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46 Cards in this Set
- Front
- Back
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this periord begins with signs of approaching menopause and ends approximetly 12 months after menopause
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perimenopause
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what is the average age of menopause
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51 years
range 45 to 55 years |
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what is the physiology of menopause
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decreased ovarian follicular activity
decreased progesterone and estrogen increase in FSH and LH because of decreased ovulation increase in androgens |
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where is estrone made in PM
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adrenals and ovaries, converted in the liver and fat cells
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what factors influence age of menopause
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heredity
age of menarche - later cigarette smoking altitude and poor nutrition high BMI noncontraceptive HT history of OP |
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what menstrual changes occur during perimenopause
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DUB by increased androgens
irregular menses, either farther apart or closer toghether, heavier or lighter |
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what are vasomotor symptoms seen in menopause
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hot flashes, can cause insomnia, related to a decrease in serotonin, surge in LH, fluctuating estrogen levels, and excitation of heat release mechanism in hypothalmus
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what atrophic conditions occur in menopause
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vaginal ephithelium thins, less elastic and pale, shortens, narrows, less rugae, smoother, decreased lubrication, increased PH
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why are women more prone to UTIs in menopause
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high PH, urethra shortens, incontinence occurs from lower estrogen receptors, decreased peripheral blood flow
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what hair pattern changes occur in menopause
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hirsutism, course hair on face, abdomen or back, scalp hair loss, nails thin and brittle from increased androgens
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what lipid changes occur in menopause
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increase in LDL, cholesterol, TG
decrease in HDL |
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name typical signs and symptoms of perimenopause
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urinary incontinence, UTIs
psych - mood swings, irritable, anxiety, depresion, memory loss sexual discomfort skin changes - dry, hyperpigment breast change - decrease adipose hair pattern changes - hair loss and hirsutism buccal mucosa change - dry OP HL Weight gain hot flashes insomnia vaginal atrophy DM Macular degeneration increased risk of colon cancer |
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how do you make the diagnosis of menopause
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no menses for one year if over 45
consistent FSH over 30 and over 40 years FSH over 30 LH over 30 if under 45 years |
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what are some benefits of HT
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decreased mortality, vasomotor symptoms, GU symptoms, hip and vertebral fractures, CV disease, colorectal cancer, tooth loss, dementia
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what are absolute contraindications for HT
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undiagnosed vaginal bleeding
pregnancy history of breast cancer or estorgen dependent neoplasia active or history of DVT or PE recent stroke or MI liver failure |
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what are SE of etrogen and progesterone
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headache nause and breast tenderness
withdrawl bleeding, nausea, headache, mood changes |
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what is ethynl estradiol used for
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natural - much lower then in OCP
cream - local transdermal 0.625 mg PO - in premarin with norethindrone - femHRT |
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what is conjugated estrogen used in
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Premarin vaginal cream
start at 0.3mg, increases TG, ex: premphase with medroxyprogesterone 2.5mg/5mg or prempro |
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what is 17B estradiols used in
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estring - local 7.5mcg/day
oral - estrace 0.5mg Estraderm Patch 0.5mg Vivelle, Climara Pro patch with levonorgesterol (0.045mg + 0.0015mg) Combipatch - with norethindrone |
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what are the benefits of estradiol esters
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Femring - systemic ring 12.4mg for 90 days
do not increase TG do not increase DVT good for diabetes ex, Menest or Estratest - with methyltestosterone |
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what progesterone do you have to watch peanut allergies and is used for CVD risk
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prometrium
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why would you prescribe and androgen - methyltestotserone Estratest
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for decreased libido
young women with surgical menopause depression or if symptoms not alleviated with estrogen |
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what symptoms would cue you to treat with HT
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hot flashes >8 per day
vulvar or vaginal atrophy OP prevention |
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why would you treat with ET only
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history of hysterectomy
never with uterus because of increased endometrial hyperplagia |
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what is the goal of combined HRT for symptoms
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goal is to avoid vaginal bleeding, entirely or make it predictable, with hot flashes and irregular menses, combo will reduce hot flashes and stop menses
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what organ is estrogen metabilzed through
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liver
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what are the benefits of transdermal patches
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avoids first pass
peak serum concentrations are unlikely does not increase CRP constent rate so lowers risk of DVT, does not affect lipids, good for DM |
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what medical history would make you want to prescibe a transdermal patch over oral1
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high TG
GB disease DM Migraines Mood swings Smokers stomach upset with PO estrogen |
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when would you order local vaginal preparations for your patient
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with local vaginal symptoms, atrophy, increased UTIs, improve stress incontinence and urge, do not need supplement of progesterone
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what is the treatment regimen for vaginal cream
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2-4g per day for 1-2 weeks then 1g/d 1-3x per week
Ex estrace, premarin, estring, vagifem |
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what therapy would you choose for hot flashes
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EPT or ET
SSRI or SNRI Gabipentin Remifenin |
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what are the benefits of soy based products - phytoestrogens for menopausal symptoms
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need a lot of soy to reduce hot flashes,
minimal improvement OTC is variable and inconsistent because not FDA approved. for those who do not want medications and willing to try OTC |
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how many months will you re-evaluate your patient who you started on HT
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3 months then yearly
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what tests must be completed before starting on HT
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OP
Mamogram Pap ask about VTE and CHD risks |
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what are the CHD benefits of estrogen
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increase HDL, decrease LDL, decrease carb metabolism
decrease platlets increase vasodialation and contractility and heart flow |
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what is the risk of breast cancer with estrogen therapy
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very minimal, as long as taken less than 4 years
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what risk occur with women on HT longer than 4 years or older than 60 years old
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stroke and MI
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after 5 years of stopping estrogen, what benefits still exist
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reduction in breast cancer
hip facture CHD and MI all cause mortality |
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when is the greatest risk of stroke, MI or DVT when on HT
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first 2 years
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what HRT is used for prevention of OP
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conjugated estorgen with medroxyprogesterone,
ethinyl estradiol and norethindrone 17B estradiol with norethindrone |
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what medications are only used for prevention of OP
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HRT
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what medications are used for only the treatment of OP
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Calcitonin
Forteo - Teriparatide Prolia - Denosumab |
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what OP medications are used only for vertebral fractures
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boniva
evista calcitonin |
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what OP medications are available IV
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boniva
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what OP medications are available nasal
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calcitonin
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what OP medications are available SQ
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calcitonin - every other day
forteo - daily prolia - 6months |
