Table of contents
- 1. Menopausal Symptoms
- 2. Treatment of Symptoms
- 2.1.1. Hormone Replacement Therapy (HRT)
- 2.1.2. Venlafaxine (Effexor)
- 2.1.3. OCP
- 2.1.4. Bisphosphonates
Menopausal Symptoms
Vasomotor Symptoms- 10% have extreme symptoms (soak bed sheets, need to change 5x/night)
- 10% have no symptoms at all, and 80% in between
Abnormal Uterine Bleeding
Decline in Fertility
Vaginal Symptoms (dyness, discomfort, itching, odour, dyspareunia).
- Frequent Sex
- Lubricants
Urinary Incontinence (bladder and urethra have estrogen receptors)
Sleep Problems
Mood changes (23%)
Weight gain (2-4lb)
Osteoporosis
Treatment of Symptoms
General Notes:
- Do Not monitor LH/FSH (fluctuate too much to diagnose menopause)
Hormone Replacement Therapy (HRT)
- Indicated for vasomotor symptoms ONLY + must be freshly menopausal (<1yr)
- Osteoporosis: Works well (reduces hip fractures by 40%), but use other drugs
- Dose: as low as possible, as short duration as possible (<5years)
- Often comes with progesterone to reduce risk of endometrial ca.
- Adverse effects:
- CVA, Stroke (only worry if >70yo)
- Breast Cancer
- Benefits:
- Reduces colon cancer risk
- Generally safe if used short term. CVA/Stroke risk present, but extremely low.
Risk Factors (50-70yo) Baseline Risk /100 Additional Cancers
/100No HRT (Baseline) 4.5 0.0 5 years of HRT 4.5 0.2 10 years of HRT 4.5 0.6 15 years of HRT 4.5 1.2 Late Menopause 4.5 1.3 BMI (per 10 kg/m2 increase) 4.5 1.4 Alcohol (2drinks/d) 4.5 2.7 Lack of exercise (<4h/w) 4.5 2.7 Weight Gain after menopause (>20kg) 4.5 4.5
(SOGC/HRT "Lets Talk" series
Venlafaxine (Effexor)
- Small doses 35.5-75mg for vasomotor symptoms
OCP
- Treats anovulatory menses (irregular bleeding and/or heavy bleeding)
- Treat 6-12mo (hopefully enough to take them through the transition)
- 3 possible results when stop:
- 1. No more bleeding
- 2. Return to irregular menses (anovulatory)
- 3. Odd oligomenorrhea
- Still need to do endometrial biopsy
Bisphosphonates
- Significant GI symptoms (dyspepsia). In the past required to sit upright x30min after ingestion. Still developed esophageal cancer.
- Recent formulations weekly + monthly.
- Can cause osteonecrosis of the jaw.
Selective Estrogen Receptor Modulators (SERMs)
- Were popular in the past.
- Decrease Estrogen, and can increase vasomotor symptoms and VTE risk
- Used for bone health,
- Endometrial Cancer can be perpetuatd by SERMS (unopposed estrogen), but apparently some do not affect endometrium (i.e. raloxifene)
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