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PHARMACOTHERAPY PRINCIPLES AND PRACTICE CARE PLANS & CASES

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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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INTRODUCTION

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Menopause is the permanent cessation of menses following the loss of ovarian follicular activity. The diagnosis of menopause is primarily a clinical one and is made after a woman experiences amenorrhea for 12 consecutive months. The loss of ovarian follicular activity leads to an increase in follicle-stimulating hormone (FSH), which, on laboratory examination, may help to confirm the diagnosis.

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The role of hormone therapy (HT) has changed dramatically over the years. HT has long been prescribed for relief of menopausal symptoms and, until recent years, has been purported to protect women from coronary heart disease (CHD). The reason behind recommending HT in postmenopausal women revolved around a simple theory: If the hormones lost during menopause were replaced through drug therapy, women would be protected from both menopausal symptoms and chronic diseases that often follow after a woman experiences menopause. Recent studies have disproved this theory.

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In 1996, the United States Preventive Services Task Force first published its recommendations that not all postmenopausal women should be prescribed HT, but that therapy should be individualized based on risk factors. This recommendation was further supported with publication of the Heart and Estrogen/Progestin Replacement Study (HERS) in 1998, which demonstrated that women who had established CHD were at an increased risk of experiencing a myocardial infarction within the first year of HT use compared with a similar group of women without CHD risk factors. As a result, the authors concluded that HT should not be recommended for the secondary prevention of CHD.1 Then, in 2002, the Women’s Health Initiative (WHI) study was published. This trial demonstrated that HT was not protective against CHD but rather could increase the risk in women with underlying CHD risk factors. The risk of breast cancer was also increased after a woman was on combination estrogen and progestogen for approximately 3 years. It should be noted that this was not the case with estrogen alone. As a result of this study, the US Food and Drug Administration (FDA) issued a statement that HT, in general, should not be initiated ...

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