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25 Cards in this Set
- Front
- Back
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Perimenopause
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Period immediately prior to menopause and the first year of menopause.
Characterized by menstrual cycle irregularity due to the increased frequency of anovulatory cycles. Signs of dysfunctional uterine bleeding. |
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Menopause
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Permanent cessation of menses
Usually defined as 12 consecutive months of amenorrhea. Loss of ovarian function and subsequent hormonal deficiency. Signs of urogenital atrophy. |
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Vasomotor symptoms associated with menopause
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Hot flashes and night
Primarily characterized by perception of intense heat (hot flash) and subsequent cooling by cutaneous vasodilation (skin flushing), perspiration, and chills. Also, may include headache, dizziness, palpitations, and sleep disturbances. Symptoms are associated with circadian rhythm and are worse in early morning and evening. Symptoms can range from being a minor nuisance to being severe and disruptive to daily living. Occur due to a transient lowering of the hypothalamic temperature regulatory set point. Approximately 75-85% of women are affected with vasomotor symptoms. Median duration of vasomotor symptoms is from 4 to 10 years. |
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Sleep disturbances associated with menopause
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Insomnia
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Mood changes and memory problems associated with menopause
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Anxiety, depression and mood swings
Difficulty with concentration and memory |
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Genitourinary symptoms associated with menopause
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Atrophic vaginitis
- Urogenital atrophy is caused by estrogen loss because the urogenital tissues (vagina, vulva, urethra, and bladder) contain a large number of estrogen receptors. Atrophy results in thinning of tissue and loss of elasticity. Genital symptoms include dryness, burning, dyspareunia, loss of vaginal secretions, and vulvar pruritus. Over time, lack of vaginal lubrication may lead to sexual dysfunction and emotional distress. Urinary symptoms include urethral discomfort, frequency, dysuria, stress incontinence, and increased urinary tract infections. Urogenital atrophy occurs in at least 50% of postmenopausal women. |
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Osteoporosis associated with menopause
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Associated with low bone mass and increased fracture risk.
Risk factors for osteoporosis include being female and postmenopausal. Approximately 40% of postmenopausal women have osteopenia and 7% have osteoporosis. |
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Hormone therapy (HT)
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Refers to estrogen with or without progestins.
Indicated for women with vasomotor symptoms (hot flashes, night sweats), urogenital atrophy and prevention of osteoporosis. |
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What is the most effective drug intervention for vasomotor systems?
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Systemic hormone therapy
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What products should be considered for symptoms of urogenital atrophy?
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Intravaginal products
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What products should be considered for osteoporosis prevention?
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Transdermal patch (Menostar®)
Nonestrogen products (raloxifene and bisphosphonates) |
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What HT is indicated for women with an intact uterus?
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HT consisting of estrogen plus progestin.
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Contraindications to hormone therapy
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Endometrial cancer
Breast cancer Undiagnosed vaginal bleeding Coronary heart disease Thromboembolism Stroke Transient ischemic attack Active liver disease |
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Relative contraindications to hormone therapy
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Uterine leiomyoma
Migraine headaches Seizure disorders |
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Contraindications to oral estrogen therapy
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Hypertriglyceridemia
Liver disease Gallbladder disease |
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What alternative should be used for women with contraindications to oral estrogen therapy?
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Transdermal administration
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What are the primary side effects that cause women to stop hormone therapy?
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Bleeding
Breast tenderness Bloating Premenstrual-like symptoms |
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What can help reduce the severity of side effects of HT?
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Reducing the dose, changing the regimen or a different route of administration.
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Risks of hormone therapy
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Ovarian cancer
Endometrial cancer Breast cancer Venous thromboembolism Gallbladder disease Increase in blood pressure Stroke Cardiovascular disease in older women |
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Adverse effects of estrogen
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Nausea
Bloating Headaches Breast tenderness Edema |
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Adverse effects of progestin
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Increased appetite
Weight gain Fatigue Hypomenorrhea Acne Oily scalp Hair loss Hirsutism Depression Irritability Headaches |
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Adverse effects of transdermal
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Application site reactions in 5-10% of women.
Transdermal therapy has been shown to be less likely to cause nausea and headache versus oral therapy. |
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Dyspareunia
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Painful intercourse
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What treatment is recommended for women who have not undergone hysterectomy?
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Should be treated concurrently with a progestogen in addition to estrogen.
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What combination estrogen and progestin regimens are currently in use?
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Continuous cyclic (sequential)
Continuous combined Continuous long-cycle (or cyclic withdrawal) Intermittent combined (or continuous pulsed) hormone therapy |
