EXAM 4- Follen

based on study guides

What is the definition of menopause?

• cessation of menses permanently

• amenorrhea for 12 months

What are the 3 stages of menopause?

1. perimenopause

2. menopause

3. post menopause

What is the clinical presentation of menopause?

• vasomotor symptoms: hot flashes, night sweats

• sleep changes

• mood/cognitive changes

• vulvovaginal symptoms: itching, burning, dryness, etc.

What are long term concerns following menopause tx?

• osteoporosis

• CVD

• dementia

• body changes

• skin changes

What are the goals of therapy for menopause tx?

relieve symptoms, improve quality of life, minimize ADRs

What are non-pharm options for menopause?

• dress in layers

• decrease room temperature

• stress management

• exercise

• avoid caffeine, alcohol, spicy food

What pharm therapy is considered the backbone of menopausal hormone therapy (MHT)?

estrogen

When using MHT, when should progesterone be added to estrogen therapy?

when the female has an INTACT UTERUS

What is recommended for pts. with mild menopausal symptoms?

NONPHARM 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

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

What MHT products are local?

• cream

• ring

• tablet

• inserts

What MHT products are systemic?

• transdermal patch

• transdermal spray

• gel

• oral

• pellet

• Femrings

Does the Femring provide local or systemic effect?

systemic

What are the benefits of non-oral routes of estrogen?

• bypass GI tract

• avoid 1st pass metabolism

• in patches: continuous infusion rate

What are the disadvantages of non-oral routes of estrogen?

variable absorption

What are the C/I to MHT?

• undiagnosed genital bleeding'

• breast cancer

• neoplasia (E or P dependent)

• thromboembolic issues

• liver dysfunction

If MHT is used it should be used at the __________________effective dose for the _____________ duration needed.

minimum; shortest

Is compounded bioidentical therapy a preferred 1st tx for menopause symptoms?

no

Which SERM is FDA-approved for use in moderate-severe vasomotor symptoms?

Bazedoxifene

Which SERM is indicated for the tx of moderate-severe dyspareunia from menopausal vulvar and vaginal atrophy?

Ospemifene

What tx options are available for patients that cannot take MHT?

• SSRIs/ SNRIs

  • ex: Paroxetine, citalopram

• Gabapentin

• Oxybutynin'

• Fezolinetant

What is dysmenorrhea? What’s the difference between primary and secondary?

dysmenorrhea- painful periods

primary- not due to pelvic disease

secondary- due to pelvic origin

What is amenorrhea? What’s the difference between primary and secondary?

amenorrhea- absence of menstruation

primary- no menstrual bleeding by the age of 16

secondary- absence of periods for at least 3 previous cycles or 6 months

What is the definition of oligomenorrhea?

irregular cycle (>35 days, long bleeding, or lots of blood etc.)

What is the definition of heavy menstrual bleeding/ menorrhagia?

regular menstrual bleeding w/ blood loss >80 ml per cycle or prolonged bleeding >7 days

What is the cause of primary dysmenorrhea?

factors affecting:

• uterine hypercontractility

• reduced uterine blood flow

• increase peripheral nerve hypersensitivity

What are the risk factors for severe episodes of dysmenorrhea?

• <12 yrs old

• longer cycles

• longer duration of bleeding

• heavy flow

• nulliparity

• family history

• smoking

What is the clinical presentation of dysmenorrhea?

• cramps before starting period

• backache

• thigh pain

• n/v

• HA

What are non-pharm recommendations for dysmenorrhea?

• heating pad

• exercise

• vegetarian diet

What are the pharm recommendations for dysmenorrhea?

• NSAIDS

  • not APA

• Hormonal Contraceptives

What are the goals of tx for oligomenorrhea and amenorrhea?

establish regular bleeding, resume ovulation

What are the pharm tx recommendations for amenorrhea and oligomenorrhea?

• combined contraceptive (E+P)

• Cyclic progestin

• Bromocriptine and Cabergoline if cause is hyperprolactinemia

Which oligomenorrhea/amenorrhea tx option is preferred for a patient that does not want to become pregnant?

COMBINED CONTRACEPTIVE

• (CYCLIC PROGESTIN DOES NOT PROVIDE CONTRACEPTION)

What are the goals of tx for heavy menstrual bleeding (menorrhagia)?

• reduce monthly menstrual blood loss

• correct iron-deficiency anemia

• improve QOL

What are the tx options for heavy menstrual bleeding (menorrhagia)?

• surgery

• CHC’s

• progestin only regimens

• LNG- IUS

• NSAIDs

• GnRH antagonists

• tranexamic acid

Which heavy menstrual bleeding tx options are preferred for a patient that does not want to become pregnant?

• CHC’s

• Depo Provera

• IUD

What is the clinical presentation of endometriosis?

• dysmenorrhea

• pelvic pain

• dyschezia (painful pooping)

• dyspareunia (painful sex)

What are the non-pharm tx recommendations for endometriosis?

• exercise

• surgery

• alternative therapies (ex: massage)

What are the pharm tx recommendations for endometriosis?

• NSAIDS

• CHC’s

• progestins

• GnRH agonists and antagonists

• Danazol

What is the most common cause of tubal factor infertility?

PID (pelic inflammatory disease)

What are the nonpharm tx recommendations for infertility?

• weight management

• stress control

• avoid smoking, caffeine marijuana

What is the MOA of clomiphene?

SERM—> inhibits negative feedback of estrogen

Does clomiphene stimulate the ovary directly?

no

Can clomiphene be used with other medications? If so, which meds?

yes, dexamethasone, hCG, low dose exogenous gonadotropins

Whats ADRs of clomiphene should patients be instructed to notify their physician?

visual disturbances

What is the MOA of aromatase inhibitors?

inhibit conversion of androgens to estrogens

What is the MOA of the gonadotropins?

Allow development of multiple follicles by exposure to an increased level of FSH

FSH—> follicular growth

LH—> ovulation

Do gonadotropins stimulate the ovaries directly?

yes

Why GnRH agonists and antagonists are used in the management of infertility?

Used to suppress spontaneous LH surge in ovulation induction procedures

Allows optimal duration of gonadotropin administration to maximize follicular maturation

What is the MOA of hCG?

stimulate natural LH surge

What medication is used in patients with PCOS? Why?

Metformin because it helps increase insulin sensitivity

Which medications are dopamine agonists? What are they used to treat?

meds- bromocriptine and cabergoline

tx for hyperprolactinemia

What are potential complications of infertility tx?

• OHSS (ovarian hyperstimulation syndrome)

• ovarian enlargement

• multiple births

• cancer risk