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HORMONE THERAPY USES IN POST-MENOPAUSE - Coggle Diagram
HORMONE THERAPY
USES IN POST-MENOPAUSE
MENOPAUSE SYMPTOMS
vasomotor symptoms
takes 6-8 weeks
transdermal estradiol patch 0.025 mg
oral conjugated equine estrogen 0.3 mg
oral 17β-estradiol ≤ 0.5 mg
symptomatic without a uterus - estrogen therapy
symptomatic with a uterus - EPT or TSEC
veozah - non-hormonal
monitor liver enzyme
discontinue all estrogen prior to initiation
sleep disturbances
medroxyprogesterone acetate 100 mg or 200 mg nightly
AE bloating
low dose estrogen
genitourinary symptoms
low-dose vaginal ET preprations
transdermal ET
rings - change every 3 months
vaginal insert softgel
creams
gel - systemic
oral ET is less favored
nonestrogen therapy
ospemifene
intravaginal DHEA - convert into testosterone + estrogen
UTI/pelvic floor disorder
vaginal ET
pelvic muscle floor training
pessaries
surgery
sexual dysfunction / libido
Addyi
specialty medications
only available at specific pharmacy
patient assistance program available
include peanut oil
vylessi
injectable
only available at specific pharmacy
intrarosa
vaginal
nonestrogen
increase testosterone -> increase libido
OSTEOPOROSIS PREVENTION
weekly patch estradiol 0.014 mg/d
women < 60 years or within 10 years of menopause onset - systemic hormone therapy
women with premature menopause - hormone therapy or oral contraceptive
ENDOMETRIAL PROTECTION
bazedoxifene + conjugataed equine estrogen
treatment of vulvovaginal symptoms
estrogen cream
estrogen ring
estring - low dose, oral
femming - systemic
Imevexxy 10 mcg gel cap
tablets Yurafem, vagifem
PRIMARY OVARIAN INSUFFICIENCY
oral contraceptives - recommended in healthy younger women
ovarian conservation - recommended
when hysterectomy is performed for benign indication in premenopausal women
SKIN, HAIR,
OTHER SENSES
hormone therapy - decrease risk of neovascular and soft drusen age-related macular degeneration
estrogen therapy - beneficial for skin thickness and elasticity
African-American women - estrogen therapy reduces intraocular pressure, decrease risk for open-angle glaucoma
COMORBIDITIES CONDITION
GALLBLADDER
LIVER
oral estrogen increase bile crystallization -> increase cholecystic, cholecystectomy
transdermal estrogen - less risk of gallstone
hormone therapy - potentially beneficial for fatty liver and liver fibrosis
DIABETES
hormone therapy reduces new onset of type 2 diabetes
pre-existing type 2 diabetes - hormone therapy improve glycemic control
small effect with decreasing weight
PSYCHIATRIC
COGNITION
women > 65 years old - initiating hormone therapy increase risk of dementia
best to initiate immediately after hysterectomy with bilateral oophorectomy - neutral effect on cognition
hormone therapy NOT recommended to prevent or treat decline in cognition
DEPRESSION
estrogen therapy is NOT effective and NOT indicated to treat mood disturbances in post menopause
Euthymic perimenopausal women
to delay onset of depressive symptoms may use
transdermal estradiol
intermittent MP
CARDIOVASCULAR DISEASE
surrogate markers of coronary heart disease
initiate hormone therapy fewer than 10 years after menopause onset
oral 17β-estradiol 1mg/d plus progesterone oral 100 mg
Stroke risk
NO increased risk of stroke in women with hormone therapy initiated at age younger than 60 years or fewer than 10 years from menopause onset
venous thromboembolism
HIGHER risk for women initiated more than 10 years after menopause on set or aged younger
blood clot risk - higher incidence in oral > transdermal
ONCOLOGY
BREAST
low dose vaginal ET or DHEA for survivors of breast cancer
regular breast screening for post-menopause women
ENDOMETRIUM
ET + progesterone to decrease risk of endometrial cancer
low-dose vaginal ET do not appear to increase endometrial cancer risk
systemic therapy are to advised with high-grade, advanced-stage endometrial cancers
OVARIES
oral contraceptives is associated with reduction in ovarian cancer
history of ovarian cancer
benefits to start hormone therapy for women with VMS or early menopause
not recommended in women with hormone-dependent ovarian cancers
granulosa-cell tumors
low-grade seous carcinoma
short-term hormone therapy are safe with BRCA1 and BRCA2 variants
COLORECTAL
EPT reduced colorectal cancer risk
no difference in colorectal cancer mortality with either EPT or ET
LUNGs
hormone therapy are neutral on lung cancer incidence and survival
encourage smoking cessation