Menopause Flashcards

(35 cards)

1
Q

What is perimenopause, menopause, and postmenopause

A

Perimenopoouase: 2-8 year period proir to menopause AND the 1 year following menopause
Menopuase: The last menstrual period
Postmenopause: Time after the last menses

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2
Q

When dose menopuase usually occur in women

A

Ages 40-60 years old ( Average in America = 51)

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3
Q

What is the most common vasomotor symptom of menopause, how is characterized, when dose it usually begin, rhythm and length of episode

A

Hot flashes, sudden feeling of warmth with increased sweating/flushing, years before last menstrual period, episodes last 5-12 minutes while mostly occurring at night

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4
Q

T/F: The average duration of hot flashes in menopause is 7.5 years

A

True

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5
Q

What is the vaginal symptom of menopause, characteristics

A

Vaginal Dryness/ irritation, discomfort, painful sex

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6
Q

T/F: Just like hot flashes, vaginal atrophy decreases with time since menopause

A

False: Vaginal atrophy does NOT wane with time since menopause

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7
Q

T/F: Women with menopause can have breast atrophy as well

A

True

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8
Q

What are risks that women with menopause must now be aware of

A

Osteoprorisis and Cardivascular disease

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9
Q

What hormone is increased during menopause

A

FSH ( Greater than 40 pg/mcl)

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10
Q

What are possible triggers for hot flashes in menopausle women

A

Hot beverages, spicy foods, alcohol, warm environment, emotional stress

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11
Q

What type of exercises can be done for menopausle women and what would they help these women with

A

Aeorbic exercise (cardiovascular protection), weight-bearing (bone protection)

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12
Q

What are diet suggestions in menopausle women

A

adequate dietary calcium intake, adequate vitamin D, heart healthy diet

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13
Q

What are the hormone therapy options to give menopausle women

A

Estrogen +/- progestin, Tissue selective estrogen complex (TSEC), SERM

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14
Q

What are non hormone therapy options to give menopausle women

A

Seritonergic agents, antiepileptic drugs, antihypertensives, local (vaginal) therapies, herbals

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15
Q

What are the types of estrogen only hormone therapies

A

Systemic estrogen (oral, transdermal, high dose vaginal), localized estrogen (low-dose vaginal)

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16
Q

T/F: Estrogen plus Progesterone can be given oral, transdermal or high-dose vaginal

17
Q

What is SYSTEMIC estrogen monotherapy indicated for , what is the most important rule and why

A

Vasomotor symptoms, ONLY used in women with NO UTERUS, could increase risk of endometrial cancer in women with a uterus

18
Q

What hormone therapy can be used for vasomotor symptoms in women who still have a uterus

A

SYSTEMIC estrogen/PROGESTIN therapy

19
Q

What TSEC is used in menopausle women, what is the indication, what women should avoid this drug

A

Estrogen plus Bazedoxifene (Duavee)/ moderate to severe vasomotor symptoms, prevention of postemenopausal osteoporosis/ those with renal or hepatic disease

20
Q

T/F: Women who Duavee are still at high risk of endometrial cancer

A

False: Estrogen plus Bazedoxifene has estrogenic effects on bone BUT antiestrogenic effects on the uterus/breast

21
Q

What hormone therapy would be used for vaginal atrophy, changes if they have a uterus

A

Low dose vaginal estrogen, Can be used in women who have uterus because the estrogen does not have significant systemic absorption

22
Q

What is the most effective therapies for vasomotor symptoms, vaginal atrophy

A

Both estrogen AND estrogen/progestin therapies, systemic and vaginal routes

23
Q

What are the estrablished benefits of using hormone therapy

A

Controlled vasomotor symptoms, less osteoporisis, less vaginal atrophy

24
Q

What are the established risks of hormone therapy

A

Thromboembolic disease, breast cancer. cardiovascular disease, endometrial cancer, ischemic stroke. gallbladder disease, hypertriglyceridemia

25
What are the ABSOLUTE CONTRAINDICATIONS of using hormone therapy
Undiagnosed vaginal bleeding, severe active liver disease, active venous thrombosis, history of hormone related thrombosis, history of ischemic stroke and/or TIA, history of dementia, migraine WITH aura, pregnancy, current tobacco use, histroy of estrogen dependent cancer
26
What are the RELATIVE CONTRAINDICATIONS of using hormone therapy
Enometriosis, gallbladder or moderate liver disease, hypertriglyceridemia, Migraine WITHOUT aura, uncontrolled DM or HTN, obese, strong family history of breast cancer
27
Why would a transdermal patch be preffered over an oral route
Patient has a high risk of thromboembolic disease, gallbladder disease, HTN, hypertriglycerdiemia
28
Side effects from using hormone therapy
nausea, breast tenderness, headaches, increased blood pressure, leg crams, decreased libido, skin irritation (transdemal)`
29
What are key concepts for using hormone therapy
Use lowest effective dose, use less than 5 years, can use vaginval ET long term as long as it isn't systemic
30
What serotonergic antidepressant is also FDA approved for menopause (vasomotor), other antidepressants
Paroxetine mesylate, citalopram, duloxetine,fluoxetine, sertraline,mitrazapine,venalfaxine
31
What AED and NSAID can be used for vasomotor symptoms of menopause, hypertension med
Gabapentin (900mg/day), pregablin, clonidine
32
What vaginal lubricant can be used extended relief of symptoms
Vaginal moistrurizer (Replens)
33
What SERM therapy is okay for vaginal symptoms and ok for bone, contraindications
Osphena (estrogenic in vaginal mucosa/bone while agonist in uterus) 60 QD/ active or history of thromboembolic disease, breast cancer
34
What are adverse effects of ospemifene
hot flashes, muscle cramps, vaginal discharge, sweating, concurrent use of CYP3A4 and/or 2C9 inhibitors/induces
35
What intravaginal DHEA is indicated for pain during sex
Prasterone