Menopause/Hypogonadism

Question 1

What is menopause

Answer 1

Last menstrual period was over 12 months

Question 2

Hormones effecting menopause

Answer 2

↓ estrogen and progesterone → vasomotor sx

Question 3

Sx of menopauses

Answer 3

Night sweats, hot flashes, vaginal dryness, burning, dyspareunia

Question 4

What is the most effective treatment for vasomotor sx

Answer 4

Estrogen → ↓ LH and more stable temperature control

Question 5

When is local estrogen recommended

Answer 5

Patient only has vaginal sx only

Question 6

Risks of estrogen

Answer 6

VTE, stroke, dementia, breast cancer

Question 7

When is progesterone added to estrogen

Answer 7

In women with uterus. Unopposed estrogen increases the risk of endometrial cancer

Question 8

When should hormone therapy be initiated

Answer 8

1. Healthy, symptomatic women who are within 10 yrs of menopause, ≤60 YO, and have no contraindications to use
2. Extending treatment beyond 60 YO may be acceptable if the lowest dose is used and the woman is advised of the safety risk
3. Consider quality of life and patient risk factors

Question 9

Local hormone therapies

Answer 9

17-beta-estradiol
Conjugated equine estrogns

Question 10

Conjugated equine estrogens

Answer 10

Premarin crem, tablet

Question 11

17-beta-estrogen cream

Answer 11

Estrace

Question 12

17-beta-estrogen ring

Answer 12

Estring

Question 13

17-beta-estrogen vaginal tablet

Answer 13

Vagifem

Question 14

Systemic hormone therapies

Answer 14

Estradiol
17-beta-estradiol
Conjugated equine estrogens +/- MPA
MPA
Micronized progesterone

Question 15

Estradiol

Answer 15

Patch: Climara, Vivelle Dot

Question 16

Conjugated equine estradiol + MPA

Answer 16

Prempro

Question 17

MPA

Answer 17

Provera

Question 18

Micronized progesterone

Answer 18

Prometrium

Question 19

BBW of estrogens

Answer 19

Endometrial cancer (with uterus), dementia (≥65YO), increased VTE and stroke, breast cancer

Question 20

CI of estrogens

Answer 20

Breast cancer, pregnancy, uterine bleeding, VTE

Question 21

Duration of Climara

Answer 21

QW

Question 22

Duration of Vivelle-dot

Answer 22

twice weekly

Question 23

What is Bijuva

Answer 23

PO capsule that is estrogen and progesterone combined for the treatment of moderate-severe hot flashes

Question 24

Application of Divigel

Answer 24

Upper thigh QD (alternate legs)

Question 25

Application of Elestrin

Answer 25

Apply to upper arm and shoulder

Question 26

Application of Estrogel

Answer 26

Entire arm from wrist to shoulder

Question 27

Where to apply patch

Answer 27

Apply to lower abdomen, below the waistline

Question 28

MOA of ospemifene

Answer 28

Oral estrogen agonist/antagonist indicated for dyspareunia and moderate-severe vaginal dryness → vulvar and vaginal atrophy Not for mild sx

Question 29

Antidepressant approved for the tx of moderate-severe vasomotor sx

Answer 29

Paroxetine

Question 30

What is Veozah

Answer 30

Fezolinetant: neurokinin B antagonist that works to modulate neuronal activity in the thermoregulatory center approved for treatment of moderate-to-severe vasomotor sx associated with menopause

Question 31

Fezolinetant

Answer 31

Veozah

Question 32

Nonhormonal drugs that can be used for vasomotor sx

Answer 32

Gabapentin Oxybutinin

Question 33

Natural products for menopause

Answer 33

Black cohosh, evening primrose ou=il, red clover, soy

Question 34

Drugs that can reduce testosterone

Answer 34

Methadone Chemo Cimetidine Spiranolactone

Question 35

Risks of using testosterone

Answer 35

↑ clotting risk (↑ Hct) Noncancerous prostate growth (not recommend in BPH) Baldness, acne, gynecomastia Abuse potential

Question 36

BBW of testosterone

Answer 36

Secondary exposure to testosterone in children

Question 37

Testosterone

Answer 37

Androgel, Androgel Pump

Question 38

Testosterone cypionate

Answer 38

Depo-Testosterone

Question 39

ADR of testosterone

Answer 39

↑ appetite, acne,edma, hepatotoxicity, reduced sperm count

Question 40

Counseling on T-gel

Answer 40

1. Apply at the same time every morning, flammable until dry 2. Max absorption, wait 2-6 hrs after applying gels/solutions before shower or swim 3. Apply deodorant prior to application 4. Before first use, prime devise by pumping 3 times