MHT/SERMs/TSECs (Segars)

Question 1

What is the primary therapy for menopausal symptoms and what may or may not be required?

Answer 1

Estrogen is primary therapy.

Progestin is also necessary for women with an intact uterus

Question 2

Why is progestin necessary for women with an intact uterus?

Answer 2

Progestin opposes estrogen’s effects on uterine proliferation. Women with an intact uterus and soley estrogen therapy are at an increased risk of endometrial hyperplasia/carcinoma

Question 3

Harms associated with combined estrogen and progestin use in postmenopausal women

Answer 3

• breast CA
• coronary heart disease
• dementia
• gallbladder disease
• stroke
• venous thromboembolism
• urinary incontinence

Question 4

Benefits associated with combined estrogen and progestin use in postmenopausal women

Answer 4

• diabetes
• all fractures
• colorectal CA

Question 5

Harms associated with estrogen use alone in postmenopausal women

Answer 5

• dementia
• gallbladder disease
• stroke
• venous thromboembolism
• urinary incontinence

Question 6

Benefits associated with estrogen use alone in postmenopausal women

Answer 6

• breast CA
• all fractures
• diabetes

Question 7

Summary message from findings in the Women’s Health Initiative Study

Answer 7

MHT very effectively minimizes/treats vasomotor symptoms and vaginal changes (and their associated complications)

Question 8

Describe MHT therapy for younger women

Answer 8

MHT is an acceptable option for treating moderate to severe menopausal symptoms in relatively young (up to age 59 or within 10 years of menopause) and healthy women

• individualization with risk-stratification is key
• some organizations recommend patch over oral therapy

Question 9

Describe treatment for women with vaginal symptoms only

Answer 9

the preferred treatments are low doses of vaginal estrogen (topical)

Question 10

MHT treatment for women with a uterus

Answer 10

estrogen + progestin

Question 11

MHT treatment for women without a uterus

Answer 11

estrogen alone

Question 12

Notes on MHT treatment for women at risk of blood clots/stroke

Answer 12

• estrogen (+ progestin) increases risk of blood clots

- risk is less in 50-59 y/o age group

Question 13

Notes on MHT treatment for women at risk of breast cancer

Answer 13

increased risk of breast CA seen within 3-5 years of continuous estrogen with progestin therapy

Question 14

What happens to the risks/benefits of MHT years after therapy is stopped?

Answer 14

risks and benefits are attenuated/eliminated

Question 15

Two important guidelines for MHT therapy

Answer 15

1) use the lowest dose possible

2) treat for the shortest duration possible; re-evaluate patient at least yearly for need for therapy

Question 16

what does SERM stand for?

Answer 16

selective estrogen receptor modulator

Question 17

what does TSEC stand for?

Answer 17

tissue selective estrogen complex

Question 18

goal of SERMs

Answer 18

beneficial pro-estrogenic (agonist) actions in select tissues with beneficial anti-estrogenic (antagonist) actions in other tissues

Question 19

describe TSECs

Answer 19

combines the unique elements of a SERM with an estrogen compound

Question 20

two examples of SERMs

Answer 20

• ospemifene

- clomiphene

Question 21

Example of TSEC

Answer 21

Bazedoxifene

Question 22

Indications Ospemifene

Answer 22

treatment of moderate to severe dyspareunia (painful intercourse)

Question 23

Indications Bazedoxifene

Answer 23

1) treatment moderate to severe vasomotor symptoms associated with menopause in women with a uterus
2) prevention of post-menopausal osteoporosis in women with a uterus

Question 24

Example of anti-estrogen

Answer 24

Clomiphene

Question 25

Indication Clomiphene

Answer 25

infertility in anovulatory women

Question 26

MOA clomiphene

Answer 26

primarily blocks inhibitory actions of estrogen on hypothalamus GnRH and pituitary gonadotropin release (increases gonadotropin secretion thereby stimulating the ovaries to develop oocyte follicles)