••• CHAPTER 33^ Menopause^333
❍ Who should be offered genetic screening for BRCA mutation?
Women with a history of a first-degree relative with premenopausal breast cancer or a family history of several
women with breast and/or ovarian cancer or women with premenopausal breast or ovarian cancer.
❍ What can be recommended for BRCA protection for mutation-positive women?
Prophylactic oophorectomy in the late 40s or use of oral contraceptive pill for long term.
❍ Is oophorectomy 100% protective in these women?
No. About 2% to 3% of women get primary peritoneal cancer.
HORMONE REPLACEMENT THERAPY
❍ What dosages of the following estrogens are equivalent to conjugated estrogens 0.625 mg?
Estrogen medication Equivalent dose (mg)
Oral micronized estradiol 1
Transcutaneous 17 b-estradiol 0.05
Estrone sulfate 0.625
Esterified estrogen 0.625❍ What type of estrogens is present in the following medications?
medication Type of Estrogen
Premarin Conjugated estrogens
Transdermal patch; Estrace Estradiol
Ogen Estropipate
Estratab Esterified estrogens❍ What are conjugated estrogens?
Estrone, Equilin, and 17 a-dihydroequilin; they have hydrophilic side groups attached to them, such as sulfate.
❍ What is the daily dose of norethindrone equivalent to 2.5 mg medroxyprogesterone acetate?
0.35 mg.
❍ Can intravaginal estrogen be absorbed and have systemic effects?
Yes. Atrophic mucosa absorbs estrogen readily. If the patient has a uterus, she needs progesterone therapy as well.