Treatment of Menopause Exam with
Accurate solutions
common menopausal symptoms - ANS-1. hot flashes
2. amenorrhea
3. decreased BMD
4. urogenital atrophy
associated symptoms of menopause - ANS-1. mood swings
2. depression
3. insomnia
4. migraines
5. formication
6. arthralgia
7. myalgia
8. decreased libido
9. sexual dysfunction
10. cognitive symptoms
FSH and menopause - ANS-FSH levels increase at menopause due to relief of
feedback
typical FSH measurements - ANS-1. typical pre-menopausal levels = 5-25 mIU/mL
2. typical postmenopausal level = >40 mIU/mL
3. during perimenopause = may surge to 500 mIU/mL
4. COCs, HRT, ovarian and pituitary tumors may alter test results
5. usually unnecessary or unreliable
goals of menopause therapy - ANS-1. relive menopausal symptoms
2. enhance quality of life
3. reduce morbidity/mortality associated with sex-hormone deficiency (bone loss, CV
disease, and diabetes)
therapeutic treatment options for menopause - ANS-1. lifestyle modifications
2. hormonal therapies (traditional agents, bioidentical hormone therapy (BHRT))
3. symptomatic relief
4. alternative products
lifestyle modification - ANS-1. smoking cessation
2. decrease caffeine and alcohol intake
3. increase exercise
, 4. for vasomotor symptoms = dress in layers; avoid hot spicy foods, alcohol and
caffeine; deep breathing / stress reduction techniques, meditation
5. OTC vaginal lubricants and moisturizers
6. alternative products
purpose of Women's Health Initiative (WHI) - ANS-define risks and benefits of
interventions to decrease heart disease, breast and colorectal cancer, and osteoporotic
fractures in postmenopausal women
why were the HRT and ERT arms of the WHI terminated? - ANS-1. HRT arm terminated
due to increase in cases of breast cancer
2. ERT arm terminated due to increased risk of stroke
issues with data from WHI - ANS-1. study population ~63yrs
2. 1:6 patients were ≤5yrs of menopause
3. patients primarily asymptomatic
4. only products used were Prempro 0.625/2.5mg and Premarin 0.625mg
5. would results be similar in women who are newly diagnosed, symptomatic, using
lower doses, using other estrogens and progestins, receiving a different dosage form?
5 years post-WHI report results - ANS-1. 65% of women stopped HRT in 2002
2. 1 in 4 women subsequently returned to therapy -> still offers best relief of symptoms,
willing to take risks to get benefits, follow-up reports of WHI, uncertainty of what results
mean
treatment of postmenopausal dyspareunia (difficult/painful intercourse) - ANS-
ospemifene (Osphena)
1. dyspareunia caused by vulvovaginal atrophy
2. novel SERM
3. taken once daily with food
ospemifene (Osphena) ADRs - ANS-1. boxed warning for endometrial stimulation
2. DVT, stroke -> lower risk than estrogen alone
3. hot flashes also possible
what is duavee? - ANS-1. combination of CEE and bazedoxifene, a SERM
2. the SERM substitutes for progestin in the HT therapy regimen
Duavee use - ANS-1. for treatment of vasomotor symptoms in women with a uterus
2. can also be used to prevent osteoporosis in women with significant risk factors
non-hormonal therapies for vasomotor symptoms - ANS-1. SNRIs (serotonin-
norepinephrine reuptake inhibitors)
2. SSRIs
3. Gabapentin
4. Clonidine
Accurate solutions
common menopausal symptoms - ANS-1. hot flashes
2. amenorrhea
3. decreased BMD
4. urogenital atrophy
associated symptoms of menopause - ANS-1. mood swings
2. depression
3. insomnia
4. migraines
5. formication
6. arthralgia
7. myalgia
8. decreased libido
9. sexual dysfunction
10. cognitive symptoms
FSH and menopause - ANS-FSH levels increase at menopause due to relief of
feedback
typical FSH measurements - ANS-1. typical pre-menopausal levels = 5-25 mIU/mL
2. typical postmenopausal level = >40 mIU/mL
3. during perimenopause = may surge to 500 mIU/mL
4. COCs, HRT, ovarian and pituitary tumors may alter test results
5. usually unnecessary or unreliable
goals of menopause therapy - ANS-1. relive menopausal symptoms
2. enhance quality of life
3. reduce morbidity/mortality associated with sex-hormone deficiency (bone loss, CV
disease, and diabetes)
therapeutic treatment options for menopause - ANS-1. lifestyle modifications
2. hormonal therapies (traditional agents, bioidentical hormone therapy (BHRT))
3. symptomatic relief
4. alternative products
lifestyle modification - ANS-1. smoking cessation
2. decrease caffeine and alcohol intake
3. increase exercise
, 4. for vasomotor symptoms = dress in layers; avoid hot spicy foods, alcohol and
caffeine; deep breathing / stress reduction techniques, meditation
5. OTC vaginal lubricants and moisturizers
6. alternative products
purpose of Women's Health Initiative (WHI) - ANS-define risks and benefits of
interventions to decrease heart disease, breast and colorectal cancer, and osteoporotic
fractures in postmenopausal women
why were the HRT and ERT arms of the WHI terminated? - ANS-1. HRT arm terminated
due to increase in cases of breast cancer
2. ERT arm terminated due to increased risk of stroke
issues with data from WHI - ANS-1. study population ~63yrs
2. 1:6 patients were ≤5yrs of menopause
3. patients primarily asymptomatic
4. only products used were Prempro 0.625/2.5mg and Premarin 0.625mg
5. would results be similar in women who are newly diagnosed, symptomatic, using
lower doses, using other estrogens and progestins, receiving a different dosage form?
5 years post-WHI report results - ANS-1. 65% of women stopped HRT in 2002
2. 1 in 4 women subsequently returned to therapy -> still offers best relief of symptoms,
willing to take risks to get benefits, follow-up reports of WHI, uncertainty of what results
mean
treatment of postmenopausal dyspareunia (difficult/painful intercourse) - ANS-
ospemifene (Osphena)
1. dyspareunia caused by vulvovaginal atrophy
2. novel SERM
3. taken once daily with food
ospemifene (Osphena) ADRs - ANS-1. boxed warning for endometrial stimulation
2. DVT, stroke -> lower risk than estrogen alone
3. hot flashes also possible
what is duavee? - ANS-1. combination of CEE and bazedoxifene, a SERM
2. the SERM substitutes for progestin in the HT therapy regimen
Duavee use - ANS-1. for treatment of vasomotor symptoms in women with a uterus
2. can also be used to prevent osteoporosis in women with significant risk factors
non-hormonal therapies for vasomotor symptoms - ANS-1. SNRIs (serotonin-
norepinephrine reuptake inhibitors)
2. SSRIs
3. Gabapentin
4. Clonidine
