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Summer 1 > Hormone replacement therapy > Flashcards

Hormone replacement therapy Flashcards

1
Q

What is perimenopause

A

Onset of menstrual irregularity-12 months after LMP

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2
Q

What is menopause

A

permanent cessation of menses caused by loss of ovarian follicular activity

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3
Q

In menopausal women, bleeding is

A

cancer until proves otherwise

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4
Q

What happens when ovarian function ceases

A

Ovaries no longer are primary site of estradiol and progesterone synthesis
Serum FSH reaches >40

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5
Q

Menopause is characterized by

A

10-15x increase in circulating FSH
4-5x increase in LH
>90% decrease in estrogen and progesterone

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6
Q

Perimenopause is characterized by

A

FSH fluctuates between normal and postmenopausal ranges (so don’t use FSH to Dx perimenopause!)
-You can still get pregnant in perimenopause!

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7
Q

Leading up to menopause, most women have

A

4-8 years of heavy, irregular cycle changes which is mostly caused by anovulatory cycles (can also be 2/2 thyroid abn, hyperPRL, or PCOS)

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8
Q

What are symptoms of menopause

A 
Vasomotor Sx (hot flashes, night sweats) 
slep disturbances 
mood changes 
problems with concentrating and memory 
vaginal dryness and dyspareunia
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9
Q

What lab tests can you get to diagnose menopause and perimenopause

A

Peri: FSH on day 2 or 3 of cycle >10-12 IU
Meno: FSH >40 IU
-Can also get thyroid tests, iron stores, and a lipid profile

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10
Q

FDA approved therapy for these 4 indications

A

Vasomotor symptoms (hormonal Tx is A1)
Prevention of bone loss
Hypoestrogenism
GU Sx

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11
Q

How can estrogen be given to postmenopausal women

A

W/ a uterus: estrogen + progesterone (or estrogen agonist-antagonist)
Had a hysterectomy: unopposed estrogen

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12
Q

What is MHT

A

menopause hormone therapy
individualized based on severity of Sx and risk of CVD, breast cancer, osteoporotic Fx, and VTE
DO NOT use to reduce risk of CVD

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13
Q

In what way does MHT increase the risk of breast cancer

A

With progesterone added to estrogen therapy!

Breast cancer risk is not higher in women taking unopposed estrogen

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14
Q

Recently postmenopausal women are at an increased risk for

A

fracture!

May use systemic estrogen to prevent osteoporotic Fx when alternate Tx are CI or have excess ADE

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15
Q

Per USPSTF, should post menopausal women use hormone therapy as primary prevention for chronic diseases

A

No! It is a grade D recommendation that if with a uterus you NOT use estrogen+progesterone, and if without a uterus you NOT use estrogen

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16
Q

Absolute contraindications to using MHT are

A 
undiagnosed genital bleeding 
known or suspected Hx of breast cancer 
Known or suspected E/P  dependent neoplasia
Active or Hx of DVT or PE 
Active or recent MI or CVA
Liver dysfunction or disease
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17
Q

What lifestyle modifications can help relieve vasomotor symptoms

A

Wear layered clothing
lower room temperature
decrease intake of spicy food, caffeine, or hot beverages
exercise

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18
Q

Does HRT provide contraception?

A

NO

19
Q

What is the estrogen transdermal patch

A

17 b-estradiol

20
Q

Different formulations of estrogen include

A 
topical emulsion, gel 
topical transdermal spray 
implanted 
vaginal ring 
intravaginal products (to Tx urogenital Sx)
21
Q

What are the oral types of progsterone

A

Medroxyprogesterone acetate
Micronized progesterone
Norethindrone acetate

22
Q

Why do women typically not like progesterone

A

Because it messes with your menses, and can cause your periods to return

23
Q

Commonly used oral hormone replacements are

A

Conjugated equine estrogen + MPA

Ethinyl estradiol + Norethindrone acetate

24
Q

Commonly used topical hormone replacements are

A

Estradiol + Norethindrone acetate patch

Estradiol + Levonorgestrel patch

25
Q

What can you use other than estrogen to treat hot flashes

A
  • Venlafaxine: may cause nausea, HA, dizzy, constipation, HTN
  • Desvenlafaxine: may cause same as above but no HTN
  • Paroxetine: may cause same as above but no HTN
  • Megestrol acetate: progesterone can be linked to breast cancer
  • Clonidine: may cause drowsiness, dizzy, hypotension, dry mouth
  • Gabapentin: may cause dizzy, mental confusion, ataxia
26
Q

What therapy is becoming more widespread

A

therapeutic use of testosterone (androgens)

even though it is unclear if there is a true androgen deficiency!

27
Q

What effects do androgens have in women

A

Act directly via androgen receptors in bone, skin, hair follicles, and sebaceous glands
Act indirectly via aromatization of T-to-E in ovaries, bone, brain, adipose, and other tissues

28
Q

Symptoms of androgen insufficiency include

A

diminished well being
persistent, unexplained fatigue
decreased libido, sexual receptivity, and pleasure

29
Q

What androgen treatments are available

A

Methyltestosterone + Esterfied estrogens
Testosterone pellets
Transdermal testosterone system
Oral tablet Flibanserin (came out for women)

30
Q

What are phytoestrogens

A

Plant compounds with bioactivity like estrogen (but weak estrogen receptor binding) that have a physiologic effect in humans

31
Q

What are the 3 main classes of phytoestrogens

A

Isoflavones: Genistein and Daidzein (active components)- found in soybeans
Lignans- found in cereal, oilseeds, flaxseeds
Coumestans- found in alfaalfa sprouts

32
Q

What is Black Cohosh

A

an herbal supplement that acts through the serotonergic system, but does not have strong estrogenic properties
Relatively safe but has been linked to hepatotoxicity
May not offer a lot of relief of hot flashes

33
Q

Never put transdermal products on

A

The breasts!!

34
Q

After prescribing HRT, follow up

A

in 6 weeks to discuss patient concerns, and evaluate Sx relief, ADE, and patterns of withdrawal bleeding

35
Q

How long should hormone therapy be used

A

only as long as Sx control is necessary; usually 2-3 years

36
Q

ADE of estrogen are

A

Breast tenderness!
Reduce the estrogen dose, or switch to transdermal
(If hot flashed persist, raise estrogen dose)

37
Q

ADE of progesterone are

A

Bloating
PMS-like Sx
-switch to a different progesterone

38
Q

What does ACCE NOT recommend

A

Use of bioidentical hormone therapy

39
Q

Part of the general statement on HRT put out by NAMS

A
  • Benefits >risks for women <60, w/in 10 years of menopause
  • HRT should be individualized
  • VMS and GSM prevent bone loss and fracture
40
Q

What are bioidentical hormones

A

Natural forms of estrogen, progesterone, and testosterone

carry the same risks as traditional hormone therapy!

41
Q

If women only have vulvovaginal Sx, how do you treat

A

Mild: vaginal moisturizer/lube

Mod-Severe: vaginal estrogen at lowest dose

42
Q

If women have only vasomotor Sx, how do you treat

A

Mild: Non-pharm therapy

Mod-severe: If not CI, use estrogen +/- progesterone. If CI, use SNRI, SSRI, clonidien, or gabapentin

43
Q

If a woman has vasomotor and vulvovaginal Sx, how do you treat

A

Basically combine the two !

Summer 1 (16 decks)

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