Women's Health - MHT

Question 1

MHT gets graded D for ___ of disease

Answer 1

prevention

Question 2

MHT is composed of…
(3)

Answer 2

• estrogen only
• estrogen and progestin
• estrogen and SERM

Question 3

Indications for MHT

• ___ symptoms
• ____ atrophy
• ___ prevention (not a main reason for MHT)

Answer 3

• Vasomotor
• Vulvovaginal
• Osteoporosis

Question 4

Absolute Contraindications to MHT

• Unexplained ___ bleeding
• Pregnancy
• Endometrial and ___ cancer
• ___ and thromboembolic
  disorders (or prior history)
• Active ___ disease

Answer 4

• vaginal
• breast
• stroke
• liver

Question 5

Estrogen Monotherapy Oral Products

• Premarin® (___ estrogens)
• Menest® (___ estrogen)
• Estrace® generics (___ estradiol)

Answer 5

• conjuagted
• esterified
• micronized

Question 6

Estrogen Monotherapy Oral Transdermal Products

Answer 6

• Alora®
• Climara®
• Menostar®
• Minivelle®
• Vivelle®
• Vivelle-dot®

Question 7

Other Estrogen Monotherapy Topical Products

Answer 7

• topical gel (Estrogel, Divigel, Elestrin)
• topical spray (Evamist)

Question 8

Estrogen Monotherapy Intramuscular Injections

• Estradiol cypionate (___)
• Estradiol valerate (___ )

Answer 8

• Depo-Estradiol
• Delestrogen

Question 9

Estrogen Monotherapy Intravaginal Products

• vaginal cream (___ , ___)
• vaginal insert (___)
• vaginal tablet (___, ___)
• vagnial ring (___, ___)

Answer 9

• Premarin, Estrace
• Imvexxy
• Vagifem, Yuvafem
• Estring, Femring

Femring needs a progestin (highly absorbed systemically)

Question 10

Critical factors in determining whether hormone therapy reduces or increases risk of ___:
___ and ___

Answer 10

CHD
* time since menopause
* age of initiation

Question 11

(E+P) Women with intact uterus was significantly associated with a ___ risk of breast cancer.

(Mono E) Women with prior hysterectomy had significantly ___ risk of breast cancer

Answer 11

• higher
• lower

Question 12

Menopausal Hormone Therapy: Current Recommendations

Initiation of treatment should be limited to women Age < ___ OR Within ___ years of last period

Answer 12

60
10

Question 13

Methods of Administration: Combined Estrogen and Progestin
(4)

Answer 13

• continuous cyclic
• continuous combined
• continuous long cycle
• intermittent combined

Question 14

Continuous Cyclic Therapy

• AKA ___
• Estrogen administered ___
• Progesterone administered at least ___ days out of a 28 day cycle
• scheduled ___ bleeding (90%)
• preferred in ___ menopausal women

Answer 14

• Sequential treatment
• daily
• 12-14
• withdrawal
• recently

Question 15

Continuous Cyclic Therapy Example 1/2

Premphase
Route: ___
Estrogen Component: ___
Progestin Component: ___

Answer 15

• oral
• conjugated estrogens
• medroxyprogesterone acetate

Question 16

Continuous Cyclic Therapy Example 2/2

Combipatch
Route: ___
Estrogen Component: ___
Progestin Component: ___

Answer 16

• transdermal
• estradiol
• norethindrone acetate

Question 17

Continuous Long Cycle

• Rare
• AKA ___
• Estrogen administered ___
• Progesterone administered at least 12-14 days every other ___
• results in ___ scheduled bleeding times per year
• unclear endometerial safety data

Answer 17

• “cyclic withdrawal
• daily
• month
• 6

Question 18

Continuous Combined

• ___ estrogen and progesterone
• Results in endometrial ___ and absence of vaginal bleeding
• Initial ___ spotting or bleeding which usually resolves within ___months
• Recommended for women ___ years post-final menstrual period
• ___ long-term endometrial protection

Answer 18

• daily
• atrophy
• unpredictable, 6-12
• > 2
• BEST

Question 19

Continuous Combined Oral Examples 1/5

Prempro
Estrogen Component:
Progestin Component:

Answer 19

• conjugated estrogens
• medroxyprogesterone acetate

Question 20

Continuous Combined Oral Examples 2/5

Fyavolv/Jinteli
Estrogen Component:
Progestin Component:

Answer 20

• ethinyl estradiol
• norethindrone acetate

Question 21

Continuous Combined Oral Examples 3/5

Angeliq
Estrogen Component:
Progestin Component:

Answer 21

• estradiol
• drospirenone

Question 22

Continuous Combined Oral Examples 4/5

Activella/Amabelz/Mimvey
Estrogen Component:
Progestin Component:

Answer 22

• estradiol
• norethindrone acetate

Question 23

Continuous Combined Oral Examples 5/5

Bijuva
Estrogen Component:
Progestin Component:

Answer 23

• estradiol 1 mg
• micronized progestin 100 mg

bio-identical hormone replacement therapy

Question 24

Continuous Combined Transdermal Examples (1/2)

ClimaraPro
Estrogen Component:
Progestin Component:

Answer 24

• estradiol
• levonorgestrel

Question 25

# Continuous Combined Transdermal Examples (2/2) Combipatch Estrogen Component: Progestin Component:

Answer 25

* estradiol * norethindrone acetate

Question 26

# Intermittent Combined * AKA ___ * ___ days of estrogen, ___ days of estrogen + progesterone * Pulsing prevents ___ of progesterone receptors * Long-term endometrial protection: Unknown

Answer 26

* pulsed-progesterone * 3 * down-regulation

Question 27

# Intermittent Combined Example Prefest Route: Estrogen Component: Progestin Component:

Answer 27

* oral * estradiol * norgestimate

Question 28

# Oral Progestin for Endometrial Protection Medroxyprogesterone Brand: Continous Min Dose: Cyclic Min Dose:

Answer 28

Provera 2.5 mg 5 mg

Question 29

# Oral Progestin for Endometrial Protection Norethindrone acetate Brand: Continous Min Dose: Cyclic Min Dose:

Answer 29

Aygestin 5 mg 5 mg

Question 30

# Oral Progestin for Endometrial Protection Micronized progestin Brand: Continous Min Dose: Cyclic Min Dose:

Answer 30

Prometrium 100 mg 200 mg | BEST (metabollically neutral)

Question 31

# Vaginal/Intrauterine Progestin for Endometrial Protection Levonorgestrel Brand: Continous Min Dose: Cyclic Min Dose:

Answer 31

Mirena IUM 0.20 mcg N/A

Question 32

# Vaginal/Intrauterine Progestin for Endometrial Protection Progesterone gel Brand: Continous Min Dose: Cyclic Min Dose:

Answer 32

Crinone 45 mg 45 mg

Question 33

# Estrogen & SERM treat both ___ symptoms and prevent ___ loss in women with intact uterus * AKA ___ * non-___ * agonist: ___ * antagonist: ___ * decrease risk of ___ cancer

Answer 33

* menopausal, bone * tissue-selective estrogen complex (TSEC) * hormonal * bone * breast, uterus * endometrial

Question 34

# Estrogen & SERM side effects * ___ track disorders * muscle spasm * ___ and ___ pain * dizziness

Answer 34

* GI * neck, oropharyngeal

Question 35

# Estrogen & SERM example Duavee Route: Estrogen Component: SERM Component:

Answer 35

oral * conjugated estrogen 0.45 mg * bazedoxifene 20 mg

Question 36

What is the preferred regimen?

Answer 36

transdermal estrogen +/- progestin

Question 37

alternatives to preferred regimen (2)

Answer 37

1. Bazedoxifene + Estrogen 2. oral estrogen +/- progestin 3. systemic vaginal estrogen +/- progestin

Question 38

alternatives for vasomotor symptoms | herbal/random stuff

Answer 38

* phytoestrogens * black cohosh * Dong Quai * Gabapentin/Pregabalin * Clonidine

Question 39

# SSRIs/SNRIs for Hot Flashes SSRIs for Hot Flashes

Answer 39

* Paroxetine (Brisdelle®) 7.5 mg QHS * Paroxetine (Paxil, Pexeva) 10-20 mg/day * Paroxetine CR (Paxil CR®)12.5 or 25 mg/day * Citalopram (Celexa®) 10-30 mg/day * Escitalopram (Lexapro®)10-20 mg/day

Question 40

SNRIs for Hot Flashes

Answer 40

* Venlafaxine (Effexor®) 75-150 mg/day * Desvenlafaxine (Pristiq®) 100-150 mg/day * Duloxetine (Cymbalta®) 60 mg/day | Side effects: mouth dryness, anorexia, nausea, constipation

Question 41

Women with high 10-year CVD (>___%) should avoid MHT

Answer 41

10% | if genitourinary symptoms, consider low-dose vaginal estrogen

Question 42

First line (non-hormonal) for Genitourinary Symptoms (2)

Answer 42

* Lubricants * vaginal moisurizers

Question 43

Second line (non-hormonal) for Genitourinary Symptoms (4)

Answer 43

* cream * vaginal tablet * ring * low dose OC | low dose vaginal estrogen doesn't require progestin

Question 44

# Treatment of Moderate-Severe Dyspareunia Ospemifene (Osphena®) * SERM * agonist: ___, uterus * **Black Box Warning:** ___ cancer, stroke, VTE * ___ mg once daily in postmenopausal women * take with ___ * SE: discharge, endometrial hyperplasia, and ___

Answer 44

* vagina * endometrial * 60 mg * food * hot flashes | Similar precautions to estrogen therapies

Question 45

# Treatment of Moderate-Severe Dyspareunia Prasterone (Intrarosa) * Inactive ___ converted to active estrogen and androgen * ___mg qd qhs in postmenopausal women * no black box warning * Contraindications: ___ vaginal bleeding * Avoid if history of ___ cancer * SE: vaginal ___

Answer 45

* DHEA * 6.5mg * undiagnosed * breast * discharge | Estrogen-based regimen remain the first line for vulvovaginal atrophy

Question 46

# Hormone Regimen in Transgender Persons Oral Estradiol dosage

Answer 46

2.0-6.0 mg/day

Question 47

# Hormone Regimen in Transgender Persons Estradiol transdermal patch dosage

Answer 47

0.025-0.2 mg/day (New patch placed every 3-5 days)

Question 48

# Hormone Regimen in Transgender Persons Parenteral Estradiol valerate and Estradiol cypionate dosage

Answer 48

* 5-30 mg IM every 2 weeks * 2-10 mg IM every week