5 NR 568 FINAL WEEK
1. When and
when not to use progestin for hormone replacement therapy and why?:
combined estrogen-progestin therapy for women with an intact uterus. Estrogen-
only HRT can be given to someone with a hysterectomy. Progestin is required to
prevent estrogen-associated endometrial hyperplasia.
2. Local vs. systemic estrogen options and why one would be chosen
over the other: intravaginal preparations are most helpful in treating symptoms
associated with local estrogen deficiency, such as vaginal and vulvar atrophy;
these preparations are associated with a lower risk of systemic effects
progesterone is contraindicated in women who have undergone a hysterectomy
but required in women with an intact uterus who have undergone hormone
replacement therapy
IV administration is generally limited to acute, emergency control of heavy uterine
bleeding.
One of the two available vaginal rings (Estring) are used only for local effects,
primarily treatment of vulval and vaginal atrophy associated with menopause.
The other vaginal ring (Femring) is used for systemic effects (e.g., control of hot
flashes and night sweats) as well as local effects (e.g., treatment of vulval and
vaginal atrophy).
3. Peri-menopausal estrogen therapy (ET): remains the most effective
treatment option for relieving perimenopausal and menopausal hot flashes and
night sweats. taken to compensate for the loss of estrogen that occurs during
menopause. There are two basic regimens for HT: estrogen alone (ET) and
estrogen plus a progestin (estrogen/progestin therapy [EPT]).
The purpose of estrogen in both regimens is to control menopausal symptoms by
replacing estrogen that was lost owing to menopause.
4. Transdermal estrogen therapy has fewer adverse effects: The total dose
of estrogen is greatly reduced (because the liver is bypassed).
There is less nausea and vomiting.
Blood levels of estrogen fluctuate less.
There is a lower risk for DVT, pulmonary embolism, and stroke.
Types:
Emulsion (Estrasorb)
Spray (Evamist)
Gels (EstroGel, Elestrin, Divigel)
1/9
, 5 NR 568 FINAL WEEK
Patches (Alora,
Climara, Estraderm, Menostar, Vivelle-Dot, Oesclim )
5. Selective estrogen receptor modulator (SERM): Are drugs that activate
ERs in some tissues and block them in others.
These drugs were developed in an effort to provide the benefits of estrogen (e.g.,
protection against osteoporosis, maintenance of the urogenital tract, reduction of
LDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast cancer,
uterine cancer, and thromboembolism)
6. Bazedoxifene: Duavee (conjugated estrogens/bazedoxifene) for prevention
of vasomotor symptoms and osteoporosis in postmenopausal women with a
uterus. Duavee is the first drug to combine estrogen with an estrogen
agonist/antagonist (bazedoxifene).
The bazedoxifene component of Duavee reduces the risk for excessive growth of
the lining of the uterus that can occur with the estrogen component.
Contraindications to taking Duavee are the same as for other estrogen-containing
products.
7. Prevention of osteoporosis with hormone replacement therapy: HT
reduces postmenopausal bone loss and thereby decreases the risk for
osteoporosis and related fractures.
Unfortunately, when HT is stopped, bone mass rapidly decreases by
approximately
12%. ****Hence to maintain bone health, HT must continue lifelong.***
HT should be considered only for women with significant risk for osteoporosis, and
only when that risk outweighs the risks of HT.
A person on HT and pts, in general, should practice primary prevention of bone
loss by ensuring adequate calcium and vitamin D intake, regular weight-bearing
exercise, and avoiding smoking and excessive alcohol use.
8. How to change a patient from one combination oral contraceptive to
another: start the new brand on active hormone tablets and skip the pill free
interval or use non-hormonal forms of contraception until 7 active tablets of the
new brand have been taken
9. How to initiate treatment (when in the cycle is it best to start- may vary
based on the type of contraceptive): Use is initiated on day 1 of the menstrual
cycle, and one pill is taken daily thereafter.
A backup contraceptive method should be used for the first 7 days.
2/9
1. When and
when not to use progestin for hormone replacement therapy and why?:
combined estrogen-progestin therapy for women with an intact uterus. Estrogen-
only HRT can be given to someone with a hysterectomy. Progestin is required to
prevent estrogen-associated endometrial hyperplasia.
2. Local vs. systemic estrogen options and why one would be chosen
over the other: intravaginal preparations are most helpful in treating symptoms
associated with local estrogen deficiency, such as vaginal and vulvar atrophy;
these preparations are associated with a lower risk of systemic effects
progesterone is contraindicated in women who have undergone a hysterectomy
but required in women with an intact uterus who have undergone hormone
replacement therapy
IV administration is generally limited to acute, emergency control of heavy uterine
bleeding.
One of the two available vaginal rings (Estring) are used only for local effects,
primarily treatment of vulval and vaginal atrophy associated with menopause.
The other vaginal ring (Femring) is used for systemic effects (e.g., control of hot
flashes and night sweats) as well as local effects (e.g., treatment of vulval and
vaginal atrophy).
3. Peri-menopausal estrogen therapy (ET): remains the most effective
treatment option for relieving perimenopausal and menopausal hot flashes and
night sweats. taken to compensate for the loss of estrogen that occurs during
menopause. There are two basic regimens for HT: estrogen alone (ET) and
estrogen plus a progestin (estrogen/progestin therapy [EPT]).
The purpose of estrogen in both regimens is to control menopausal symptoms by
replacing estrogen that was lost owing to menopause.
4. Transdermal estrogen therapy has fewer adverse effects: The total dose
of estrogen is greatly reduced (because the liver is bypassed).
There is less nausea and vomiting.
Blood levels of estrogen fluctuate less.
There is a lower risk for DVT, pulmonary embolism, and stroke.
Types:
Emulsion (Estrasorb)
Spray (Evamist)
Gels (EstroGel, Elestrin, Divigel)
1/9
, 5 NR 568 FINAL WEEK
Patches (Alora,
Climara, Estraderm, Menostar, Vivelle-Dot, Oesclim )
5. Selective estrogen receptor modulator (SERM): Are drugs that activate
ERs in some tissues and block them in others.
These drugs were developed in an effort to provide the benefits of estrogen (e.g.,
protection against osteoporosis, maintenance of the urogenital tract, reduction of
LDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast cancer,
uterine cancer, and thromboembolism)
6. Bazedoxifene: Duavee (conjugated estrogens/bazedoxifene) for prevention
of vasomotor symptoms and osteoporosis in postmenopausal women with a
uterus. Duavee is the first drug to combine estrogen with an estrogen
agonist/antagonist (bazedoxifene).
The bazedoxifene component of Duavee reduces the risk for excessive growth of
the lining of the uterus that can occur with the estrogen component.
Contraindications to taking Duavee are the same as for other estrogen-containing
products.
7. Prevention of osteoporosis with hormone replacement therapy: HT
reduces postmenopausal bone loss and thereby decreases the risk for
osteoporosis and related fractures.
Unfortunately, when HT is stopped, bone mass rapidly decreases by
approximately
12%. ****Hence to maintain bone health, HT must continue lifelong.***
HT should be considered only for women with significant risk for osteoporosis, and
only when that risk outweighs the risks of HT.
A person on HT and pts, in general, should practice primary prevention of bone
loss by ensuring adequate calcium and vitamin D intake, regular weight-bearing
exercise, and avoiding smoking and excessive alcohol use.
8. How to change a patient from one combination oral contraceptive to
another: start the new brand on active hormone tablets and skip the pill free
interval or use non-hormonal forms of contraception until 7 active tablets of the
new brand have been taken
9. How to initiate treatment (when in the cycle is it best to start- may vary
based on the type of contraceptive): Use is initiated on day 1 of the menstrual
cycle, and one pill is taken daily thereafter.
A backup contraceptive method should be used for the first 7 days.
2/9
