Course:PHAR451/Menopause Endometriosis
Updated September 2013
Instructor
Dr. Nicole Bruchet, B.Sc., B.Sc.(Pharm), ACPR, PharmD.
Pre-Session Objectives
Prior to attending the session, by completing the pre-readings, the student will be able to:
Endometriosis
- Define endometriosis and describe its major sequelae
- Describe the clinical presentation of endometriosis
- Describe the overall therapeutic approach to managing endometriosis-associated pelvic pain
Menopause
- Define menopause and perimenopause
- Differentiate between naturally occurring menopause and menopause occurring through non-natural means
- Describe the clinical presentation of menopause
- Define vasomotor symptoms
Preparation for the session
- Guidice LC. Endometriosis. NEJM 2010;362:2389-98.
- Grady D. Management of Menopausal Symptoms. NEJM 2006;355:2338-47.
Post-Session Assessment
By the end of the session and through self-study, the student will be able to:
Endometriosis
- Identify the goals of therapy for endometriosis-associated pain
- Compare the therapeutic alternatives for the management of endometriosis-associated pain
- Explain the place in therapy for NSAIDs, oral contraceptives, medroxyprogesterone acetate, gonadotropin releasing hormone agonists and danazol in the management of the endometriosis-associated pain
- Explain the rationale for add-back therapy when using gonadotropin releasing hormone agonists
- When given the case of a patient with endometriosis-associated pain, develop a patient-specific therapeutic plan to manage this pain and outline an appropriate monitoring plan for efficacy and toxicity
Menopause
- Identify the goals of therapy for the management of menopausal symptoms
- Explain the non-pharmacologic approach to managing menopause-associated vasomotor symptoms
- Compare the pharmacologic therapeutic alternatives for managing menopause-associated vasomotor symptoms
- Explain the place in therapy for hormone replacement therapy in the management of menopause-associated vasomotor symptoms
- Explain the place in therapy for the non-hormonal therapeutic alternatives in the management menopause-associated vasomotor symptoms
- Differentiate between the various hormone replacement regimens
- Explain the potential risks associated with the long-term use of hormone replacement therapy
- When given the case of a patient with menopause-associated vasomotor symptoms, develop a patient-specific therapeutic plan to manage these symptoms and outline an appropriate monitoring plan for efficacy and toxicity
Things to Ponder about Endometriosis & Menopause Therapeutics
- How is add-back therapy postulated to work in decreasing some of the side effects associated with the gonadotropin-releasing hormone agonists?
- One of your patients asks you whether hormone replacement therapy would be safe for her to take for her menopausal symptoms. How would you approach explaining to her the benefits and potential risks associated with the use of hormone replacement therapy?
- What are some of the clinical considerations that come to mind when interpreting the results of the WHI and HERS studies on the use of hormone replacement therapy for the treatment of menopausal symptoms?
Supportive Literature & Further Reading
- Writing Group for the Women’s Health Initiative Investigators. Risks and Benefits of Estrogen Plus Progestin in Health Postmenopausal Women: Principle results from the Women’s Health Initiative Randomized Controlled Trial. JAMA 2002;288:321-33.
- Hulley S, Grady D, Bush T, et al. Randomized trial of estrogen plus progestin for secondary prevention of coronary heart disease in postmenopausal women. JAMA 1998;280:605-13.
- Reid RL, Blake J, Abramson B, et al. SOCG Clinical Practice Guideline: Menopause and Osteoporosis Update 2009. J of Obs and Gynaecol Can 2009;31:Supplement 1.
- Leyland N, Casper R, Laberge P, et al. SOGC Clinical Practice Guideline: Endometriosis Diagnosis and Management. J of Obs and Gynaecol Can 2010;32:Supplement 2.