WEEK 5 NR 568 FINAL REVIEW
(Latest 2023/ 2024) When and when not to use progestin for hormone replacement therapy and why?combined estrogen-progestin therapy for women with an intact uterus. Estrogen-only HRT can be given to someone with a hysterectomy. Progestin is required to prevent estrogen-associated endometrial hyperplasia.Local vs. systemic estrogen options and why one would be chosen over the other intravaginal preparations are most helpful in treating symptoms associated with local estrogen deficiency, such as vaginal and vulvar atrophy; these preparations are associated with a lower risk of systemic effects progesterone is contraindicated in women who have undergone a hysterectomy but required in women with an intact uterus who have undergone hormone replacement therapy IV administration is generally limited to acute, emergency control of heavy uterine bleeding.One of the two available vaginal rings (Estring) are used only for local effects, primarily treatment of vulval and vaginal atrophy associated with menopause.The other vaginal ring (Femring) is used for systemic effects (e.g., control of hot flashes and night sweats) as well as local effects (e.g., treatment of vulval and vaginal atrophy).Peri-menopausal estrogen therapy (ET) remains the most effective treatment option for relieving perimenopausal and menopausal hot flashes and night sweats.taken to compensate for the loss of estrogen that occurs during menopause.There are two basic regimens for HT: estrogen alone (ET) and estrogen plus a progestin (estrogen/progestin therapy [EPT]).The purpose of estrogen in both regimens is to control menopausal symptoms by replacing estrogen that was lost owing to menopause.Transdermal estrogen therapy has fewer adverse effects The total dose of estrogen is greatly reduced (because the liver is bypassed).There is less nausea and vomiting.Blood levels of estrogen fluctuate less. 1 / 2
There is a lower risk for DVT, pulmonary embolism, and stroke.
Types:
Emulsion (Estrasorb) Spray (Evamist) Gels (EstroGel, Elestrin, Divigel) Patches (Alora, Climara, Estraderm, Menostar, Vivelle-Dot, Oesclim ) Selective estrogen receptor modulator (SERM) Are drugs that activate ERs in some tissues and block them in others.These drugs were developed in an effort to provide the benefits of estrogen (e.g., protection against osteoporosis, maintenance of the urogenital tract, reduction of LDL cholesterol) while avoiding its drawbacks (e.g., promotion of breast cancer, uterine cancer, and thromboembolism) Bazedoxifene Duavee (conjugated estrogens/bazedoxifene) for prevention of vasomotor symptoms and osteoporosis in postmenopausal women with a uterus.Duavee is the first drug to combine estrogen with an estrogen agonist/antagonist (bazedoxifene).The bazedoxifene component of Duavee reduces the risk for excessive growth of the lining of the uterus that can occur with the estrogen component.Contraindications to taking Duavee are the same as for other estrogen-containing products.Prevention of osteoporosis with hormone replacement therapy HT reduces postmenopausal bone loss and thereby decreases the risk for osteoporosis and related fractures.Unfortunately, when HT is stopped, bone mass rapidly decreases by approximately 12%.****Hence to maintain bone health, HT must continue lifelong.*** HT should be considered only for women with significant risk for osteoporosis, and only when that risk outweighs the risks of HT.A person on HT and pts, in general, should practice primary prevention of bone loss by ensuring adequate calcium and vitamin D intake, regular weight-bearing exercise, and avoiding smoking and excessive alcohol use.How to change a patient from one combination oral contraceptive to another start the new brand on active hormone tablets and skip the pill free interval or use non- hormonal forms of contraception until 7 active tablets of the new brand have been taken
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