Anki Flashback
These are five symptoms of menopause.
What are:
vasomotor sx's (hot flashes, night sweats)
GU sx's (vulvovaginal irritation & dryness, dyspareunia, urinary problems)
problems w/ sleep, mood, sexual function, bone health, and quality of life
Although heavily studied and shown to have potential benefit, this intervention is not routinely recommended.
What is black cohosh?
(due to being herbal supplement; lack of regulatory oversight)
This therapy is known to increase the risk of endometrial cancer and should not be administered without progesterone in women with a uterus.
What is unopposed estrogen therapy?
This intervention was found to be non-inferior to estrogen-based therapies for treating GU syndrome.
What are hormone-free vaginal moisturizers?
Nonhormonal medications including SSRIs, SNRIs, gabapentin, clonidine, and oxybutynin may reduce hot flashes and are reasonable alternatives for patients who cannot or choose not to use hormone therapy.
What is a SORT B recommendation?
(Inconsistent or limited-quality patient-oriented evidence from RCTs and systematic reviews)
The definition of natural menopause, a clinical diagnosis
What is cessation of menses for 12 consecutive months?
Consensus guidelines support offering hormone therapy to women who are younger than this age.
Also within 10 years of symptom onset, do not have contraindications to hormone therapy, and desire it for the treatment of moderate to severe vasomotor symptoms.
What is 60 years?
This population of women should not take SSRI's.
(Specifically, those who are being evaluated for menopause or drug induced menopause)
Who are tamoxifen patients?
This (hormonal) intervention may not increase VTE risk compared to oral estrogen.
What is transdermal estrogen?
(more studies are needed)
Effective nonhormonal therapies for genitourinary syndrome of menopause include vaginal lubricants and moisturizers, oral ospemifene (Osphena), and intravaginal dehydroepiandrosterone.
What is a SORT B recommendation?
(Limited-quality patient-oriented data from small, short-term RCTs)
Vasomotor symptoms affect up to this many women worldwide.
What is 80% of women?
(1.5m excess OP visits per year, $330m in costs when untreated)
These are three contraindications to hormone therapy.
What are unexplained vaginal bleeding, hx of stroke, active estrogen-sensitive cancer, hx of VTE, personal or strong fam hx of thromboembolic disorders, hx of CAD, and active liver disease?
These four symptoms are common adverse effects of systemic hormone therapy.
What are nausea, bloating, weight gain, fluid retention, breast tenderness, uterine bleeding, and mood alteration?
This intervention may also improve urge incontinence and prevent recurrent UTI.
What is vaginal estrogen?
Because of potential risks with long-term use of hormone therapy, physicians should prescribe the lowest effective dose for the shortest duration necessary to improve symptoms.
What is a SORT C recommendation?
(Consensus and expert opinion)
Of the symptoms of menopause, these are naturally progressive without treatment
What are genitourinary symptoms?
One long term followup concluded this intervention significantly decreased the risk of breast cancer in women with a hysterectomy.
What is conjugated estrogen?
(conversely, those with a uterus were at increased risk of breast cancer w/ combination estrogen/progesterone)
This intervention has been shown to reduce frequency of hot flashes, but is associated with significant dizziness, headaches, and/or somnolence.
What is gabapentin?
This medication is the only FDA-approved SSRI/SNRI for vasomotor symptoms.
What is paroxetine?
(technically, Brisdelle, a low dose 7.5mg form)
Cognitive behavior therapy and clinical hypnosis are effective for reducing vasomotor symptoms in the short-term. Other nonpharmacologic therapies, including black cohosh and isoflavones, may be considered for select patients, although there is low-quality evidence to support their effectiveness.
What is a SORT B recommendation?
(Inconsistent results or limited-quality data (small or heterogeneous studies) from RCTs)
Vasomotor symptoms may persist, on average, for this long.
What is seven to eight years?
One long term followup concluded that there was no significant increase in risk of death from all causes or CV causes among women receiving hormone therapy for this time period.
What is five to seven years?
Women who have vaginal bleeding with vaginal estrogen should be considered for this.
What is an endometrial biopsy?
This intervention showed significantly decreased short-term and medium-term perceived severity of vasomotor symptoms, but not frequency.
What are behavioral interventions?
(CBT, clinical hypnosis)Systemic estrogen-containing hormone therapy is effective for treating menopausal hot flashes.
What is a SORT A recommendation?
(Clinical practice guidelines supported by a Cochrane review and other RCTs and meta-analyses)