Follen 1 endocrine test 4

What is moneopause?

A permanent cessation of menses for 12 months, following the loss of ovarian follicular activity.

What are the three stages of menopause?

1) Perimenopause- abnormal uiterine bleeding, similar signs and symptoms of menopause. Basically, periods are random, and this ends 12 months after last period, which is then the start of menopause

2) Menopause- Amnorhea for 12 months

3)Post menopause

What is the clinical presentaion of menopause?

Vasomotor symptoms: Hot flashes and Night sweats

Sleep disurbances

Mood changes

Genitourinary symptoms of menopause

• Vaginal Itching, burning, dryness

What are long term concerns of menopause

Osteoporesis

CVD

Dementia

Body comp

Skin chnages

What are the goals of therapy of menopause?

Allieviate ssymptoms and improve quality of life

What are non pharmological options for menopause?

-Stress managment

-Wear layered clothing

-Decrease room temperature

-Exercise

-Decrease hot food, alcohol, Caffeine

How can vaginal dryness be managed?

Sexual activity and Stress reduction, and lubricants for sex.

What is the backbone of menopausal hormone therapy?

Estrogen

When should progesterone be added to menopausal hormone therapy?

If patient has intact uterus

What is recommended for a patient experiencing mild menopausal symptoms?

Non-Pharm therapy!

A patient with no contraindications to menopausal hormone therapy is experiencing moderate to severe vulvovaginal symptoms. Should local or systemic menopausal hormone therapy be recommended for this patient?

Local menopausal hormone therapy

A patient with no contraindications to menopausal hormone therapy is experiencing moderate to severe vasomotor symptoms. Should local or systemic menopausal hormone therapy be recommended for this patient?

Systemic menopausal hormone therapy

Which therapies are local?

Creams, Tablets, Rings

What therapies are systemic?

Oral Tablets, Capsules, Gels, Patch, Vaginal ring, Transdermal Spray

Does the FemRing provide systemic or local effects?

Systemic effects, indicated for vasomotor symptoms

What are the benefeits of non oral routes of estrogen?

-Bypass the GI tract

-Avoid first pass liver metabolism

-Enters circulation at continuous rate

What are the disadvantages of non oral routes of estrogen?

Absorption varies between topical gels, creams and emulsions

What are the contraindications to menopausal hormone therapy?

Breast cancer

Undiagnosed genital bleeding

Clotting (thrombosis)

Neoplasia

Liver dysfunction

If menopausal hormone therapy is used, it should be used at the ____________ effective dose for the ____________ duration needed.

Lowest : Shortest

T/F: bioidentical hormone therapy is preferred as a first-line treatment for symptoms of menopause.

No, only used when it is medically needed

What SERM is FDA approved for use in moderate to severe vasomotor symptoms?

Bazedoxifene

What SERM is indicated for the treatment of moderate to severe dysparenunia from menopausal vulvar and vaginal atrophy?

Ospemifene

What treatment options are available for patients that cannot take menopausal hormone therapy?

SSRI’s and SNRI’s

-Paroxtine, Desvenlafaxine, Venlafaxine

-Citalopram and Escitolpram