Menopause
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- Created by: Melissaloughlin
- Created on: 16-06-23 23:51
Estrogen, progesterone and testosterone all decline as a woman ages.
T/F?
T/F?
True
1 of 33
What are the 3 stages of menopause?
Peri-menopause
Menopause
Post-menopause
Menopause
Post-menopause
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When does menopause occur?
12 months after the woman's LMP
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Which surgical procedure would induce menopause regardless of the patient's age?
Hysterectomy
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Why does chronic stress have an impact on menopausal symptoms?
raised cortisol levels can reduce oestrogen levels
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Post-menopausal women receiving HRT are at higher risk of osteoporosis.
True/False?
True/False?
False - lesser risk as oestrogen can increase bone formation
6 of 33
If the patient has had a hysterectomy or has the mirena coil, which HRT would be appropriate?
Estrogen only
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Why is oestrogen only the most appropriate and not combined with progesterone?
Mirena coil - already contains progesterone component (levonorgestrel)
Hysterectomy - Progesterone is used to balance the risks of uterine cancer with oestrogen-only treatment - however no uterus then there is no risk
Hysterectomy - Progesterone is used to balance the risks of uterine cancer with oestrogen-only treatment - however no uterus then there is no risk
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What are some factors that would influence the commencing/switching to estradiol transdermal preparation rather than oral?
Individual preference
BMI>30
GI disorder affecting absorption
Migraine
Previous/family history of VTE
Poor symptom control with oral
Gall bladder disease
Medication - enzyme inducers
BMI>30
GI disorder affecting absorption
Migraine
Previous/family history of VTE
Poor symptom control with oral
Gall bladder disease
Medication - enzyme inducers
9 of 33
What formulations do the transdermal preparations come in for estradiol?
Patch (Evorel)
Gel (Oestrogel)
Spray (Lenzetto)
Gel (Oestrogel)
Spray (Lenzetto)
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What oral estrogen only pills are available?
Estradiol hemihydrate
- Elleste solo tablets
- Progynova tablets
- Elleste solo tablets
- Progynova tablets
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Which therapy is used for peri-menopausal women who have not had a hysterectomy or minera?
Sequential
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Name some oral sequential therapy.
Estradiol and norethisterone (Elleste Duet, Novofem)
Estradiol and dydrogesterone (Femoston)
Estradiol and dydrogesterone (Femoston)
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What is the transdermal sequential therapy?
Estradiol and norethisterone (Evorel Sequi patches)
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How does the sequential therapy work?
eostrogen is given every day whereas the progesterone component is only taken for around 2 weeks.
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What does the safety of HRT largely depend on?
Age of patient
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Should women <60 years of age be concerned about the safety profile of HRT?
No - benefits usually outweigh risks
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What kind of therapy is used in post-menopausal women who still have a womb and do not have the mirena coil?
Continuous therapy
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What is continuous therapy?
Patient is treated with a combination of oestrogen and progesterone every day without a break
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Which oral preparations are available for continuous therapy?
Estradiol and dydrogesterone (Femoston-Conti)
Estradiol and norethisterone (Kliofem, Kliovance)
Estradiol and medroxyprogesterone (Indivina)
Estradiol and norethisterone (Kliofem, Kliovance)
Estradiol and medroxyprogesterone (Indivina)
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Which transdermal preparations are available for continuous therapy?
Estradiol and norethisterone (Evorel Conti patch)
Estradiol and levonorgestrel (FemSeven Conti patch)
Estradiol and levonorgestrel (FemSeven Conti patch)
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Progesterone only tablet can be taken alongside transdermal estradiol.
T/F?
T/F?
True
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When should a review be carried out after commencing or changing HRT therapy?
3 months
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What is the 3rd line hormone that can be added to therapy if there are distressing symptoms of low libido and other causes of this have been excluded?
Testosterone
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Why should utrogestan be taken before bed?
Mildly sedative
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Utrogestan (micronised progesterone) has a lower risk of which type of cancer compared to older synthetic progesterones?
Lower risk of breast cancer
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Micronised progesterone is a natural progesterone - where is it derived from?
Plants
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The younger the patient and if surgical menopause, the higher the need for testosterone replacement - Why is this?
Younger - have higher levels than women at normal menopausal age
Surgical - Sudden drop in testosterone
Surgical - Sudden drop in testosterone
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What can happen to the vagina due to menopause?
Lining becomes thin and dry
Elasticity declines
Elasticity declines
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What symptoms can this cause in women?
Painful intercourse
Vaginal dryness
Low libido ?
Vaginal dryness
Low libido ?
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What can be used to alleviate these symptoms?
Estriol intravaginal creams (Ovestin)
Estradiol vaginal tablets - pessaries (Vagifem, Vagirux)
Estradiol vaginal ring (Estring)
Vaginal moisturisers/lubricants (Replens, YES)
Estradiol vaginal tablets - pessaries (Vagifem, Vagirux)
Estradiol vaginal ring (Estring)
Vaginal moisturisers/lubricants (Replens, YES)
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These topical preparations can be used in combination with systemic HRT.
T/F?
T/F?
True
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The correct HRT is usually the 1st treatment that the patient is started on.
T/F?
T/F?
False - On average takes 3 switches to get it right
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Other cards in this set
Card 2
Front
What are the 3 stages of menopause?
Back
Peri-menopause
Menopause
Post-menopause
Menopause
Post-menopause
Card 3
Front
When does menopause occur?
Back
Card 4
Front
Which surgical procedure would induce menopause regardless of the patient's age?
Back
Card 5
Front
Why does chronic stress have an impact on menopausal symptoms?
Back
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