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Contraindications for HRT
- abnormal vaginal bleeding
- presence/history of hormone-dependant malignancy
- active/history of VTE
- active endometriosis
- severe liver disease
- active/recent (1yr) thromboembolic disease (MI, stroke)
- breast cancer
- endometrial cancer
- hypersensitivity to estrogen/progestin therapy
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Phytoestrogen reduce/protect
- reduce menopausal symptoms
- protect against CAD
- breast cancer
- osteoporosis
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Black Cohosh
- Rhizomes: contain formononetin (a phytoestrogen) & provide estrogenic activity
- triterpenoid 27-deoxyactein: estrogenic activity
- isoferulic acid: anti-inflammatory & decrease muscle spasm
- salicyclic acid: antiinflammatory & analgesic prperties
- cimicifugoside: affect hypothalamus-pituitary function
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Menopause definition
- defined as the time of the last menstrual period
- average age of menopause 51
- menopause occurs 2yrs earlier if you smoke
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Perimenopause definition
- begins when menstrual cycle irregularity and continues until 12 months of amenorrhea (no bleeding)
- begins abour 4yrs prior to menopause
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Postmenopause definition
women who have not experienced menstrual bleeding for at least 12 months
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Estrogen produced where in menopausal woman???
- thecal cells
- liver
- adrenal glands
- *estrone levles increase and estradiol levels decrease
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Menopausal sex characteristics
- loss of body hair
- reduction in skin elasticity
- reduce in subcutaneous fat (decreasing breast size)
- vaginal dryness
- urinary stress incontinence and urgency (caused by urogenital atrophy)
- nocturia
- UTI
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vasomotor instability (symptoms)
- hot flashes
- night sweats
- dizziness
- headaches
- vasomotor symptoms lead to irritability, anxiety, depression
- occur most in obese and smokers
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Long-term complications menopausal woman
- cardiovascular disease (leading cause of death in postmenopausal woman)
- osteoporosis
- vision loss
- cognitive impairment
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Trigger vasomotor symptoms
- hot weather
- caffeine
- alcohol ingestion
- intake of spicy foods
- hot drinks
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Progestins used in HRT include:
- medroxyprogesterone acetate
- micronized progesterone
- norethindrone acetate
- norgestrel
- levonorgestrel
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Primary estrogens used in HRT include:
- conjugated equine estrogens (CEE)
- endogenous estrogen (estradiol acetate)
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Phytoestrogens
- made from beans, seeds, grains, soybean has high content of phytoestrogens
- benefical effects: postmenopausal symptoms, cardiovascular disease, prevents osteoporosis
- low doses: act like estrogen
- high doses: block estrogen
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Alternative medications for menopause
- venlafaxine
- paroxetine
- clonidine
- gabapentin
- megestrol acetate
- black cohosh
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Black Cohosh adverse effects
- can cause acute hepatitis
- need baseline and periodic LFT
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