Flashcards in Menopause: It and HRT for It Deck (16)
Replacement of estrogen in perimenopausal women will improve which symptoms of menopause?
1. vasomotor symptoms
2. vaginal dryness
3. mood and sleep deterioration
Based on the results of major HRT studies, what is the current thinking regarding HRT?
Basically: good for symptoms, bad for disease
- HT is appropriate for managing moderate-to-severe symptoms in early menopause
- but current evidence does not support the use of either EPT or ET alone for long-term chronic disease prevention
Describe the role of ET in the treatment of osteoporosis.
- ET is approved for prevention of OP, not treatment
- it's recommended that tx be limited to women of high risk fracture
Describe the differences in risk/benefit analysis of CEE+MPA vs. CEE alone
- CEE alone has more balanced risks/benefits, dec. risk of BrCa
- CEE+MPA has dec. risk of hip fractures, DM, and vasomotor sx, but inc. risk of CHD, BrCa, stroke, PE, gallbladder dz, dementia, and urinary incontinence
Describe the patient who is appropriate for HT.
1. moderate to severe menopausal sx
2. no inc. risk of stroke by FSS, and no CI's to HT
3. very low, low, or moderate risk of CHD
4. ≤10yr since last period
*Reassess each criterion at least q6-12mo while HT still desired
Best treatment for a perimenopausal women with only vaginal symptoms (dryness or dyspareunia)
low doses of vaginal estrogen
(no need for progestins)
1 yr without menses
FSH > 30
With less estrogen produced, FSH levels rise.
Most common symptom of menopause:
Name some others.
**Hot flashes** (aka vasomotor symptoms). Sweating.
At night, can cause sleep disturbances.
Vaginal atrophy, dryness, painful intercourse, depression, decr. libido, "going crazy"
We treat symptoms of menopause with:
Estrogen +/- progesterone (depending on circumstances)
Women who still have their uterus need to take a _______ along with estrogen to prevent uterine cancer.
Progesterone (or similar product)
Those w/ hysterectomy can have estrogen alone.
Women w/ only vaginal dryness/painful intercourse can have this tx only.
Vaginally administered estrogen
Is estrogen approved for prevention or tx or both of osteoporosis?
Early loss of endogenous estrogen is associated with CVD. How does it do this?
Incr. smooth muscle proliferation, lowers cholesterol, and improves vascular tone.
Estrogen replacement therapy has these CVD protective effects if administered before the vascular damage has already occured:
Positive effects on vascular remodeling of age
Decr. intimal thickening
Decr. incidence of plaques
Why is initiation of estrogen tx not recommended after the age of 65?
Plaques already formed.
Estrogen is prothrombotic