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40 Cards in this Set
- Front
- Back
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What are the two main symptoms that occur with menopause? |
1.Vasomotor symptoms 2.Vaginal symptoms |
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What is the median age for when menopause occurs? |
51 years old |
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When can you diagnose pt of having menopause? |
When there is amenorrhea for 12 consecutive months |
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How can you determine if patient has menopause for the patient that have undergone hysterectomy (no uterus)? |
Must rely on symptoms to estimate the actual time of menopause |
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What causes menopause? |
1.normal aging (estrogen levels decline) 2. Bilateral Ovarian surgery 3. Chemotherapy medication 4. Pelvic irradiation |
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Which other compounds produce estrogen? |
cholesterol (origin of all hormonal steroids) When ovaries is not the main origin of estrogen, the body can produce estrogen from cholesterol thats in the blood but its not enough. |
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What are vasomotor symptoms? |
hot flashes and night sweats |
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What are the clinical presentation of Menopause? |
1. vasomotor symptoms 2. sleep disturbance 3. mood changes 4. problems with concentration and memory 5. vaginal dryness and dyspareunia 6. arthralgia 7 metabolic changes (increase abdominal fat) |
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What are the risk factors for vasomotor symptoms? |
1. Race: African American most, Asian women least 2. Obesity: >30kg/m2 3. Cigarette smoking 4. Maternal history 5. Menopause younger then 52 years of age 6. Abrupt menopause induced by surgical procedure, chemotherapy, or irradiation |
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What are the clinical presentation of vaginal Atrophy ? |
1. bothersome vaginal symptoms 2. loss of superficial epithelial cells causing thinning of the tissue 3. loss of vaginal rugae and elasticity 4. vaginal pH becomes more alkaline increasing risk of urogenital infection 5. Dyspareunia can impair sexual functions |
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What is perimenopause? |
Begins with early menopausal transition and last early part of postmenopause early menopausal transition -increase FSH late menopausal transition- increase more of FSH and vasomotor symptoms occur |
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What are some non-pharmacologic therapy for menopause? |
-Wear layer clothing so they can remove or add as necessary -use fans, air conditioning, and light cotton clothing -decrease intake of hot spicy foods, caffeine, hot beverages -exercise -relaxation therapy |
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What are the contraindications of Menopausal Hormone Therapy (MHT)? |
1. current, past, or suspected breast cancer 2. known or suspected estrogen-sensitive malignant conditions 3. undiagnosed genital bleeding 4. untreated endometrial hyperplasia 5. previous idiopathic or current venous thromboembolism 6. active or recent arterial thromboembolic disease 7. untreated hypertension 8. active liver disease 9. known hypersensitivity to the active substance of MHT or to any of the excipients 10. Porphyric cutanea tarda (blood disorder can cause pulmonary embolism) |
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If patient presents with vasomotor symptoms and/or urogenital symptoms and no contraindication, what type of Menopausal hormonal therapy can she use? |
Consider estrogen +/- progestogen |
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If patient presents with vasomotor symptoms and/or urogenital symptoms and contraindication, what type of Menopausal hormonal therapy can she use? |
Non-estrogen therapy |
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What type of MHT do you give if patient has only Urogenital symptoms? |
Vaginal preparation with low-systemic exposure |
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When do you prescribe estrogen alone? |
When patient has undergone hysterectomy and does not have an uterus |
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When do you prescribe estrogen + progestogen? |
patient with an intact uterus Giving a women with uterus only estrogen can cause endometrial hyperplasia and endometrial cancer |
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Which route of estrogen administration lowers incidence of breast tenderness and deep vein thrombosis? |
Transdermal patches |
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What are the instructions of transdermal patches of estrogen? |
Must rotate the application site, can not use the same site within a week Can use hydrocortisone cream for rash |
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What is Continuous cyclic estrogen-progestogen (sequential) treatment? |
Continuous estrogen daily co-administer progestogen for at least 12-14 days of 28 day cycle Progestogen causes schedule withdrawal bleeding which begins 1-2 days after the last progestogen dose |
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What is continuous combined estrogen-progestogen treatment |
Give both estrogen and progestogen together no interruption |
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What is continuous long-cycle estrogen-progestogen treatment? |
Continuous estrogen daily Progestogen is given 6 times per year, every other month for 12-14 days giving 6 periods per year. Bleeding episodes are heavier and last more days than withdrawal bleeding with sequential regimans |
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What is intermittent combined estrogen-progestogen treatment? |
3 days of estrogen alone, followed by 3 days of combined estrogen and progestogen, which is then repeated with out interruption Designed to lower the incidence of uterine bleeding. also called continuous-pulsed estrogen-progestogen or pulsed-progestogen regimen |
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When can you use progestogen alone ? |
For women with a history of venous thrombosis or patient has a contraindication with estrogen agents: Medroxyprogesterone & Megestrol acetate |
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What are some ADRs of Progestogen? |
Premenstrual-like symptoms: mood swings, bloating fluid retention and sleep disturbance Bleeding and weight gain |
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Which generation and type of drugs are used as nonsteroidal compounds that act as estrogen agonist? |
Selective Estrogen Receptor Modulators (SERMs) 3rd generation: Conjugated-Equine Estrogen Plus Bazedoxifene |
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When can you use SERMs Conjugated-Equine Estrogen Plus Bazedoxifene ? |
Used for moderate to severe vasomotor symptoms (hot flashes) Women must have uterus |
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What are the contraindication of Conjugated-Equine Estrogen Plus Bazedoxifene ? |
1. undiagnosed abnormal uterine bleeding 2. known, suspected, or past history of breast cancer 3. known or suspected estrogen-depended neoplasia 4. active or past history of venous thromboembolism |
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Which SERM is used only for vaginal symptoms? |
Ospeminfene |
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When can you use SERM Ospemifene? |
Used for moderate to severe dyspareunia (painful sex) Only used for vaginal symptoms |
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What is the black box warning for Ospemifene? |
Increased risk of endometrial cancer in a women with a uterus who uses this agent without progestogen. Ospeminfene must be combined with progestogen |
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Estrogen plus progestogen can reduce the risk of which type of cancer? |
colorectal cancer is reduced |
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What is the recommendation of monitoring MHT? |
6 week follow-up visit if hot flashes occur with estrogen, increase dose if pt experience breast tenderness, reduce estrogen dose or switch to transdermal regimen if patient experience ADRs with progestogen, just switch to another progestogen |
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When to discontinue MHT? |
By 5 years of use of MHT, risk of CHD, stroke, venous thromboembolism and breast cancer significantly increase. methods of discontinuation: cold turkey taper WHI trail shows discontinuing decreases risk of stroke and venous thromboembolism but increase risk of hip fracture |
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What are some non-hormonal Alternative therapy for vasomotor symptoms? |
1.SSRIs/SNRIs: venlafaxine, paroxetine, fluoxetine, citalopram 2.Clonidine 3.Gabapentin useful for highly symptomatic women who cannot take estrogen |
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What are some over the counter products for menopause? |
Phytoestrogen: Isoflavones, lignans, coumestans from common food sources Black Cohosh- do not use for more than 6 months - can cause hepatitis and myopathy |
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What are most effective non-estrogen class of agents for women who cannot or do not wish to use estrogen for severe vasomotor symptoms? |
antidepressents |
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What drugs would you give for only vasomotor symptoms? |
1. Conjugated Equine estrogen PLUS Bazedoxifene 2. SSRI/SNRI: venlafaxine, paroxetine, fluoxetine, and citalopram |
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What drugs would you give for only Urigenital symptoms? |
1. Vaginal estrogen preparation 2. Ospemifene plus progestogen |
