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What are the sx of menopause?
- Hot flashes
- Genitourinary atrophy
- Insomnia and fatigue
- Impaired memory
- Crying spells
- Decrease in sexual function
What is the tx for hot flashes?
- estrogen at the lowest dose that controls the sx
- continue for 3-5yrs
What is the tx for genitourinary atrophy?
- Nonprescription agents (replens)
- Intravaginal estrogen
- Systemic estrogen
What are the benefits of estrogen in HRT?
- Relieves hot flashes
- Relieves genitourinary atrophy
- Reduces hip fractures
- Reduces vertebral fractures
- Lowers LDL, increases HDL
- Relieves insomnia and fatigue
- Relieves mood changes
- Improves sexual function
What are the risks of estrogen in HRT?
- Increased risk of endometrial cancer
- Increased risk of breast cancer
- Increased risk of CV outcomes
- Breast tenderness
- Unpredictable bleeding
What are the benefits of progestin in HRT?
Decrease risk of estrogen-induced irregular bleeding, endometrial hyperplasia, and carcinoma
What are the risks of progestin in HRT?
- Wt gain
- Unpredictable bleeding for first 8-12 months
What type of HRT is most appropriate for women with a hysterectomy?
Unopposed estrogen (conjugated estrogen only)
What is the disadvantage to Estrogen plus cyclic progestin in HRT?
Regular menses every month until tx is d/c
What is the advantage of estrogen plus continuous progestin in HRT?
Menses only lasts for first 8-12mo of tx
What are the other tx options for hot flashes?
- Gabapentin (most effective, but not most used)
- Clonidine (most effective, but not most used)
- Clonidine patch (most effective, but not most used)
- Megestrol acetate
- Venlafaxine (most used and help mood changes)
- Fluoxetine (most used and help mood changes)
- Paroxetine (most used and help mood changes)
- Vitamin E
- Black cohosh