Menopause
Which 2 nonpharmacologic treatments are HIGHLY recommended by the North American
Menopause Society (NAMS) to treat VMS? - ANSCognitive behavioral therapy, clinical hypnosis
What other nonpharmacologic options are used to treat VMS? - ANSTemperature control
(colder pillow)
Yoga/relaxation therapy
Avoid spicy foods, chocolate, caffeine
Exercise
Acupuncture
Paced respiration (slowed down breathing)
What are vasomotor symptoms? - ANSHot flushes and night sweats
What are the non-VMS of menopause? - ANSDyspareunia, vaginal dryness, mood changes,
sleep disturbances, concentration and memory issues, arthralgia
If patient has a uterus, you must give them - ANSestrogen + progestin combo
If patient does NOT have a uterus, you can give them - ANSestrogen alone
What are the 3 main differences in estrogen of transdermal estrogens? - ANSLower VTE risk
No impact on triglycerides
Potential lower stroke risk, so lower blood clot risk
What are the 2 main differences in estrogen of oral estrogens? - ANSIncreases triglycerides
Potential for decreased libido
What is the Women's Health Initiative (WHI)? - ANSClinical study started in 1991. Studied the
use of conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) in women
with and without a uterus
What was the most important "shocking" result from the WHI? - ANSEstrogen + progestin
combo resulted in an increased risk of breast cancer
What was the problem with how the WHI ended? - ANSThere was some bias in the study, since
it stopped early. Upon further investigation 18 years later, increased mortality was not
associated with hormone therapy. Women would have less side effects over time
, When is it considered safe to start menopause hormone therapy (MHT) in women? - ANSLikely
safe to start in patients with no contraindications who are within 10 years of menopause, and/or
<60 years old according to NAMS (North American Menopause Society)
Is tobacco use a contraindication to MHT? - ANSTobacco use is NOT a contraindication to
hormone therapy, but transdermal therapy may be preferred
What is the 1st line treatment to help with VMS of menopause after trying nonpharmacologic
therapies? - ANSSystemic hormone therapy (HT), since it provides optimal relief of hot flushes
What symptoms should be present for a woman to be on HT? - ANSVMS
If patients have vaginal symptoms only, only use what kind of products? - ANSVaginal products
What are the 2 most common estrogens used in HT? - ANSEstradiol and Conjugated equine
estrogens (CEE)
What are the 2 most common progestogens used in HT? - ANSMedroxyprogesterone acetate
(MPA) and Micronized progesterone (MP)
Which hormone should be used with caution in patients with a peanut allergy? - ANSMicronized
Progesterone (MP)
What are all of the contraindications to MHT? - ANS-History/concern for breast cancer
-Estrogen-sensitive malignancies
-Undiagnosed genital bleeding
-Untreated endometrial hyperplasia
-Past idiopathic or current DVT/PE
-Active or recent arterial thrombolic disease (stroke or MI)
-Uncontrolled hypertension >140/90
-Active liver disease
-Porphyria cutanea tarda (skin condition more sensitive to bruising)
What are the nonhormonal medications that can be used to treat VMS? - ANSSSRIs, SNRIs,
Clonidine, Gabapentin, Pregabalin
What SSRI should be used if the patient is taking Tamoxifen for breast cancer? -
ANSEscitalopram
Which 2 SSRIs should be avoided in patients taking Tamoxifen? - ANSFluoxetine, Paroxetine
Which formulation of estrogen may be favored in patients that smoke? - ANSEstradiol patches
Which 2 nonpharmacologic treatments are HIGHLY recommended by the North American
Menopause Society (NAMS) to treat VMS? - ANSCognitive behavioral therapy, clinical hypnosis
What other nonpharmacologic options are used to treat VMS? - ANSTemperature control
(colder pillow)
Yoga/relaxation therapy
Avoid spicy foods, chocolate, caffeine
Exercise
Acupuncture
Paced respiration (slowed down breathing)
What are vasomotor symptoms? - ANSHot flushes and night sweats
What are the non-VMS of menopause? - ANSDyspareunia, vaginal dryness, mood changes,
sleep disturbances, concentration and memory issues, arthralgia
If patient has a uterus, you must give them - ANSestrogen + progestin combo
If patient does NOT have a uterus, you can give them - ANSestrogen alone
What are the 3 main differences in estrogen of transdermal estrogens? - ANSLower VTE risk
No impact on triglycerides
Potential lower stroke risk, so lower blood clot risk
What are the 2 main differences in estrogen of oral estrogens? - ANSIncreases triglycerides
Potential for decreased libido
What is the Women's Health Initiative (WHI)? - ANSClinical study started in 1991. Studied the
use of conjugated equine estrogens (CEE) and medroxyprogesterone acetate (MPA) in women
with and without a uterus
What was the most important "shocking" result from the WHI? - ANSEstrogen + progestin
combo resulted in an increased risk of breast cancer
What was the problem with how the WHI ended? - ANSThere was some bias in the study, since
it stopped early. Upon further investigation 18 years later, increased mortality was not
associated with hormone therapy. Women would have less side effects over time
, When is it considered safe to start menopause hormone therapy (MHT) in women? - ANSLikely
safe to start in patients with no contraindications who are within 10 years of menopause, and/or
<60 years old according to NAMS (North American Menopause Society)
Is tobacco use a contraindication to MHT? - ANSTobacco use is NOT a contraindication to
hormone therapy, but transdermal therapy may be preferred
What is the 1st line treatment to help with VMS of menopause after trying nonpharmacologic
therapies? - ANSSystemic hormone therapy (HT), since it provides optimal relief of hot flushes
What symptoms should be present for a woman to be on HT? - ANSVMS
If patients have vaginal symptoms only, only use what kind of products? - ANSVaginal products
What are the 2 most common estrogens used in HT? - ANSEstradiol and Conjugated equine
estrogens (CEE)
What are the 2 most common progestogens used in HT? - ANSMedroxyprogesterone acetate
(MPA) and Micronized progesterone (MP)
Which hormone should be used with caution in patients with a peanut allergy? - ANSMicronized
Progesterone (MP)
What are all of the contraindications to MHT? - ANS-History/concern for breast cancer
-Estrogen-sensitive malignancies
-Undiagnosed genital bleeding
-Untreated endometrial hyperplasia
-Past idiopathic or current DVT/PE
-Active or recent arterial thrombolic disease (stroke or MI)
-Uncontrolled hypertension >140/90
-Active liver disease
-Porphyria cutanea tarda (skin condition more sensitive to bruising)
What are the nonhormonal medications that can be used to treat VMS? - ANSSSRIs, SNRIs,
Clonidine, Gabapentin, Pregabalin
What SSRI should be used if the patient is taking Tamoxifen for breast cancer? -
ANSEscitalopram
Which 2 SSRIs should be avoided in patients taking Tamoxifen? - ANSFluoxetine, Paroxetine
Which formulation of estrogen may be favored in patients that smoke? - ANSEstradiol patches
