Exam (elaborations)
Menopause Questions and Answers
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Exam of 6 pages for the course nams at nams (Menopause)
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MenopauseWhich 2 nonpharmacologic treatments are HIGHLY recommended by the North
American Menopause Society (NAMS) to treat VMS? - answerCognitive behavioral
therapy, clinical hypnosis
What other nonpharmacologic options are used to treat VMS? - answerTemperature
control (colder pillow)
Yoga/relaxation therapy
Avoid spicy foods, chocolate, caffeine
Exercise
Acupuncture
Paced respiration (slowed down breathing)
What are vasomotor symptoms? - answerHot flushes and night sweats
What are the non-VMS of menopause? - answerDyspareunia, vaginal dryness, mood
changes, sleep disturbances, concentration and memory issues, arthralgia
If patient has a uterus, you must give them - answerestrogen + progestin combo
If patient does NOT have a uterus, you can give them - answerestrogen alone
What are the 3 main differences in estrogen of transdermal estrogens? - answerLower
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? - answerIncreases
triglycerides
Potential for decreased libido
What is the Women's Health Initiative (WHI)? - answerClinical 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? - answerEstrogen +
progestin combo resulted in an increased risk of breast cancer
What was the problem with how the WHI ended? - answerThere 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? -
answerLikely 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? - answerTobacco 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? - answerSystemic hormone therapy (HT), since it
provides optimal relief of hot flushes
What symptoms should be present for a woman to be on HT? - answerVMS
If patients have vaginal symptoms only, only use what kind of products? -
answerVaginal products
What are the 2 most common estrogens used in HT? - answerEstradiol and Conjugated
equine estrogens (CEE)
What are the 2 most common progestogens used in HT? - answerMedroxyprogesterone
acetate (MPA) and Micronized progesterone (MP)
Which hormone should be used with caution in patients with a peanut allergy? -
answerMicronized Progesterone (MP)
What are all of the contraindications to MHT? - answer-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? - answerSSRIs,
SNRIs, Clonidine, Gabapentin, Pregabalin
What SSRI should be used if the patient is taking Tamoxifen for breast cancer? -
answerEscitalopram
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