Menopause Management: Poppin' Pills and Poppin' this Pu$$y
- Thromboembolic disease - Breast cancer - Estrogen-dependent neoplasms - Pregnancy - Liver disease - Undiagnosed vaginal bleeding
CIs to Hormone Replacement Therapy (HRT)
SSRI meds
Citalopram Paroxetine Sertraline (Zoloft) Fluoxetine
- Probable reduction of small vessel response to various stimuli - Significant reduction of hot flushes in some trials - Possibly a good options for patients with frequent hot flushes & hypertension
Clonidine MoAa
Risk for venous thromboembolism similar to other SERM or conjugated estrogen alone
Conjugated estrogen + bazedoxifene AE
Treats vasomotor sx & prevents osteoporosis - Estrogen + SERM - SERM: substituted for progestin (antagonizes estrogen effects on endometrium)
Conjugated estrogen + bazedoxifene MoA
What is the only case in which someone with a uterus can take estrogen alone?
Estrogen alone can only be given in pts with a hx of a hysterectomy. - Others should receive both estrogen and progesterone
- Treatment of moderate to severe vasomotor symptoms & vulvovaginal atrophy associated with menopause - Prevention of post-menopausal osteoporosis (2nd line)
Estrogen indications
T/F: Dosing of estrogen is based off serum levels.
False. Dosing of estrogen is NOT based off serum levels. - Should base off pt symptoms
estrogen + progestin med
Medroxyprogesterone acetate
testosterone (androgens) meds
Methyltestosterone Esterfied estrogen
Can cause or worsen hot flashes & increased risk of thromboembolism (like other SERMs)
Ospemifene AE
SERM: agonist activity on vaginal tissue only - Used for postmenopausal women with dyspareunia
Ospemifene MoA
vaginal discharge, abnormal pap smear
Prasterone AE
Undiagnosed, abnormal genital bleeding - Has not been studied in women with hx breast cancer however serum levels of estrogen after use do not appear to be above normal range for healthy, premenopausal women
Prasterone CI
dehydroepiandrosterone (DHEA) which is converted in vaginal tissues to estrogens and androgens
Prasterone MoA
Dyspareunia - Seems to work as well as vaginal estrogen for painful intercourse (alternative to low-dose vaginal estrogen)
Prasterone indication
Venlafaxine med class
SNRI
Citalopram med class
SSRIs
Fluoxetine med class
SSRIs
Paroxetine med class
SSRIs
Sertraline (Zoloft) med class
SSRIs
How should you discontinue HRT? Describe the tapering mechanism.
Treatment should be tapered - Optimal timeframe for tapering is unknown 2 general tapering mechanisms: - Dose taper:↓dose of estrogen over weeks to months & monitor for return of symptoms - Day taper:↓the days per week of HRT; from 7 days to 5 days & slowly from there
T/F: Estradiol is the most prominent/active form of endogenous estrogen.
True. Estradiol is the most prominent/active form of endogenous estrogen.
T/F: Studies show that postmenopausal women taking estrogen with a progestin had ↑risk of MI, CVA, breast cancer, & thromboembolism.
True. Studies show that postmenopausal women taking estrogen with a progestin had ↑risk of MI, CVA, breast cancer, & thromboembolism.
T/F: When prescribing estrogen, you should use the minimum amount required to relieve symptoms & prevent bone loss.
True. When prescribing estrogen, you should use the minimum amount required to relieve symptoms & prevent bone loss.
SNRI med
Venlafaxine
Steady rate of estrogen absorption for more uniform symptom control, avoid 1st pass & less GI symptoms
advantages of transdermal estrogen
Cyclic withdrawal bleeding (continued menstrual cycles)
continuous Medroxyprogesterone acetate AE
Avoids cyclic withdrawal bleeding
daly Medroxyprogesterone acetate AE
Medroxyprogesterone acetate med class
estrogen + progestin
Glucose intolerance Lipid abnormalities Na/water retention: edema, ↑BP Nausea Breast tenderness Melasma Thromboembolism, DVTs
estrogen AE
- Has shown reduction of hot flushes - Complex mechanism affecting the thermoregulatory system & neurotransmitters - Generally considered safe for short-term treatment of hot flushes
gabapentin MoAa
What is gold standard for treating menopausal symptoms?
hormonal therapy (HRT)
↑ sebum (oily skin) ↑ facial & body hair Gallbladder dysfunction Headache Fatigue Breast tenderness Mood changes ↑appetite/weight gain Lipid abnormalities•↑ sebum (oily skin) ↑ facial & body hair Gallbladder dysfunction Headache Fatigue Breast tenderness Mood changes ↑appetite/weight gain Lipid abnormalities
progestin AE
Esterfied estrogen med class
testosterone (androgens)
Methyltestosterone med class
testosterone (androgens)
↑appetite/weight gain Oily skin/acne Hirsuitism ↑LDL & ↓HDL Fluid retention Acne
testosterone (androgens) AE
Use in women is controversial Alleviates symptoms of ↓libido, ↓energy, & ↓sense of well-being Addition to estrogen may improve bone mineral density
testosterone AE