Term
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Definition
time period immediately prior to menopause through 1st yr after menopause;
Sx: irregular menses, heavy breakthrough bleeding |
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Term
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Definition
permanent end of menstruation & fertility following end of ovarian follicular function; occurs after 12 consecutive months of amenorrhea;
normal part of aging;
genitourinary atrophy occurs in 100% of women |
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Term
| Signs/Symptoms of Menopause |
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Definition
dysfunctional uterine bleeding;
vasomotor symptoms: hot flashes/flushes, night sweats, excessive perspiration, HA, N/V, dizziness, palpitations;
Sleep disturbances;
Sexual dysfunction;
mood changes;
problems w/ concentration/memory;
Vaginal atropy - dryness, burning, itching, dypareunia, dysfunctional uterine bleeding;
Urogenital atrophy - urinary urgency & frequency incontinence; |
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Term
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Definition
Exercise;
Weight Control;
Smoking cessation;
Healthy diet;
For hot flashes: avoid triggers (spicy foods, caffeine, hot drinks), dress in layers, keep fan nearby, cool water on face/neck/wrists); |
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Term
| Indications for Hormone Therapy in Tx of Menopause |
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Definition
relief of menopausal symptoms: moderate-severe symptoms, vaginal atrophy;
prevention of osteoporosis (not 1st line) |
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Term
| ET: Administration of Estrogens |
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Definition
| for women w/ history of histerectomy |
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Term
| HT: Administration of Estrogen + Progestrogen |
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Definition
| for women without history of histerectomy - decreases risk of endometrial hyperplasia & endometrial cancer |
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Term
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Definition
use lowest dose to control symptoms;
if only vaginal Sx, use vaginal drugs first;
short-term therapy: 6 months - 5 yrs;
ADRs:
Common - N, HA, breast tenderness, vaginal bleeding, fluid retention, bloating, increases TGs & HDL, decreases LDL;
Serious - risk of CHD, stroke, VTE, breast cancer, gallbladder dx |
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Term
| Oral Estrogens - micronized estradiol (Estrace), estradiol acetate (Femtrace), conjugated equine estrogen (Premarin), esterified estrogen (Menest), synthetic conjugated estrogens (Cenestin) |
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Definition
0.625 mg vs 0.3 mg - increased risk of stroke??
significant first pass effect --> metabolized to estrone --> higher conc. of estrone --> measuring levels to monitor therapy is NOT RECOMMENDED |
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Term
| Estradiol Transdermal System - Climara, Estraderm, Vivelle-Dot |
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Definition
ADRs:
Application Site Rxns - skin irritation;
ADRs: vaginal bleeding;
Less likely to cause N or HA;
Lower incidence of breast tenderness or VTE;
Safer for women w/ hypertriglyceridemia, liver dx, gallbladder dx;
Avoids 1st pass effect;
More continuous delivery; |
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Term
| Topical Estradiol Emulsion product - Estrasorb |
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Definition
1.74 g pouches;
Dose: 3.48 g /day (delivers 0.05 mg/day);
Application:
Apply to clean dry skin on both legs qAM;
Open up pouch, squeeze entire contents on to hands;
Rub into left thigh & calf for 3 min or until completely absorbed, rub any excess into buttocks;
Repeat with another pouch to right leg;
Allow legs/buttocks to dry before putting on clothing;
Wash hands w/ soap & water; |
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Term
| Topical Estradiol Gel - Estrogel |
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Definition
Pump or tube w/ 0.06% conc. containing 0.75 g/1.25 g;
Administration:
Prime pump before administering or fill applicator to halfway mark (if tube);
Squeeze appropriate amount on to hands;
Apply amt to clean, dry, unbroken skin after bath/shower;
Spread on arm from wrist to shoulder in thin layer;
Allow to dry for at least 5 min before dressing;
Wash hands w/ soap & water; |
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Term
| Vaginal Estrogen tablets - Vagifem |
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Definition
equiv. to 25 mcg of drug;
Initial dose: 1 tab intravaginally daily x 2 wks;
Maintenance: 1 tab intravaginally twice weekly;
Application:
Insert tab as far as possible into vagina using provided applicator without excessive force |
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Term
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Definition
Estrace vaginal:
Initial - 2-4 g intravaginally daily x 1-2 wks;
Maintenance - 1 g intravaginally 1-3x/wk;
Premarin, Ogen vaginal:
Dose - 2-4 g intravaginally daily |
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Term
| Vaginal Estrogen Rings - Estring, Femring |
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Definition
Used for relief of genitourinary symptoms & vasomotor symptoms;
AVoids significant systemic absorption;
ADRs: vaginal irritation;
Insertion:
Press into oval shape;
Insert into upper 1/3 of vaginal vault, when in place, pt should not feel anything;
If pt feels discomfort, it prolly isn't in far enough;
Stays in for 90 days, if removed or falls out prior to that, rincse in warm water & reinsert; |
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Term
| Equivalent Doses for Different Estrogen Dosage Forms |
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Definition
| 0.625 mg conjugated equine estrogens = 1 mg micronized 17-beta estradiol = 1.25 mg estropipate = 50 mcg/day 17-beta estradiol transdermal patch |
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Term
| Progestogens - medroxyprogesteron acetate (Provera), micronized progesterone (Prometrium), norethindrone acetate (Aygestin) |
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Definition
Indications: for women w/ a uterus due to increased endometrial hyperplasia & endometrial cancer if estrogen is given unopposed;
ADRs:
Common - irritability, depression, HA, bloating, fluid retention, irregular bleeding, change in libido |
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Term
| Combination Products (Estrogen + Progestins [EPT]) |
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Definition
Oral:
conjugated estrogens + medroxyprogesterone acetate (Prempro, Premphase);
ethinyl estradiol + norethindrone acetate (Femhrt);
estradiol + norethindrone (Activella);
estradiol + drosperinone (Angeliq);
Transdermals:
estradiol + levonorgestrel (ClimaraPro);
estradiol + norethindrone (CombiPatch) |
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Term
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Definition
daily estrogen;
progesterone given for at least 12-14 days of cycle;
May cause withdrawal bleeding in 90% of women, occurs 1-2 days after last progestogen dose |
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Term
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Definition
daily estrogen & progestogen;
May cause unpredictable spotting/bleeding - resolves w/in 6-12 months --> INCREASE estrogen dose or DECREASE progestogen dose;
Best for women at least 2 yrs post-menopause |
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Term
| Continuous Long-Cycle E/P |
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Definition
Daily estrogen;
Progestogen for 12-14 days 6x/yr;
Rationale: decreased incidence of uterine bleeding;
Drawback: heavier & longer bleeding episodes ompared to other cycles |
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Term
| Intermittent-combined E/P |
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Definition
3 days of estrogen alone alternating w/ 3 days of estrogen + progestogen;
lower incidence of uterine bleeding, less side effects w/ progestogen --> better tolerated; |
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Term
| Heart & Estrogen/Progestin Replacement Study (HERS) |
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Definition
RCT looking at >2500 postmenopausal women w/ established CHD - effect of HRT on 2ndary prevention of CHD;
Pts put on either 0.625 mg CEE + 2.5 mg medroxyprogesterone or placebo;
Results:
- 179 women in HRT group & 182 in placebo experienced nonfatal MI or CHD death;
- no difference b/w groups for 2ndary CV outomes;
- 1st yr of study --> more events in HRT group;
- higher rate of VTE events in HRT
Conclusions: do NOT start HRT for 2ndary CHD prevention, may consider continuing tx in women already on HRT |
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Term
| Women's Health Initiative Trial (WHI) |
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Definition
CT conducted in >27,000 healthy postmenopausal women --> long-term HRT can redue incidence of CHD and/or fractures w/o increasing risk of breast cancer;
Women w/ uterus (CEE + P or placebo):
- HRT group had increased risk of VTE & breast cancer, increased risk of MI & stroke, decreased risk of colorectal cancer, fewer fractures;
Women W/O uterus (EE only or placebo):
- ET group had increased risk of stroke & blood clots, no difference in risk of MI, breast or colorectal cancer; |
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Term
| Benefits of Hormone Therapy |
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Definition
relief of menopausal symptoms;
prevention of bone loss/osteoporosis;
tx of vaginal dryness & dyspurenia;
More evidene needed for decreased risk of colon cancer & DM |
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Term
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Definition
Cardiovascular dx: HT - increased risk, ET - no effect in risk;
Stroke - increased risk w/ both HT & ET;
Breast Cancer - HT: increased risk w/ increased duration, ET: increased risk in pts 10-15 yrs past menopause;
Endometrial Cancer: HT - no increased risk, ET - increased risk for uterine & endometrial cancer;
Ovarian Cancer - HT may increase risk;
VTE - increased risk w/ both HT & ET;
Cognition - HT increases risk of dementia >= 65 yrs;
Gallbladder dx: risk increases w/ longer exposure |
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Term
| Absolute Contraindications to HRT |
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Definition
| pregnancy, Hx of breast cancer, hx of hormone sensitive cancer, hx of endometrial cancer, unexplained uterine bleeding, active liver dx, hx of blood clotting disorder, confirmed CVD, Hx of stroke/TIA |
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Term
| Relative Contraindications for HT |
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Definition
| hypertriglyceridemia, migraine HAs, seizure disorder, uterine leiomyoma, gallbladder dx, liver impairment |
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Term
| Androgens - methyltestosterone/esterified estrogen, mixed testosterone esters, testosterone pellets, nandrolone decanoate |
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Definition
Sx of androgen insufficiency: decreased libido, diminished well-being, loss of energy, decreased bone mass, reduced muscle strength;
More extreme in women w/ surgically-induced menopause;
C/Is: moderate/severe acne, hirsutism, androgenic alopecia, pregnancy, lactation, androgen-dependent neoplasm;
Only give in combo w/ estrogen replacement!! |
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Term
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Definition
hormones that are chemically idential to hormones produced in the body;
"Custom made" hormone therapy;
promoted as safer & more effective than HRT but not FDA-regulated |
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Term
| SSRIs/SNRIs/others - venlafaxine (Effexor), paroxetine CR (Paxil CR), gabapentin (Neurontin), clonidine (Catapres), megestrol acetate (Megace) |
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Definition
use suggests benefits but results are inconsistent;
for tx of vasomotor symptoms |
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Term
| Phytoestrogens - isoflavones, lignans, coumestans |
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Definition
plant compounds w/ structure similar to estrogen;
ADRs: constipation, bloating, nausea;
Dose: 50 mg/day appears beneficial, takes 3 months to see improvement |
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Term
| Mammogram Screening Guidelines |
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Definition
| yearly screenings starting at age 40 |
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