Welcome to the ETIQ test!
Answers:
1. What is the definition of menopause?
- a: The permanent end of menstruation and fertility, defined as occurring 12 months after your last menstrual period or after ovaries have been surgically removed
- b: The beginning of hot flashes and night sweats, no matter how long it has been since your last menstrual period
- c: The permanent end of menstruation and fertility, defined as occurring immediately after your last menstrual period
- d: I have absolutely no idea
Answer
a: Menopause is the permanent end of menstruation and fertility, defined as occurring 12 months after your last menstrual period.1 During this time a woman’s body decreases its estrogen production, which can bring on symptoms such as hot flashes and vaginal dryness.2
2. What is the average age of menopause?
- a: 48
- b: 51
- c: 55
- d: 60
Answer
b: Most women experience natural menopause between the ages of 40 and 58, with the average age of 51.3
3. What is the most common symptom of menopause?
- a: Hot flashes
- b: Fatigue
- c: Irritability
- d: Headaches
Answer
a: The most common menopause-related discomfort is the hot flash.3 About 75% of all women going through menopause have hot flashes. It is a sudden feeling of heat that spreads over the face and body. The skin may redden like a blush. Sometimes women break out in a sweat as a result. A hot flash may last from a few seconds to several minutes or longer. They may occur a few times a month or several times a day, day or night.2
4. Menopausal women should be prescribed estrogen therapy whether or not they are experiencing symptoms, such as hot flashes.
- a: True
- b: False
Answer
b: False. Menopause itself requires no medical treatment. Instead, treatments focus on relieving symptoms associated with menopause, such as hot flashes and vaginal dryness. If you are not experiencing any symptoms, you should not be prescribed estrogen therapy.1
5. Is there a recommended window of commencing estrogen therapy after the onset of symptoms associated with menopause?
- a: Yes, it is recommended that estrogen therapy commence any time within 10 years of your last menstrual period
- b: There is no definitive period, but emerging studies suggest that commencing estrogen as close to the onset of menopause as possible may be beneficial
- c: Yes, it is recommended that estrogen therapy commence any time within 5 years of your last menstrual period
Answer
b: Women with symptoms associated with menopause should start estrogen therapy at the lowest effective dose for the shortest amount of time, consistent with the treatment goals, benefits and risks for the individual woman. Emerging data reveal that the timing of estrogen therapy initiation in relation to proximity to the onset of menopause may be important. How soon treatment is begun after reaching menopause may have an impact on long-term health outcomes.4More research on this topic is needed.
6. What are the treatment options for symptoms associated with menopause?
- a: Estrogen therapy
- b: Estrogen-progestin therapy
- c: Lifestyle adjustments, such as exercise and a balanced diet
- d: Let’s be honest, there’s really nothing you can do to – just grin and bear it
- e: A, B, and C
Answer
e: Estrogen-only therapy, combined estrogen-progestin therapy and lifestyle changes are all treatment options for relieving symptoms associated with menopause. Studies show that estrogen and estrogen-progestin therapy is the most effective treatment for moderate-to-severe hot flashes available.3 Keep in mind that although estrogen or estrogen with progestin are effective options for relieving symptoms associated with menopause, they both have side effects and contraindications (circumstances in which they should not be used) so not all are appropriate options for all women. Talk with your healthcare provider to find a treatment that is right for you.
7. What is estrogen therapy?
- a: Estrogen therapy helps to manage symptoms associated with menopause that are caused by fluctuations in hormone levels
- b: Estrogen therapy adds additional estrogen to the amount your body is already producing – women’s bodies require increased amounts of estrogen as they age
- c: Estrogen therapy reduces the amount of estrogen that your body produces – menopause causes an over-production of estrogen in a woman’s body
Answer
a: The amount of estrogen produced by a woman’s ovaries decreases as a woman ages. At a certain point, the ovaries stop making enough estrogen to continue menstruation and menopause occurs. Estrogen therapy helps to alleviate the symptoms associated with this decrease in estrogen, including hot flashes and vaginal dryness, by replacing the estrogen that is lacking during menopause.2
8. What do leading health authorities, such as the American College of Obstetricians and Gynecologists and The North American Menopause Society, recommend in terms of estrogen dosage?
- a: The lowest dosage for the shortest amount of time to meet the individual woman’s goals for treating her symptoms
- b: The highest dosage for as long as you want, regardless of symptoms
- c: There are tests to determine the exact dosage that your body requires, such as saliva tests -- experts recommend this method to determine dosing requirements
- d: Leading health authorities do not recommend that you pursue estrogen therapy
Answer
a: Leading health authorities advise that women should use the lowest effective dose for the shortest time necessary to provide relief and avoid the increased risks associated with higher doses and long-term use.2, 3
9. What does the term “bioidentical” mean?
- a: A bioidentical is a substance that is made synthetically to be an exact chemical match to a substance produced by the human body
- b: Bioidentical means natural
- c: A bioidentical is a substance that slightly resembles a substance produced by the human body
- d: A bioidentical is a drug created only in compounding pharmacies
Answer
a: Bioidentical hormones are an exact match chemically to the hormones produced by a woman before menopause. They are made by chemically changing a hormone-like substance from another source – such as soy bean or yam – to make it exactly the same molecular structure as the hormones produced in a woman’s body.5
10. Are all bioidentical estrogens the same?
- a: All bioidentical estrogens are FDA approved and tested for potency by FDA standards
- b: Some bioidentical estrogens are FDA approved, others are not
- c: No bioidentical estrogens are approved by the FDA
Answer
b: Some bioidentical estrogens are FDA approved, others are not. 5
11. Compounding by a pharmacist is a legitimate practice when an FDA-approved product cannot be used by a patient due to allergies or other specific reasons.
- a: True
- b: False
Answer
a: True. The FDA considers traditional compounding to be a valuable service when used appropriately, such as customizing a drug for someone who is allergic to a dye or preservative in an FDA-approved medicine. But some pharmacies that compound estrogen make unsupported claims that these drugs are more effective and safer than FDA-approved hormone therapies, which the FDA calls false and misleading. Products are FDA approved as a result of well designed clinical studies that prove safety and efficacy.6
12. Compounded estrogen therapy products have been individually approved as safe and effective by the U.S. Food and Drug Administration.
- a: True
- b: False
Answer
b: False. Compounded estrogen formulations do not have an FDA-approved label with indication for the treatment of menopause symptoms, like commercially available, pharmaceutical-manufactured, FDA-approved estrogen products. Because the FDA has not approved these formulations they cannot assure the efficacy or safety of compounded estrogen formulations for menopausal symptoms.6
13. How is estrogen therapy administered?
- a: Transdermally
- b: Orally
- c: Vaginally
- d: All of the above
Answer
d: Estrogen therapy can be administered in all of the forms above. 7
14. What are transdermal estrogens?
- a: Estrogen therapy applied to the skin
- b: Estrogen therapy taken in pill form
- c: Estrogen injections inserted beneath the surface of the skin
- d: Estrogen that is a heat-activated and administered in weekly patches
Answer
a: Transdermal estrogen therapies are those applied to the skin that absorb directly into the bloodstream without having to pass through the liver first, like oral estrogen.8
15. Which estrogen therapy has been shown to provide consistent levels of estrogen in the body?
- a: Oral
- b: Transdermal
- c: Neither one
Answer
b: Transdermal (those applied to the skin) estrogen therapies allow for relatively consistent estrogen levels throughout the day. Oral administration can cause fluctuating levels of estrogen in the body. 6
16. The same dosage of estrogen administered either orally or transdermally will result in equal amounts of estrogen absorbed into the bloodstream.
- a: True
- b: False
Answer
b: False. Transdermal estrogen therapies are those applied to the skin that absorb directly into the bloodstream without having to pass through the liver first. When ingested, oral estrogen passes through the liver before it is absorbed into the bloodstream and a large amount of estrogen is metabolized and discarded. This allows lower doses to be used in transdermal therapies and reduces exposure to higher hormone levels. 9
17. On a scale of 1 (most influential) to 5 (least influential), when making decision about my health, I am most influenced by:
- a: My healthcare professional
1 2 3 4 5 - b: My friends
1 2 3 4 5 - c: The media
1 2 3 4 5 - d: Celebrities
1 2 3 4 5 - e: My family
1 2 3 4 5
Answer
It is okay to consider what others have to say about estrogen therapy, but ultimately educate yourself and have a conversation with your healthcare provider to assess if estrogen therapy treatment is right for you based on your individual needs.
- 1. Menopause. Mayo Clinic. http://www.mayoclinic.com/health/menopause/DS00119. October 21, 2009.
- 2. ACOG Education Pamphlet: Hormone Therapy. American College of Obstetricians and Gynecologists. http://www.acog.org/publications/patient_education/bp066.cfm. October 12, 2009.
- 3. Menopause Guidebook, 6th Edition. North American Menopause Society. October 2006.
- 4. The North American Menopause Society: Position Statement. Menopause 2010; 17(2)242-255.
- 5. The Endocrine Society. Bioidentical Hormones. October 2006. www.menopause.org/bioidenticalHT_Endosoc.pdf.
- 6. North American Menopause Society. Understanding the Controversy: Hormone Testing and Bioidentical Hormones. 2007. www.menopause.org/edumaterials/PG06monograph.pdf.
- 7. Medline Plus. http://www.nlm.nih.gov/medlineplus/ency/article/007111.htm. Accessed March 2, 2010.
- 8. Flaumenhaft, R, Nachtigall, M, Lowenstein J, et al. "Association of oral but not transdermal estrogen therapy with enhanced platelet reactivity in a subset of postmenopausal women." Menopause. 1009;16(2)407-412.
- 9. Drugs.com. www.drugs.com/dict/first-pass-metabolis.html. Accessed March 2, 2010.