week seven Flashcards
(48 cards)
Pre/Peri-menopause sx
Cycle irregularity (shortening then lengthening)
Increasing menopausal sx
Can last 3-8 years
Cessation of menses for _____ = menopause
1 full year
Avg age menopause
51
Post-menopause is used to describe
All the time following 1 full year of cessation of menses
CC-EPT vs CS-EPT
CC-EPT - continuous combined EPT; daily dosing both estrogen and progestogen
CS-EPT - continuous/sequential EPT; daily estrogen and cyclic progestogen (14 days month or 3 days on 3 days off)
Bio-identical HT options
Compounding pharmacy: bi-est, micronized progesterone
Pharm company: estradiol (vivelle patch, estring, estrace), progesterone (prometrium)
Non-bioidentical hormone options
From natural substance: esterified estrogens (premarin)
Synthetic: progestins (provera)
Indications for use of HT
Decent option for women within 10 years of menopause (or younger than 60)
Benefits outweigh risks in women with no CI
BEST indication for use:
Vasomotor instability (hot flashes)
Vaginal dryness
It NOT used for disease prevention, except in the case of osteoporosis when a pt has failed bisphosphonates (given during osteopenia)
Goals of menopausal intervention
Sx relief/improve QOL
Minimal impact on inc risk of other disease
Why would a woman post hysterectomy not need an opposed progestin?
No uterus > no endometrial lining to protect from endometrial cancer
The most effective tx of menopause related vasomotor sx (diminished sleep, irritability, difficulty concentration) according to the 2017 NAMS statement is ___
ET with or without progestogen
The most effective tx of severe sx of vulvar and vaginal atrophy (dryness, dyspareunia, atrophic vaginitis) according to the 2017 NAMS statement is ___
ET
What is another way you can describe the vulvar and vaginal changes of menopause with more patient comfortable language?
Genitourinary syndrome of menopause
If there is only vaginal sx without systemic sx what is advised?
Local vaginal ET
Sexual function effects of ET
Improved lubrication, inc blood flow and sensation
NOT supported for interest, arousal, orgasmic response, libido, etc
ET effects urinary tract health
Local ET may benefit overactive bladder and reducing UTIs (estradiol ring equivalent to oxybutynin in overactive bladder)
Systemic HT may worsen/provoke stress incontinence
Advantages HT, specifically estrogen
Osteoporosis
Endocrine effects
Relief of perimenopausal major depression
Relief of GU sx
Relief of perimenopausia vasomotor instability
Protective against colon CA
Disadvantages HT, specifically estrogen
Inc risk coronary event first year
Inc CVA (stroke)
Inc cancer risk
Inc VTE risk
Can increase incontinence
Increase GB dz
If already inc TGs > can cause pancreatitis
Absolute CI TO HT
Hx breast cancer
CHD
Previous venous thromboembolic event or stroke
Known clotting disorder
Hx heart attack, angina, coronary bypass
Active liver disease undx vaginal bleeding
Pregnancy
Relative CI to HT
Chronic liver disease
Heart disease
Endometrial cancer
HTN
Familial hyperlipidemia
Seizure disorder
Migraine headaches
Hx thrombophlebitis
Endometriosis
Gallbladder dz
Complete PE for HT intake
Height measurement
Wt measurement
Determination of obesity index
BP
Breast exam
Abdominal exam
Pelvic exam
Rectal exam
What are some pre-treatment assessment tools to use before HT?
Fasting lipid profile
Blood glucose levels
Papanicolaou test
Mammography
Demography
UA
Electrocardiography
Ultrasonography for endometrial thickness and ovarian volume
ASCVD risk score
GAIL model
3 most important factors for determining risk vs benefit for HT
Age at initiation (yrs since menopause)
Dose of estrogen
Route of administration
Before selecting a tx plan for menopause, consider:
General health status and age
Severity of sx
Risk for developing other dz
Risks and benefits
Lifestyle
Pt view on tx options
