336 Obstetrics and Gynecology Board Review •••
❍ Does estrogen therapy improve visual acuity?
Yes. Possibly due to the beneficial effect on lacrimal fluid and protection against lens opacities.
❍ What effect does estrogen therapy have on oral complaints common in menopause?
It relieves oral discomfort, burning, bad taste, and dryness. It also decreases gingival inflammation, bleeding,
and tooth loss.
❍ What effect does estrogen therapy have on skin?
It prevents the age-related declines in skin collagen and thickness.
❍ What effect does estrogen therapy have on muscle strength?
It prevents the age-related decline in handgrip strength.
❍ What are contraindications to estrogen therapy?
Estrogen sensitive-cancers, chronically impaired liver function, undiagnosed genital bleeding, history of stroke,
DVT or PE, neuro-ophthalmologic vascular disease, and known or suspected pregnancy.
❍ What disorders may be aggravated by estrogen?
Seizure disorders, familial hyperlipidemias (high triglycerides), and migraine headaches.
❍ What effect does estrogen alone or in combination with progestin have on clotting factors in menopause?
It prevents menopause-related increases in clotting factors (fibrinogen, factor VII, and plasminogen activator
inhibitor) and does not alter antithrombin.
❍ When is a history of venous thromboembolism not a contraindication to estrogen therapy?
A thromboembolic event related to trauma.
❍ Is there an increased risk of gallbladder disease with estrogen therapy?
Estrogen therapy may increase the risk of gallbladder disease by 1.5- to 2.0-fold.
❍ How is estrogen believed to induce cholelithiesis?
Estrogen alters bile salts leading to stone formation.
❍ What effect does oral estrogen replacement have on triglyceride levels?
It increases triglyceride levels.
❍ What route of estrogen administration does not affect triglycerides?
Transdermal.
❍ What complications can be precipitated by estrogen administration in women with elevated triglycerides?
Pancreatitis and severe hypertriglyceridemia.