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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the physiologic changes associated with menopause.

  2. Identify the signs and symptoms associated with menopause.

  3. Determine the desired therapeutic outcomes for a patient taking hormone therapy (HT).

  4. Explain how to evaluate a patient for the appropriate use of HT.

  5. Recommend nonpharmacologic therapy for menopausal symptoms.

  6. List the adverse effects of and contraindications to HT.

  7. Differentiate between topical and systemic forms of HT.

  8. Explain the risks and benefits associated with HT.

  9. Educate a patient regarding the proper use and potential adverse effects of HT.

  10. Describe the monitoring parameters for a patient taking HT.

  11. Describe the circumstances under which nonhormonal therapies for menopausal symptoms should be considered.

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KEY CONCEPTS

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  • Image not available. Common symptoms of menopause include hot flashes, night sweats, vulvovaginal atrophy, vaginal dryness, and dyspareunia. Women less commonly may experience mood swings, depression, insomnia, arthralgia, myalgia, urinary frequency, and decreased libido.

  • Image not available. Hormone therapy (HT) remains the most effective treatment for vasomotor symptoms and vulvovaginal atrophy and can be considered, especially for women experiencing moderate to severe symptoms.

  • Image not available. Women should receive a thorough history and physical examination, including assessing for coronary heart disease (CHD) and breast cancer risk factors before HT is considered. If a woman does not have any contraindications to HT, including CHD or significant CHD risk factors, and also does not have a personal history of breast cancer, HT may be an appropriate therapy option.

  • Image not available. Oral or transdermal estrogen products should be prescribed at the lowest effective dose and for the shortest duration possible to provide relief of vasomotor symptoms. Topical vaginal products in the form of creams, tablets, or rings should be prescribed for women exclusively experiencing vulvovaginal atrophy.

  • Image not available. Women who have an intact uterus should be prescribed a progestogen in addition to estrogen in order to decrease the risk of endometrial hyperplasia and endometrial cancer.

  • Image not available. HT is also indicated for the prevention of osteoporosis, but is not recommended for long-term use. Traditional osteoporosis therapies such as bisphosphonates should be considered as first-line therapy for the prevention and treatment of osteoporosis, in addition to appropriate doses of calcium and vitamin D.

  • Image not available. Combined estrogen plus progestogen should not be used in the prevention of chronic diseases because it increases the risk of CHD, stroke, breast cancer, venous thromboembolism (VTE), and dementia. Estrogen alone administered to women without a uterus does not increase the risk of breast cancer. Colorectal cancer and rates of fracture are reduced with combined hormonal treatment.

  • Image not available. HT improves overall well-being and mood in women with vasomotor symptoms but has not demonstrated an improvement in quality of life (QOL) in women without vasomotor symptoms.

  • Image not available. When treating moderate to severe postmenopausal symptoms, the benefit-to-risk ratio appears to be best when HT is started close to the time of menopause. Therapy should be tapered before discontinuation in order to limit the recurrence of hot flashes.

  • Image not available. Since the publication of the Women's Health ...

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