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11 Cards in this Set
- Front
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HRT
menopause and perimenopuase definitions |
permanent cessation of menses resulting from diminishing ovarian follicular f(n)
* therefore production of estrogen and progestin diminishes Sx may present 4 years premenopause Perimenopause - time must b/f menopause and the first year following |
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HRT
SX related to declining and lack of estrogen |
DECLINING
anovulation dysfunctional uterine bleeding extended menstrual cycle intervals oligomenorrhea LACK OF vaginal dryness, vulvar/vaginal atrophy hot flashes night sweats |
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HRT
General SX of menopause but ? relation to estrogen |
arthralgia
depression insomnia migraines mood swings myalgia urinary frequency |
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HRT
treatment principles - intact uterus vs pts w/hysterectomy - CIs |
Intact uterus
- estrogen plus progestin to reduce risk of endometrial hyperplasia and endometrial cancer Hysterectomy - treat w/unopposed estrogen CIs - breast cancer, estrogen-dep neoplasia - DVT, PE, thromboembolic disorder - stroke or MI in past year - pregnancy |
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HRT
Drug TX - how to alleviate s/e of each ERT=estrogen replacement tx HRT=estrogen + progestin tx |
due to estrogen
- start w/low dose - change products - transdermal patch has less a/e due to progestin - change products - change from a continuous to cyclic regimen |
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HRT
ADEs |
increased risk for (as identified by the women's health initiative WHI)
- VTE (PE) - stroke - CHD (coronary heart dz) - breast cancer (not w/unopposed estrogen in pts w/hysterectomy) Benefits of HRT as IDd by WHI - reductions in fractures - dec colorectal cancer |
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HRT
Illnesses estrogen may exacerbate |
depression
diabetes (glucose intolerance) hypertriglyceridemia CV disorders as IDd in CIs thyroid disorder *may need to ↑ dose of thyroid med |
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HRT
Definition |
system of medical treatment for surgically menopausal, perimenopausal and to a lesser extent postmenopausal women
based on the assumption that the treatment may prevent discomfort caused by diminished circulating estrogen and progesterone hormones. HRT is seen as a short-term relief (often one or two years, usually less than five) from menopausal symptoms |
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HRT
androgens (testosterone) |
testosterone - precursor to estrogen
testosterone production ↓s w/menopause only in women also receiving estrogen TX improves SX of ↓ sexual desire, ↓energy, and diminished well-being |
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What are the most important considerations when deciding to start TX for postmenopausal HRT?
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Sx
risk of CAD risk of osteoporosis Risk of breast cancer risk of VTE |
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What are the 2 indications for HRT?
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1. vasomotor sx
2. prevention of osteoporosis That's it - no primary prevention of anything else |
