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41 Cards in this Set
- Front
- Back
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What NHPs are used in Menopause?(6)
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1) Bio-identical hormones
2) Black Cohosh 3) Flaxseed 4) Red Clover 5) Soy 6) Wild Yam |
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What causes Menopausal Symptoms?
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Decrease in estrogen and progesterone production and imbalance leads to symptoms
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What are the most common Menopausal Symptoms?
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1) Vasomotor Symptoms (hot flashes, Night sweats)
2) Vulvovaginal Dryness 3) Sleep Disturbances |
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What is the issue with measuring hot flashes to measure efficacy of Menopause medications?
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Studies have shown that anywhere between 10-58% of women may report that taking the placebo is effective at treating hot flashes. So we need at least 2 or more fewer hot flashes/day than placebo to be clinically significant.
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What caused the shift towards NHPs for the treatment of Menopause?
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The results of the WHI study in 2002. Estrogen and Progesterone elevated risk of CV events.
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What is the definition of Bioidentical Hormones?
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Structurally and functionally equivalent to human hormones
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Why is it a misnomer to refer to Bioidentical Hormone Replacement Therapy as "Natural"?
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Even when they are derived from a natural source it must be synthetically modified to be identical to a human hormone.
So its not in "natural form" when given to the patient. |
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What are examples of Bio-identical Estrogens? (3)
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1) Estrone
2) Estradiol 3) Estriol |
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How is Natural Progesterone derived?
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Derived from Wild Yam
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What are the uses of Natural Progesterone? (2)
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1) Abnormal Uterine Bleeding
2) Combined with estrogens as part of HRT to treat Vasomotor symptoms (such as breast tenderness, decreased sex drive, premenopausal bone loss, water retention) |
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How does the efficacy of Topical Progesterone compare to Oral Progesterone?
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Evidence is mixed; not well studied.
Not shown to provide same protective effect as oral NHP |
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What are the concerns with Topical Natural Progesterone?
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1) Similar risks as HRT
2) No research on long term safety 3) Exempt from NHP regulations 4) Lacks protective effects on the uterus |
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What is the proper dosing of Oral Prometrium -Micronized?
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200-300mg at bedtime
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"Oral Prometrium-Micronized contains Peanut Oil" True or False?
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TRUE
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Why is it theorized that more North American women experience hot flashes than Asian women?
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Believed to be because of their high consumption of Soy protein in their diet (25-150mg per day vs 1mg per day)
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What are the characteristics of Phytoestrogens? (3)
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1) Structurally similar to estradiol (E2)
2) Able to bind to estrogen receptors 3) Have very weak estrogen like activity |
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What is the active form of Isoflavones (Soy)?
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Aglycones: genistein, daidzen
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What is the MOA of Isoflavones (Soy)?
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Isoflavones are structurally similar to Estradiol and selective estrogen receptor modifiers (SERMs).
Stimuales estrogen receptors in some tissues while blocking the effects in others. With no affinity to Breast or Uterus |
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"Isoflavone Diadizin is more potent than Equol" True or False?
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FALSE
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What is the summary of efficacy of Soy (Isoflavones) for Menopause?
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Very well studied; appears to be more benefit with products that contain >30mg genistein. POSSIBLY EFFECTIVE
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What is the summary of efficacy of Soy (Isoflavones) for Osteoporosis?
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Soy isoflavones stimualte the proliferation and differentiation of bone cells. Increase Spine BMD and BMC compared to placebo.
Effects more significant at >90mg isoflavones/day when taken for at least 3-6months. |
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What are the contraindications to taking Soy(Isoflavones)?
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Best to avoid with history of breast cancers (but can have it in diet)
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What are the drug interactions common with Soy (Isoflavones)?
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1) Competes with other sources of estrogen - AVOID IF TAKING TAMOXIFEN, SERMS, HRT
2) AVOID MAOI if using fermented soy products (potential hypertensive crisis) |
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What is the controversial relationship between Soy and Breast Cancer?
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May decrease the risk in pre-menopausal women but increase the risk in post menopausal women.
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What is the appropriate dosing for Soy (Isoflavones) in menopause?
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34-100mg/day Isoflavones (or 20-60mg/day of Soy protein)
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"Flax seed oil contains the Lignans" True or False?
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False, only seeds contain lignans
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"Flax seed is one of the most common source of ALA" True or False?
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TRUE
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What is the summary of efficacy for Flax Seed?
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Not well studied
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What is the summary of safety for Flax Seed?
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Concern of drug interaction with Warfarin (with Flaxseed oil only)
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What are the main constituents of Red Clover?
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4 Isoflavones:
Daidzein, Genistein, Formononetin, Biochanin A |
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What is the MOA of Red Clover?
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Same as Soy
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What is the summary of efficacy for Red Clover?
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Mixed evidence; heterogencity of studies is a problem
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What are the contraindications to taking Red Clover?
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1) Avoid in Hormone Sensitive Cancers
2) Pregnancy |
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What are the drug interactions common with Red Clover?
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1) Avoid with Tamoxifen, SERMs, HRT 2) Caution with Anti-coagulatns and Anti-platelt drugs
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What is the MOA of Black Cohosh?
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Estrogenic like effects; but does not bind to the estrogen receptor (but specific MOA is unknown)
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What is the summary of efficacy for Black Cohosh?
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Mixed evidence: more consistent evidence for Remifemin
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What are the contraindications to taking Black Cohosh?
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1) Liver Disease
2) Hormone Sensitive Cancers 3) Pregnancy |
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What are the drug interactions common with Black Cohosh?
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With Hepatotoxic Drugs
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What is the summary of efficacy for Chasteberry?
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No evidence that it is effective
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What is the summary of efficacy for Dong Quai?
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May have some estrogenic effects but no evidence that it is effective.
BUT NOT RECOMMENDED BECAUSE MIGHT BE CARCINOGENIC |
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What is the summary of efficacy for Evening Primrose Oil?
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No evidence that it reduces hot flashes
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