PHRM 825 > Menopausal Hormone Therapy > Flashcards

Menopausal Hormone Therapy Flashcards

(45 cards)

Study These Flashcards
1
Q

Define premenopausal

A

The time period of endocrine changes before cessation of menstruation

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2
Q

Define perimenopausal

A

The period of endocrine changes surrounding the menopause

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3
Q

Define postmenopausal

A

The time period of endocrine changes AFTER cessation of menstruation

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4
Q

When is menopause diagnosed?

A

12 consecutive months of amenorrhea

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5
Q

What is the median age of onset for menopause?

A

40-58 years

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6
Q

What can cause premature menopause?

A

Hysterectomy, radiation therapy, chemotherapy

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7
Q
  • Extensive deterioration of the follicular cells and ova with aging
  • Decrease in estrogen and progesterone levels
  • Increase in FSH and LH
A

Physiologic cause of menopause

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8
Q

What are the vasomotor symptoms of menopause?

A
  • hot flashes
  • night sweats
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9
Q

What are the genitourinary symptoms of menopause?

A
  • vaginal dryness
  • painful sex
  • urinary tract dysfunction
  • sexual dysfunction
  • urinary frequency, urgency
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10
Q

List other symptoms of menopause:

A
  • irregular menses
  • episodic amenorrhea
  • sleep disturbance
  • mood changes
  • fatigue
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11
Q

List the general menopausal hormone therapy options:

A
  • estrogen only
  • estrogen and progestin
  • estrogen and selective-estrogen receptor modulator (SERM)
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12
Q

List the nonpharmacologic therapy options:

A
  • smoking cessation
  • limit alcohol and caffeine
  • limit hot beverages
  • limit spicy foods
  • weight loss
  • keep cool
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13
Q

What are the indications for menopausal hormone therapy?

A
  • vasomotor symptoms
  • vulvovaginal atrophy
  • osteoporosis prevention
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14
Q

What are the absolute contraindications to menopausal hormone therapy?

A

Thromboembolic disorders
Active liver disease
Unexplained vaginal bleeding
Pregnancy
Estrogen-dependent malignancies (endometrial cancer, breast cancer)
Stroke

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15
Q

What are relative CI to MHT?

A
  • uterine leiomyoma
  • migraine headaches with aura
  • seizure disorders
  • diabetes
  • hypertriglyceridemia
  • active gallbladder disease
  • high risk of heart disease
  • family history of breast cancer
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16
Q

Who is eligible for estrogen monotherapy?

A

women WITHOUT a uterus

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17
Q

Which dosage form of estrogen monotherapy products is typically favored?

A

transdermal

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18
Q

When should topical vaginal products be prescribed?

A

For women exclusively experiencing vulvovaginal atrophy

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19
Q

When is an estrogen + progestin combo necessary?

Study These Flashcards
A

Women with an intact uterus should be prescribed a progestin in addition to estrogen in order to decrease the risk of endometrial hyperplasia and endometrial cancer.

20
Q

What are the two main factors that decide if women experience coronal heart disease?

Study These Flashcards
A

time since menopause and age of initiation

21
Q

What are the recommendations for initiation of MHT treatment?

Study These Flashcards
A

Initiation of treatment should be limited to:

  • women younger than 60
    or
  • within 10 years of last period
22
Q

What are the four categories of combined estrogen and progestins?

Study These Flashcards
A
  • continuous cyclic therapy
  • continuous long cycle
  • continuous combined
  • intermittent combined
23
Q
  • Estrogen administered daily
  • Progesterone administered at least 12 to 14 days of a 28 day cycle
  • mimics natural cycle
Study These Flashcards
A

Continuous cyclic therapy

24
Q

When is continuous cyclic therapy preferred?

Study These Flashcards
A

Preferred in recently menopausal women

25
List examples of continuous cyclic therapy:
- premphase - combipatch
26
- Estrogen administered daily - Progesterone co-administered with estrogen for at least 12-14 days every other month
Continuous Long Cycle
27
Daily estrogen + progesterone
continuous combined
28
When is continuous combined recommended?
Recommended for women > 2 years post-final menstrual period
29
Which estrogen + progestin combo provides the best long-term endometrial protection?
Continuous combined
30
List examples of continuous combined:
- Prempro - Angeliq - ClimaraPro - Combipatch
31
- 3 days of estrogen followed by 3 days of estrogen + progesterone
Intermittent combined
32
List an example of intermittent combined:
Prefest
33
List the progestin options for endometrial protection:
- medroxyprogesterone (Provera) - Norethindrone acetate (Aygestin) - micronized progestin (Prometrium) - levonorgestrel (Mirena IUD) - progesterone gel (Crinone)
34
What is the benefit of SERMs?
Decrease risk of endometrial cancer
35
What is the purpose of estrogen + SERM?
To treat both menopausal symptoms and prevent bone loss in women with intact uterus
36
What are the side effects of estrogen + SERM?
- GI track disorders - muscle spasm - neck pain - dizziness - oropharyngeal pain
37
What is an example of an estrogen + SERM?
Duavee
38
How often should a patient's treatment plan be reevaluated?
annually
39
List alternatives for vasomotor symptoms:
- phytoestrogens - black cohosh - dong quai - gabapentin/pregabalin - clonidine
40
What is the preferred treatment option for vasomotor symptoms if estrogen is contraindicated?
SSRIs and SNRIs
41
Compounds with unique mix of estradiol, estrone, estriol, and progesterone:
Bio-identical hormone replacement therapy
42
What is the only FDA-approved bio-identical therapy?
Bijuva
43
What are the first line (non-hormonal) treatments for genitourinary syndrome of menopause?
- lubricants - vaginal moisturizers
44
What are the second line (estrogen) treatments for genitourinary syndrome of menopause?
- topical (cream, tablet, ring) - low dose oral contraceptive
45
What are the treatment options for moderate-severe dyspareunia?
- Ospemifene (Osphena) - Prasterone (Intrarosa)
PHRM 825
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