Menopause
As a practitioner what is menopause an opportunity for? - ANS -1. Establish an ongoing
relationship with patient
2. patient education regarding menopause
3. health screening (catch cancer)
4. prevention and treatment
\At what age is menopause? - ANS -• *Average age 51.5 years*
• Range of 48-55 years
\How do you do menopause? - ANS -• *Testing usually unnecessary*
• day 2 or 3 serum FSH level >50 IU/ml
- only if still menstruating
• serum estradiol <50 pg/ml
• *amenorrhea for at least one year*
\How do you evaluate abnormal vaginal bleeding?? - ANS -• Pelvic exam
• pap smear
• endometrial biopsy
• hysteroscopy, dilation & curettage
- if you get an abnormal test OR persistent bleeding with no
OTHER pathology
• pelvic ultrasound
\How is estrogen produced AFTER menopause? - ANS -postmenopausal estrogen production is
a product of peripheral conversion of adrenal androstenedione (from adrenal glands.
- occurs within body fat
- the more fat a person has the less S/S they should have
because they will make more estrogen
\What are SERM's? - ANS -Selective estrogen receptor modulators
- work on different receptors at the same time:
- AGONIST in bone estrogen receptor
- ANTAGONIST in breast/endometrial estrogen rcptr
- AGONIST in blood vessel estrogen rcpt.
• *Raloxifene*
- No increased risk of uterine cancer
- Decreased risk of breast cancer
- No adverse effect of bleeding
- won't alleviate menopausal symptoms
- May cause hot flushes
- Increases risk of stroke
\What are some alternative to HRT that TREAT osteoporosis? - ANS -• Osteoporosis tx, *in
addition to prevention measures*:
1. Calcitonin
2. rhPTH (recombinant human parathyroid hormone)
, - Teriparatide
\What are some alternatives to HRT that deal with hot flashes? - ANS -*• SSRIs*
*• Soy protein*
• Black cohosh, other herbals
• Clonidine
• Progestins or androgens
• propranolol
\What are some alternatives to HRT that deal with vaginal dryness? - ANS -• Topical estrogen
cream or tablets
• Nonprescription lubricants
- Astroglide
- KY
\What are some alternatives to HRT that PREVENT osteoporosis? - ANS -*Osteoporosis
Prevention*
1. Bisphosphonates
a. Alendronate (Fosamax) daily or weekly
b. Risedronate (Actonel) daily or weekly
c. Ibandronate (Boniva) daily or monthly
2. Calcium 1200 mg/daily and Vitamin D 400-800 IU/daily
3. Selective estrogen receptor modulators (SERM)
\What are some different types for HRT? - ANS -1. Oral pills
2. Transdermal
3. Topical (no systemic affects)
- can be vaginal ring
\What are some of the Tx for menopause S/S? - ANS -1. Correct calcium and vitamin D
deficiency
2. weight-bearing exercise
3. alendronate and calcitonin
4. hormone replacement therapy (HRT)
5. selective estrogen receptor modulators(SERMs)
\What are the 3 major health problems associated with men-o-pause? - ANS -1. Osteoporosis
2. cardiovascular disease
3. malignancy
* these all seem to be related to the loss of estrogen*
\What are the ADVERSE affects of HRT? - ANS -*Think PMS*
• Breast tenderness
• Bloating
• Depression
• *Vaginal bleeding*
****If post meopausal need w/o to r/o cancer
• Appetite change
• Insomnia
• Nausea
• Headaches
As a practitioner what is menopause an opportunity for? - ANS -1. Establish an ongoing
relationship with patient
2. patient education regarding menopause
3. health screening (catch cancer)
4. prevention and treatment
\At what age is menopause? - ANS -• *Average age 51.5 years*
• Range of 48-55 years
\How do you do menopause? - ANS -• *Testing usually unnecessary*
• day 2 or 3 serum FSH level >50 IU/ml
- only if still menstruating
• serum estradiol <50 pg/ml
• *amenorrhea for at least one year*
\How do you evaluate abnormal vaginal bleeding?? - ANS -• Pelvic exam
• pap smear
• endometrial biopsy
• hysteroscopy, dilation & curettage
- if you get an abnormal test OR persistent bleeding with no
OTHER pathology
• pelvic ultrasound
\How is estrogen produced AFTER menopause? - ANS -postmenopausal estrogen production is
a product of peripheral conversion of adrenal androstenedione (from adrenal glands.
- occurs within body fat
- the more fat a person has the less S/S they should have
because they will make more estrogen
\What are SERM's? - ANS -Selective estrogen receptor modulators
- work on different receptors at the same time:
- AGONIST in bone estrogen receptor
- ANTAGONIST in breast/endometrial estrogen rcptr
- AGONIST in blood vessel estrogen rcpt.
• *Raloxifene*
- No increased risk of uterine cancer
- Decreased risk of breast cancer
- No adverse effect of bleeding
- won't alleviate menopausal symptoms
- May cause hot flushes
- Increases risk of stroke
\What are some alternative to HRT that TREAT osteoporosis? - ANS -• Osteoporosis tx, *in
addition to prevention measures*:
1. Calcitonin
2. rhPTH (recombinant human parathyroid hormone)
, - Teriparatide
\What are some alternatives to HRT that deal with hot flashes? - ANS -*• SSRIs*
*• Soy protein*
• Black cohosh, other herbals
• Clonidine
• Progestins or androgens
• propranolol
\What are some alternatives to HRT that deal with vaginal dryness? - ANS -• Topical estrogen
cream or tablets
• Nonprescription lubricants
- Astroglide
- KY
\What are some alternatives to HRT that PREVENT osteoporosis? - ANS -*Osteoporosis
Prevention*
1. Bisphosphonates
a. Alendronate (Fosamax) daily or weekly
b. Risedronate (Actonel) daily or weekly
c. Ibandronate (Boniva) daily or monthly
2. Calcium 1200 mg/daily and Vitamin D 400-800 IU/daily
3. Selective estrogen receptor modulators (SERM)
\What are some different types for HRT? - ANS -1. Oral pills
2. Transdermal
3. Topical (no systemic affects)
- can be vaginal ring
\What are some of the Tx for menopause S/S? - ANS -1. Correct calcium and vitamin D
deficiency
2. weight-bearing exercise
3. alendronate and calcitonin
4. hormone replacement therapy (HRT)
5. selective estrogen receptor modulators(SERMs)
\What are the 3 major health problems associated with men-o-pause? - ANS -1. Osteoporosis
2. cardiovascular disease
3. malignancy
* these all seem to be related to the loss of estrogen*
\What are the ADVERSE affects of HRT? - ANS -*Think PMS*
• Breast tenderness
• Bloating
• Depression
• *Vaginal bleeding*
****If post meopausal need w/o to r/o cancer
• Appetite change
• Insomnia
• Nausea
• Headaches
