WHNP
Menopause/Infertility/Miscellaneous
Physiology of menopause - ANS--Follicular development decreases due to decreased
response to FSH
-Ovaries produce less estradiol, progesterone, androgens, inhibin
-FSH, LH continued to be produced, but no receptors...which means labs are high in
FSH/LH, but low in estrogen/progesterone
Menopause physical changes - ANS-Breast size diminishes, lack of
glycogen=decreased pH, loss of vaginal rugae, loss of pelvic floor muscle tone, urethra
shortens and thins, bladder capacity and tone decrease, etc
Estrone - ANS-estrogen of menopause
Vasomotor symptoms - ANS-The ONLY thing that menopausal hormone therapy is FDA
approved for
Terminology of menopause - ANS-ET= estrogen therapy
EPT=estrogen/progestogen therapy
HT= Hormone therapy (encompasses ET and EPT)
HT - ANS--Indicated for moderate to severe menopausal symptoms, including hot
flashes...is the primary indication for systemic estrogen therapy/EPT
-Data does not support use of progestin only or testosterone
Progestin - ANS-ALL women with intact uterus should be prescribed this with ET to
decrease risk of endometrial hyperplasia
HT prescribing - ANS-ET and EPT should be prescribed for shortest amount of time
(start low and go slow)
Vulvovaginitis treatment in menopause - ANS-Topical estrogens- do not need systemic
therapy unless hot flashes
*progesterone is not indicated with low dose vaginal estrogen
HT effects - ANS--Bone health improves
-May reduce risk of coronary heart disease
, -Could cause increase in ischemic stroke or clots
-Could increase risk for breast cancer if used >3-5 years
-Dementia risk increased in women >65 yo
Contraindications to HT - ANS-Unexplained vaginal bleeding
Liver disease
HIGH risk for stroke
PMH for breast cancer, DVT, CHD, MI, CVA, endometrial cancer
Relative contraindications to HT - ANS-Hypertriglyceridemia
Active gallbladder disease
Paroxetine (Brisdelle) - ANS-ONLY FDA approved SSRI for treatment of vasomotor
symptoms
7.5mg per day
Full 4 week trial is required
*make sure to avoid this if patient is on tamoxifen- make increase risk of bleeding
Other approaches to vasomotor symptoms - ANS--Fluoxetine 20mg, Venlafaxine
75-150mg
-Gabapentin 300mg daily
-Clonidine 0.1mg at bedtime
Ospemifene (Osphena) - ANS-SERM
Acts like estrogen on vaginal tissues, stimulates endometrium thickening
FDA approved for treating moderate to severe dyspareunia in PM women
Low VTE risk in contrast to ERT
SE include hot flashes, discharge, muscle spasms
Bisphosphonates (alendronate, zoledronic acid) - ANS-Medications that reduce bone
resorption by decreases osteoclast activity
Make sure to take with 8oz plain water prior to food
May be associated with GI ulcerations
Hydrate well!!!!
Primary fertility - ANS-couples who have not become pregnant after at least 1 year
having sex without using birth control methods (pregnancy has NEVER been achieved)
Secondary fertility - ANS-couples who have been able to get pregnant at least once, but
now are unable
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