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11 Cards in this Set

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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
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
HRT

General SX of menopause but ? relation to estrogen
arthralgia
depression
insomnia
migraines
mood swings
myalgia
urinary frequency
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
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
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
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
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
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
What are the most important considerations when deciding to start TX for postmenopausal HRT?
Sx
risk of CAD
risk of osteoporosis
Risk of breast cancer
risk of VTE
What are the 2 indications for HRT?
1. vasomotor sx

2. prevention of osteoporosis

That's it - no primary prevention of anything else