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CC Jan 2018 Genitourinary Syndrome of Menopause (GSM)

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echoecho's version from 2018-03-11 19:08

Section

Question Answer
What is GSM?It stands for genitourinary syndrome of menopause. So when a women has reached menopause when she has not had a menstrual period for 12 months, the declining ovarian function can result in vasomotor symptoms as well as vaginal and urinary symptoms
List the symptoms of GSM?1) genital (dryness, burning, irritation) 2) sexual (anatomic) changes (decreased lubrication with intercourse, dyspareunia, postcoital bleeding 3) sexual function (decreased libido, arousal and orgasm) 4) urinary - frequency, urgency (including urge incontinence), dysuria, recurrent UTIs
What are the symptoms of GMS due to?the effects of estrogen deficiency on the urinary, vulvar and vaginal mucosae
The prevalence of GSM increases with the interval since the last ______ ______, with nearly 1/2 of women experiencing s/s ____ years after menopause?1) menstrual period 2) three
Is HT the first-line intervention for women with primarily genitourinary symptoms?no
If a patient has both vasomotor symptoms and GSM, what is an option for treatmentsystemic therapy is an option (estrogen therapy ALONE for women who have had a hysterectomy and combined estrogen-progestin therapy for women with an intact uterus
For vaginal dryness and discomfort associated with intercourse, the use of a ________ may be sufficienct treatment?lubricant
Types of lubricants available OTC?1) water-based 2) oil-based 3) silicone-based
What do long-acting vaginal moisturizers do? List one?1) decreases the vaginal pH to premenopausal levels and can help with dryness and irritation 2) Replens
Can moisturizers be used long term and concomitantly with lubricants? yes
*** What is the first-line option for womne with vaginal symptoms of GSM, but without significant vasomotor symptoms?topical (local) estrogen therapy
List the modalities that topical estrogen therapy is available in?1) cream 2) tablet 3) ring formulation
With topical estrogens, there is resultant decreases in vaginal ____ and subjective improvement in both vaginal and urinary tract symptoms?pH
Why is the addition of a progesting to topical estrogen not necessary?because the amount of estrogen that is absorbed from these preparations is minimal (although there are no studies of > 1 year duration)
Any woman experiencing vaginal bleeding, with or without topical estrogen therapy, must have what?a thorough evaluation
Did a Cochrane review find any difference in efficacy or adverse effects among the various topical preparations?no
What type of estrogen is an option for women who have had breast cancer, but it should be prescribed only after consultation with her oncologist?low-dose topical estrogen
Are topical estrogens beneficial for urinary symptosm of GSM?yes
Topical estrogens have shown improvement in _____ incontinence?urge
Topical treatment may also decreased frequency of what infections?UTIs
*** Systemic HT (estrogen alone or combined with progestin) are associated with INCREASED urinary ____ incontinence?stress
Oral HT can improve sexual function by relieving atrophy and improving lubrication, but does not improve libido, increase sexual intereste or arousal or improve orgasmic response?no
What estrogen formullation may be preferable over oral estrogen in a woman with decreased libido? Why?1) transdermal estrogen formullation 2) becasue oral therapy increases sex hormone-binding globulin, thereby reducing bioavailable testosterone
What 2 FDA approved medications can be used for women who are NOT candidates for HT? 1) Ospemifene (Osphena) 2) Dehydroepiandrosterone (DHEA)(Prasterone)
Are the above options considered first-line therapy for most women?no
Is topical progesterone effective?no
What is Ospemifene?1) a selective strogen receptor modulator (SERM) 2) has estrogen agonist and antagonist activity 3) oral ospemifene 60 mg daily is indicated for treatment of moderate-to-severe dyspareunia due to menopause
Studies have shown subjective but modest benefit of Ospemifene over placebo. Like other SERMs (raloxifene {Evista}, ospemifene is associated with an increase in what symptom (5-8%) and an increased risk of what medical condition?1) hot flashes 2) VTE
Comment on the effect of ospemifene on the endometrium and breast tissue and bone?1) minimal increase in endometrial thickness without evidence of atypical hyperplasia or carcinoma 2) neutral or perhaps a beneficial effect on breast tissue in terms of carcinogenesis 3) reduction in bone turnover (similar to raloxifene) but further studies are necessary for confirmation
Comment on intravaginal DHEA?1) dosed daily 2) there is local aromatization of DHEA to estrone and estradiol 3) improvement in subjective symptoms 4) associated with an increase in serum DHEA, testosterone and estrone, but these levels remain w/in normal range for postmenopausal women 5) the safety of this med for women with estrogen-sensitive malignancies, particularly breast cancer, is unknown 6) DHEA may improve libido (but there is no evidence to support this), but it is postulated that this is due to the increase in testosterone
*** SUMMARY = What 2 medications are the first-line therapy for mild symptoms of GSM?1) lubricants 2) long-acting vaginal moisturizers
*** SUMMARY = What is considered first-line therapy if there are no significant contraindications?topical estrogen therapy
*** SUMMARY = The addition of ______ is not necessary with topical estrogen therapy?progestin
*** SUMMARY = Other options for GSM include what 2 meds?1) ospemifene (Osphena) 2) vaginal prasterone (Intrarosa)
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