NR 566 Final Study Guide All Answers Correct
Week 1
Chapter 50: Estrogen and Progestins
Menopause
1. Estrogen Loss: Menopause is associated with a reduction in estrogen levels, which usually begins
around ages 51 to 52, with 95% of women experiencing menopause between ages 45 and 55.
2. Menstrual Changes: Initially, menstrual cycles become irregular, with possible anovulatory cycles and
alternating periods of amenorrhea and menstruation.
3. Cessation of Menstruation: Eventually, both ovulation and menstruation stop completely.
### Physiologic Changes Accompanying Menopause
1. Vasomotor Symptoms: Hot flashes and night sweats affect approximately 70% of postmenopausal
women, characterized by sudden skin flushing, sweating, and a sensation of uncomfortable warmth,
which can occur at night and result in heavy sweating.
2. Genitourinary Syndrome of Menopause: The urethra and vagina have the highest concentrations of
estrogen receptors. When estrogen levels drop during menopause, these tissues begin to atrophy,
leading to urge incontinence, urinary frequency, urethritis, and urinary tract infections.
,3. Mental Changes: Many women experience cognitive changes such as difficulty solving problems and
short-term memory loss. Some also report depression or increased anxiety.
4. Bone Loss: Without estrogen, bone resorption speeds up, resulting in a 12% decrease in bone density.
This can lead to osteoporosis, which may cause compression fractures of the vertebrae, reduced height,
and a hump. In osteoporotic women, fractures of the hip and wrist can occur from minor trauma.
5. Altered Lipid Metabolism: Studies indicate that menopause is associated with increased LDL
cholesterol and decreased HDL cholesterol, contributing to the rise in cardiovascular disease risk after
menopause.
6. Female Sexual Interest-Arousal Disorder: This condition becomes more prevalent during
menopause.Therapeutic Uses:
1. Menopausal hormone therapy- When estrogen is used for this purpose,
2. Female hypogonadism-In the absence of ovarian estrogens,
3. Acne-Estrogens, in the form of
4. Cancer palliation-sometimes used for palliative therapy
5. Gender-affirmation therapy-for
1. it is usually accompanied by the use of progestins
2. pubertal transformation will not take place. (variety of causes see pg 428) This treatment promotes
breast development, maturation of the reproductive organs, and pubic and axillary hair. This tx regimen
consists of continuous low-dose therapy (for approx a year) followed by cyclic administration of
estrogen in higher doses
3. oral contraceptives, can help control acne. Tx is limited to patients at least 14-15 years old who want
,contraception
4. in management of advanced prostate CA in men and in a select type of metastatic breast CA in men&
women
5. transgender women; not approved by the FDA) but prescribed off-label
Forms of Estrogen
1. Estrogen is available in conjugated and esterified forms. Esterified estrogens
2. Until mid-2016, synthetic conjugated estrogens A (Cenestin) and B (Enjuvia) were available; however,
3. Phytoestrogens (plant-based compounds)-commonly used by women as a
4. Phytoestrogens are not as potent as estradiol, but they carry some of the same risks.
5. Selective estrogen receptor modulators (SERMs) are drugs that activate ERs in some tissues and block
them in others. These drugs were developed in an effort
1. are plant based; conjugated estrogens are natural preparations derived from the urine of pregnant
horses.
2. the manufacturer has withdrawn them from the market
3. "natural" way to manage symptoms associated with menopause
4. Women should not use phytoestrogens if they have a history of thromboembolic events or a personal
or family history of breast, uterine, or ovarian cancer.
5. to provide the benefits of estrogen (e.g., protection against osteoporosis, maintenance of the
urogenital tract, reduction of LDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast
cancer, uterine cancer, and thromboembolism)
Estrogen-Adverse Effects
1. principal concerns with estrogen therapy are the potential for
2. endometrial hyperplasia and endometrial cancer can be resolved
, 3. Estrogens have been associated with what common SE
4. menopause may produce or uncover
5. Nausea is the most
6. (blank) a patchy brown facial discoloration, though not dangerous, may cause significant distress
1. endometrial hyperplasia, endometrial cancer, breast cancer, and cardiovascular thromboembolic
events
2. by prescribing a progestin
3. Fluid retention with edema, gallbladder disease, jaundice, and headache; especially migraine
headache
4. gallbladder disease. Jaundice may develop in women with preexisting liver dysfunction, especially
those who experienced cholestatic jaundice of pregnancy
5. frequent undesired response to the estrogens
6. Chloasma,
Contraindications of Estrogen
1. Estrogens should not be taken by patients with a history of
2. They should not be prescribed to women who
3. Patients with a hx of
1. DVT, pulmonary embolus, or conditions such as stroke or MI that occurred secondary to a
thromboembolic event.
2. are pregnant or who have vaginal bleeding without a known cause.
