Menopause and Hormone Therapy Questions with
correct answers
Describe the difference between hormone therapy and hormone
replacement therapy Correct Ans ✓✓ o Hormone therapy - not to
replace that are deficient in, but to manage symptoms associated with
menopausal transition
· At what severity level is hormone therapy indicated for vasomotor
symptoms? Correct Ans ✓✓ o Mild vasomotor symptoms require
lifestyle modification, may add non-rx therapy
o MODERATE TO SEVERE - hormone therapy recommended as
therapeutic standard
· A woman with an intact uterus will be starting systemic hormone
therapy for severe vasomotor symptoms. Which product would you
select for the patient and why? Correct Ans ✓✓ o For an intact uterus,
we would want to do use estrogen + Progestogen. Unopposed estrogen
with intact uterus = increased risk of endometrial hyperplasia and
cancer. Minimum progestogen therapy each month is required to reduce
risk
o Continuous cyclic (sequential)
§ Estrogen daily continuously, proges at least 12-14 adys per 28 day
cycle. Causes sched withdrawal bleeding. Begins 1-2 days after proges
dose.
§ Example med - Premphase (conjugated estrogen/MPA)
o Can use continuous combined method daily and no veg bleeding (but
with sometimes unpredictable bleeding) must only use 2 yrs post
menopause after using cyclic method first
, § Examples - Oral: Prempro (conjugated estrogen/MPA), Activella
(estradiol/northethindrone), Femhrt (estradiol/norethindrone), Angeliq
(estradoil/drospireneone)
§ Transdermal: Combipatch (estradiol/northethindrone), Climara
ProPatch (Estradiol/levonorgestrel)
· What are 2 benefits of topical hormone therapy over oral? Correct Ans
✓✓ o Avoids first pass metabolism in liver. Less likely to affect sex-
hormone-binding globulin levels
o Little effect on hemostatic factors = decreased risk of VTE
o Good choice for patients with hypertriglyceridemia, liver disease,
increased risk of cholelithiasis, or at an increased risk of thrombosis
· What is the difference between Femring and Estring? Correct Ans ✓✓
o Femring - estradoil acetate. 2 strengths available. Inserted once every
90 days. **Achieves systemic concentrations**. Must combine with
progrestin if intact uterus
o Estring - 17-B estradiol. Inserted once every 90 days. Does NOT
achieve systemic concentrations. If just vag symptoms, this is better
choice
· A 60-year-old woman decides to discontinue use of the Climara
ProPatch she has used for the last 10 years to control hot flashes and
night sweats. How should the medication be discontinued? Correct Ans
✓✓ o Vasomotor symptoms have 50% chance recurrence when HT is
d/c. Independent of age and duration of use
o Rates of vasomotor symptom recurrence are similar whether HT is
tapered or stopped abruptly
o Should be stopped with how the patient prefers
correct answers
Describe the difference between hormone therapy and hormone
replacement therapy Correct Ans ✓✓ o Hormone therapy - not to
replace that are deficient in, but to manage symptoms associated with
menopausal transition
· At what severity level is hormone therapy indicated for vasomotor
symptoms? Correct Ans ✓✓ o Mild vasomotor symptoms require
lifestyle modification, may add non-rx therapy
o MODERATE TO SEVERE - hormone therapy recommended as
therapeutic standard
· A woman with an intact uterus will be starting systemic hormone
therapy for severe vasomotor symptoms. Which product would you
select for the patient and why? Correct Ans ✓✓ o For an intact uterus,
we would want to do use estrogen + Progestogen. Unopposed estrogen
with intact uterus = increased risk of endometrial hyperplasia and
cancer. Minimum progestogen therapy each month is required to reduce
risk
o Continuous cyclic (sequential)
§ Estrogen daily continuously, proges at least 12-14 adys per 28 day
cycle. Causes sched withdrawal bleeding. Begins 1-2 days after proges
dose.
§ Example med - Premphase (conjugated estrogen/MPA)
o Can use continuous combined method daily and no veg bleeding (but
with sometimes unpredictable bleeding) must only use 2 yrs post
menopause after using cyclic method first
, § Examples - Oral: Prempro (conjugated estrogen/MPA), Activella
(estradiol/northethindrone), Femhrt (estradiol/norethindrone), Angeliq
(estradoil/drospireneone)
§ Transdermal: Combipatch (estradiol/northethindrone), Climara
ProPatch (Estradiol/levonorgestrel)
· What are 2 benefits of topical hormone therapy over oral? Correct Ans
✓✓ o Avoids first pass metabolism in liver. Less likely to affect sex-
hormone-binding globulin levels
o Little effect on hemostatic factors = decreased risk of VTE
o Good choice for patients with hypertriglyceridemia, liver disease,
increased risk of cholelithiasis, or at an increased risk of thrombosis
· What is the difference between Femring and Estring? Correct Ans ✓✓
o Femring - estradoil acetate. 2 strengths available. Inserted once every
90 days. **Achieves systemic concentrations**. Must combine with
progrestin if intact uterus
o Estring - 17-B estradiol. Inserted once every 90 days. Does NOT
achieve systemic concentrations. If just vag symptoms, this is better
choice
· A 60-year-old woman decides to discontinue use of the Climara
ProPatch she has used for the last 10 years to control hot flashes and
night sweats. How should the medication be discontinued? Correct Ans
✓✓ o Vasomotor symptoms have 50% chance recurrence when HT is
d/c. Independent of age and duration of use
o Rates of vasomotor symptom recurrence are similar whether HT is
tapered or stopped abruptly
o Should be stopped with how the patient prefers
