Master the board step 3

Gynecology
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Calcitonin, denosumab, and teriparatide are second-line therapy.
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Teriparatide is a PTH analog that is used when biphosphates fail.
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Estrogen is never the primary treatment of osteoporosis because of associated
risks of clots and endometrial cancer.
Hormone Replacement Therapy (HRT)
When is HRT the answer?
Treatment of:
• Menopausal vasomotor symptoms
(hot flashes)
• Genitourinary atrophy
• Dyspareunia
When is HRT NOT the answer?
Treatment of:
• Osteoporosis
When the case describes a history of:
• Estrogen-sensitive cancer (breast or
endometrial)
• Liver disease
• Active thrombosis
• Unexplained vaginal bleeding
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Women without a uterus can be given continuous estrogen.
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All women with a uterus must also receive progestin therapy to prevent
endometrial hyperplasia.
Benefits of HRT
↓Rate of osteoporotic fractures
↓Rate of colorectal cancer
Risks of HRT
↑Risk of DVT
↑Risk of heart attacks and breast
cancer in combination therapy
Risk of breast cancer is only associated
with therapy > 4 yrs
Guidelines for Hormone Replacement Therapy
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Only start HRT for vasomotor symptoms.
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Never give HRT for the prevention of cardiovascular disease.
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Use the lowest dose of HRT to treat symptoms.
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Use the shortest duration of HRT to treat symptoms; reevaluate annually.
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Do not exceed 4 years of therapy (increased risk of breast cancer after 4 years
of therapy).
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