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IOS 9 Exam 1
Menopause
| Question | Answer |
|---|---|
| Climacteric | Natural transition from reproductive life to non-reproductive life |
| Perimenopause | Approximately 2-6 years before and 1 year after the final menses |
| Menopause | Loss of ovarian function (last menses) |
| Post menopausal | No menses X 12 months |
| CS-EPT | Continous sequential estrogen-progestogen therapy (estrogen daily, with progestogen added on a set sequence) |
| Systemic ET/EPT | Preparations of ET or EPT that have a systemic, not solely vaginal, effect |
| Perimenopause S/S | (4-5 years before menopause) 1st sign irregular bleeding, hot, flashes, depression, vaginal dryness |
| Perimenopausal treatment | Low dose COC or POP, Depo-prevera or IUS (Mirena) |
| Menopause S/S | 12 months of amenorrhea, or 6 months amenorrhea with classic cymptoms, or FSH > 40 +estradiol <20. Smokers undergo 2 years before |
| Consequences of Menopause | Vasomotor instability, decreased libido, urogenital atrophy, risk osteroperosis, increased CVD, cancer, dementia |
| WHI trial | 16608 postmenopausal women-2 endpoints CHD, Invasive breast cancer |
| WHI results | Increased risk of MI, stroke, PE, and DVT, invasive breast cancer crossed designated boundry |
| WHI CHD risk | year 1 81% RR |
| WHI Breast cancer analysis | 49% RR |
| WHI memory study | No change |
| WHI QOL | Mental health improvement, less night sweats, hot flashes |
| WHI menopausal symptoms & SE | Great for Hot flashes, vadinal dryness, joint pain, but not primary outcome |
| Problem with WHI | Older women, overweight, 50% smokers, HTN, No ASA used, low compliance |
| Conslusions based on WHI | HT not indicated for CHD, risks out way benefit, Short term benefit for menopausal s/s |
| FDA labeling of HT must include | Increased risk for MI, stroke, breast cancer, thromboembolism |
| Contraindication to HT | HX of VTE, active arterial thromboembolic event (MI, Stroke), breast cancer, estrogen dependant tumor, Active liver disease |
| Oral Estrogens undergo | FIrst pass metabolism in liver and greater valiability in concentration is achieved, Increase HDL, lower LDL, increase TG, Increase gallbladder risk |
| Transdermal estrogens | Do not undergo 1st pass metabolism in liver, no effect on lipids, decrease gallbladder risk |
| Natural Estrogens | Estradiol, estropipate, conjugated equine estrogen(animal) |
| Synthetic estrogens | Ethinyl estradiol, synthetic conjugated estrogens A |
| Vaginal Estrogens | Can have systemic abs, best for urogenital symptoms watch for endometrial hyperplasia (need progestrone) |
| Synthetic Progestogens | Derrivatives of progesterone |
| Natural progesterones | Chemically synthesized in lab |
| Progesterones purpose | ONLY purpose is to prevent endometrial hyperplasia due to estrogen- endometrial cancer decreased |
| Natural progestrone products | Prometrium (peanut oil), Crinone (palm oil) , Prochieve (palm oil) |
| Continous HT regimen | Daily estrogen +progestogen- will not have menstral cycle |
| Cyclic HT regimen | Daily estrogen +cyclic progesterone (12-14days) WILL HAVE menstral cycle 2 days after progesterone |
| Intermittent regimen | Estrogen alone X3 days, then estrogen +progesterone 3X, long term endometrial effect unknown |
| Non-Pharm suggestions for Menopause s/s | Wear layers, keep cold water ice packs near, perform breathing techniques, quit smoking |
| Pharm suggestions for menopause s/s | HT- 80-90% reduction, Black cohosh (do not use in cancer pt), paxil, venlafaxine, fluoxitine, gabapentin |
| Urogenetial atrophy-incontinence | Vaginal tablets, creams or lubricants, as well as kegel exercises |
| Poor libido treatment | Short term COC, or estratest |
Created by:
liza001
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