Wilhelm Menopause

What does HT stand for?

HRT?

MHT?

Hormone therapy.

Hormone replacement therapy.

Menopausal hormonal therapy.

What is perimenopause?

What are the two stages?

The transition that begins with menstrual cycle irregularities and continues until menopause. Note: Women can remain fertile because ovulation can still occur.

Early and late perimenopause.

When does menopause occur?

When there is permanent cessation of menstrual bleeding for 12 continuous months.

What is premature ovarian insufficiency (POI)?

early menopause?

surgical menopause?

Ovarian insufficiency occurring before age 40.

Naturally occurring menopause between ages 40 and 45.

Menopause caused by bilateral oophorectomy before natural menopause.

What can cause induced menopause?

Surgery, chemotherapy, pelvic radiation, or certain medications.

What happens to estrogen, progesterone, and testosterone during menopause?

What happens to GnRH, FSH, and LH?

They decrease.

They increase (reduced negative feedback).

What are the three major categories of menopausal symptoms?

Vasomotor, genitourinary, and psychological.

What are common vasomotor symptoms of menopause?

genitourinary symptoms?

psychological symptoms?

Hot flashes/flushes, night sweats, headache, palpitations, and sleep disturbances.

Vaginal dryness, dyspareunia, recurrent UTIs, and urge/stress incontinence.

Anxiety, irritability, depression, fatigue, reduced sexual desire/arousal, and cognitive difficulties.

What are risk factors for hot flashes?

What foods can trigger them?

Low body weight or obesity, limited exercise, cigarette smoking, and early menopause.

Alcohol, caffeine, spicy foods, and hot foods or liquids.

Which medications are listed as causes of medication-induced hot flashes?

Leuprolide (GnRH agonist), Tamoxifen (SERM), Raloxifene (SERM), tricyclic antidepressant (disrupts thermoregulation in brain), Chemotherapy

What nonpharmacologic treatments can help hot flashes?

Weight loss, cognitive-behavioral therapy, hypnosis, stellate ganglion block, lighter clothing layers, lowering room temperature.

What pharmacologic treatments are listed for hot flashes?

Systemic MHT;

SSRIs/SNRIs (stabilizes thermoregulation);

gabapentin (↓ neuronal excitability);

oxybutynin (anticholinergic that reduces sweating).

What is the relationship between combined estrogen and/or progestogen MHT and breast cancer risk?

Estrogen and progestogen combined can increase breast cancer risk.

Estrogen used alone can decrease breast cancer risk.

What routes are available for estrogen MHT?

Oral, transdermal, and vaginal.

When is a progestogen needed with systemic estrogen?

Why?

In women who have a uterus.

To protect the endometrium by reducing estrogen's effects.

What is Duavee?

Who should specifically receive Duavee?

Contains conjugated estrogens and bazedoxifene (SERM). Very effective for vasomotor symptoms.

Women with a uterus (SERM protects the endometrium from estrogen)

Where do you apply an estrogen patch?

Apply on the lower abdomen or upper buttocks, and rotate the site.

What are counseling points for systemic MHT duration of use?

Is tapering required when discontinuing MHT?

Use the lowest effective dose for the shortest duration needed for symptomatic treatment.

If It should be used beyond 5 years, must have careful consideration of risks and benefits.

Tapering is not required.

What is a key principle for estrogen route selection in patients with VTE risk?

Transdermal estrogen is an option when VTE risk is a concern (bypasses the liver).

What is fezolinetant?

Boxed-warning concern?

A neurokinin-3 (NK3) receptor antagonist. NK3 is a chemical that regulates body temperature. Fezolinetant is used to treat hot flashes and night sweats.

Hepatotoxicity. Because of this, they must have liver function tests before initiation.

What is an important concern with SSRIs/SNRIs in patients taking tamoxifen?

Which medications are highlighted as interacting with tamoxifen?

They can reduce tamoxifen efficacy through CYP inhibition.

Paroxetine, fluoxetine, sertraline, and St. John's wort.

What is genitourinary syndrome of menopause (GSM)?

common symptoms?

A syndrome involving vulvovaginal atrophy, sexual symptoms, and urinary symptoms associated with menopause.

Vaginal dryness, dyspareunia (painful sex), decreased sexual intimacy, urgency, dysuria (painful urination), and recurrent UTIs.

What are treatment options for moderate-to-severe GSM?

Local vaginal estrogen (available as a cream/tablet/ring/insert);

ospemifene (oral SERM);

prasterone vaginal insert (DHEA [dehydroepiandrosterone] steroid).

What psychological symptoms are emphasized in menopause?

risk factors for psychological symptoms?

Depression, irritability, insomnia, fatigue, and decreased memory/concentration.

History of depression or PMS, physical inactivity, and stress.