MENOPAUSE EXAM QUESTIONS AND ANSWERS
Which 2 nonpharmacologic treatments are HIGHLY recommended by the North
American Menopause Society (NAMS) to treat VMS? - Answers-Cognitive behavioral
therapy, clinical hypnosis
What other nonpharmacologic options are used to treat VMS? - Answers-Temperature
control (colder pillow)
Yoga/relaxation therapy
Avoid spicy foods, chocolate, caffeine
Exercise
Acupuncture
Paced respiration (slowed down breathing)
What are vasomotor symptoms? - Answers-Hot flushes and night sweats
What was the most important "shocking" result from the WHI? - Answers-Estrogen +
progestin combo resulted in an increased risk of breast cancer
What was the problem with how the WHI ended? - Answers-There 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? -
Answers-Likely 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? - Answers-Tobacco 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? - Answers-Systemic hormone therapy (HT), since it
provides optimal relief of hot flushes
What symptoms should be present for a woman to be on HT? - Answers-VMS
If patients have vaginal symptoms only, only use what kind of products? - Answers-
Vaginal products
What are the 2 most common estrogens used in HT? - Answers-Estradiol and
Conjugated equine estrogens (CEE)
, What are the 2 most common progestogens used in HT? - Answers-
Medroxyprogesterone acetate (MPA) and Micronized progesterone (MP)
Which hormone should be used with caution in patients with a peanut allergy? -
Answers-Micronized Progesterone (MP)
What are all of the contraindications to MHT? - Answers--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? - Answers-
SSRIs, SNRIs, Clonidine, Gabapentin, Pregabalin
What SSRI should be used if the patient is taking Tamoxifen for breast cancer? -
Answers-Escitalopram
Which 2 SSRIs should be avoided in patients taking Tamoxifen? - Answers-Fluoxetine,
Paroxetine
What are the non-VMS of menopause? - Answers-Dyspareunia, vaginal dryness, mood
changes, sleep disturbances, concentration and memory issues, arthralgia
If patient has a uterus, you must give them - Answers-estrogen + progestin combo
If patient does NOT have a uterus, you can give them - Answers-estrogen alone
What are the 3 main differences in estrogen of transdermal estrogens? - Answers-
Lower 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? - Answers-Increases
triglycerides
Potential for decreased libido
What is the Women's Health Initiative (WHI)? - Answers-Clinical study started in 1991.
Studied the use of conjugated equine estrogens (CEE) and medroxyprogesterone
acetate (MPA) in women with and without a uterus
Which 2 nonpharmacologic treatments are HIGHLY recommended by the North
American Menopause Society (NAMS) to treat VMS? - Answers-Cognitive behavioral
therapy, clinical hypnosis
What other nonpharmacologic options are used to treat VMS? - Answers-Temperature
control (colder pillow)
Yoga/relaxation therapy
Avoid spicy foods, chocolate, caffeine
Exercise
Acupuncture
Paced respiration (slowed down breathing)
What are vasomotor symptoms? - Answers-Hot flushes and night sweats
What was the most important "shocking" result from the WHI? - Answers-Estrogen +
progestin combo resulted in an increased risk of breast cancer
What was the problem with how the WHI ended? - Answers-There 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? -
Answers-Likely 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? - Answers-Tobacco 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? - Answers-Systemic hormone therapy (HT), since it
provides optimal relief of hot flushes
What symptoms should be present for a woman to be on HT? - Answers-VMS
If patients have vaginal symptoms only, only use what kind of products? - Answers-
Vaginal products
What are the 2 most common estrogens used in HT? - Answers-Estradiol and
Conjugated equine estrogens (CEE)
, What are the 2 most common progestogens used in HT? - Answers-
Medroxyprogesterone acetate (MPA) and Micronized progesterone (MP)
Which hormone should be used with caution in patients with a peanut allergy? -
Answers-Micronized Progesterone (MP)
What are all of the contraindications to MHT? - Answers--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? - Answers-
SSRIs, SNRIs, Clonidine, Gabapentin, Pregabalin
What SSRI should be used if the patient is taking Tamoxifen for breast cancer? -
Answers-Escitalopram
Which 2 SSRIs should be avoided in patients taking Tamoxifen? - Answers-Fluoxetine,
Paroxetine
What are the non-VMS of menopause? - Answers-Dyspareunia, vaginal dryness, mood
changes, sleep disturbances, concentration and memory issues, arthralgia
If patient has a uterus, you must give them - Answers-estrogen + progestin combo
If patient does NOT have a uterus, you can give them - Answers-estrogen alone
What are the 3 main differences in estrogen of transdermal estrogens? - Answers-
Lower 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? - Answers-Increases
triglycerides
Potential for decreased libido
What is the Women's Health Initiative (WHI)? - Answers-Clinical study started in 1991.
Studied the use of conjugated equine estrogens (CEE) and medroxyprogesterone
acetate (MPA) in women with and without a uterus
