
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4
Q

goals of therapy

A

relieve symptoms
improve quality of life
min adverse effects

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5
Q

non drug measures

A 
avoid triggers
dress in laters
yoga
drink water
fan 
eat beans 
cut out coffee
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6
Q

evidence for non drug measures

A

some limited but prob still good for you

some evidence for weight loss, CBT, hypnosis

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7
Q

examples of herbal remedies

A

soy, isoflavones, black cohosh, dong quai, fennel, evening primrose oil

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8
Q

general recommendation for herbal remedies

A

not good evidence, limited safety data
not recommended
all have potential for various drug interactions

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9
Q

non hormonal drugs used for vasomotor symptoms

A

SSRI - paroxetine
SNRI - venlafaxine
anticonvuslant - gabapentin
clonidine

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10
Q

antidepressants decrease vasomotor symptoms by how much

A

symptoms 25-69% but placebo is 30%

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11
Q

doses for antidepressants

A

start low and titrate up to min side effects

allow 2-4 weeks for effect

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12
Q

what are the benefits of hormone therapy

A

decrease vasomotor symptoms, sleep problems, mood or anxiety problems, aches and pains
osteoporosis prevention
reversal of vulvar and vaginal atrophy

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13
Q

who should receive hormone therapy

A 
unremitting symptoms affecting QOL 
no absolute CI 
other non drug options not effective 
risk and benefit discussed 
agree to limited duration of treatment
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14
Q

what are some day to day adverse effects of hormone therapy

A 
breast tenderness
bleeding 
bloating
mood change
similar to oral contraceptives
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15
Q

risks with combined continuous

A 
coronary events
stroke
DVT 
breast cancer 
lung cancer death 
gallbladder disease
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16
Q

risks with estrogen only

A

stroke
DVT
gallbladder
less significant risks than combined

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17
Q

when does the CVD, breast cancer, ovarian cancer risk increase

A

4-5 yrs

18
Q

does breast cancer risk normalize

A

yes after 2 years of discontinuation

19
Q

contraindications to hormone therapy

A 
unexplained vaginal bleeding 
acute liver dysfunction 
estrogen dependent cancer (endometrial,breast) 
coronary heart disease
previous stroke 
active thromboembolic disease
20
Q

other risk factors for breast cancer

A

first degree family history
previous oral contraceptive use
smoking

21
Q

what is the risk if only one first degree family member is diagnosed after age 50

A

no increase in risk compared to general population

22
Q

who would you be more concerned with in a history of breast cancer

A

if more than 1 or diagnosed before 50

23
Q

why do they figure that hormonal exposure does not increase overal risk of breast cancer

A

genetic factors so large and overshadows the increase from hormonal therapy

24
Q

why do you always add a progestin to estrogen unless theres no uterus

A

estrogen unopposed causes endometrial hyperplasia which predisposes to dysplasia and endometrial cancer

25
Q

difference between cyclic and continuous

A

cyclic is a more regular bleed

continuous get breakthrough bleeds sporatic

26
Q

what is estrogen + SERM for

A

prevents hyperplasia so there is no sig effects on CVD or breast cancer risk
but only have safety data for 2 years

27
Q

if the last menstrual period is less than 1 year ago what is the recommended regimen

A

combined continuous estrogen with 14 days progestin

28
Q

if the last menstrual period is greater than 1 yr prior what regimen should you use

A

continuous combined

29
Q

if bleeding is heavy or erratic what should you do

A

increase dose of progestagen

30
Q

advantage of transdermal over oral

A

avoid first past effect

decrease liver disease, lipid effect, gallbladder disease, VTE

31
Q

consider transdermal/topical if …

A

current or history of VTE or gallbladder disease
CVD history
smoking
hypertension
diabetes
obestiy
* not automatic, consider all risk factors together

32
Q

concerns with bioidentical compounded hormones

A

safety and efficacy not tested
quality control
expensive
bioidentical not an agreed upon definition

33
Q

micronized estradiol 1mg is equal to how much conjugated equine est

A

0.625mg

34
Q

difference between provera and prometrium

A

prometrium is more expensive considered more natural because from a plant
causes sedation
caution contains peanut oil

35
Q

when should women on hormone therapy be reevaluated

A

annually

* use lowest dose for shortest period of time

36
Q

should you taper hormone therapy

A

can be tough on the woman must taper off

37
Q

what is vaginal atrophy

A

thinning drying and inflammation of the vaginal walls

cause of sexual pain

38
Q

local options for vaginal atrophy

A

non hormonal lubricants
tablets
cream
ring

39
Q

how do you start of therapy for vaginal atrophy

A

start with induction therapy of daily dosing for 1-2 weeks

then only a couple times a week

40
Q

does low dose vaginal estrogen require a progestogen for women with a uterus

A

no

41
Q

contraindications to vaginal estrogen

A

unexplained vaginal bleeding

insufficient data for breast cancer consider benefit vs risk

42
Q

when and what should you monitor for vaginal estrogen

A

1-2 months
dryness, frequent uti, painful sex, bleeding
application difficulties, expulsion during urination or intercourse
sensing ring during intercourse

Clinical 2.0 winter (28 decks)

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