menopause

• Discuss appropriate HRT for a patient with menopausal symptoms

  1. Help with vasomotor symptoms

  2. Prevent atrophy

  3. Prevent bone loss

  4. Improve lipoprotein profile

  5. Use combo of estrogen and progestin
• HRT


  • Helps with vasomotor symptoms
  • Prevents atrophy
  • Prevents bone loss
  • Improves lipoprotein profile
  • Reduces risk of endometrial hyperplasia and cancer
• Contraindications for HRT


  • Known or suspected breast or uterine cancer
  • Active DVT or history of PE or DVT
  • Factor V Leiden or other coagulopathies
  • Arterial thrombotic disease (i.e., MI)
  • Migraine with aura
  • Chronic liver disease
• Non-hormonal therapy for vaginal dryness

  • Lubrication use
  • SSRI
  • SNRI
  • Gabapentin
  • Clonidine
• Vasomotor non-hormonal therapy


  • Paroxetine
  • Venlafaxine (SNRI)
  • Gabapentin for hot flashes
  • SERM
• Life-style changes to help with menopausal symptoms

  • Proper diet
  • Phytoestrogens (soy, red clover, black cohosh)
  • Vitamin E
  • Omega-3 fatty acids
• Differential diagnoses for a patient with menopausal symptoms

  • Hot flashes
  • Vulvovaginal atrophy
  • Urinary tract dysfunction
  • Dysuria
  • Urinary urgency
  • Mood instability
  • Increased wrinkles
  • Decreased lean body mass
  • Libido loss
  • Vaginal dryness
  • Night sweats
  • Hair loss/thinning
• Treatment for vulvovaginal atrophy

  • Vaginal estrogen creams
  • Moisturizers
  • Lubricants
• Laboratory tests to evaluate menopausal symptoms

  1. Decrease estrogen

  2. Decrease progesterone

  3. Decrease hypothalamic inhibition

  4. Increase bursts of GnRH

  5. Increase FSH

  6. Increase LH
• Appropriate hormone replacement therapy for menopausal patients

  1. With uterus: use combination therapy

  2. Without uterus: use estrogen alone

  3. Creams