09. Menopause

Question 1

Perimenopause

Answer 1

Climacteric; Age-related transition from reproductive to nonreproductive state. Decreasing ovarian function starting 3-5 yrs before last menstrual period.

Question 2

Menopause

Answer 2

Event that marks menopause is the final menstrual period. End of reproductive life. Dx if 12 consecutive months amenorrhea age > 40, OR amenorrhea (+) FSH level > 40 ng/mL

Question 3

Hormone levels during Perimenopause

Answer 3

FSH, LH, Estrogen fluctuate but may still be NL

Question 4

FSH Level changes throughout life

Answer 4

Childhood 30

Question 5

Average age for menopause

Answer 5

50

Question 6

First sx of ovarian failure

Answer 6

Hot flushes

Question 7

How much does body temp rise during a hot flash?

Answer 7

3 degrees C

Question 8

Most effective hot flash tx

Answer 8

Estrogen replacement

Question 9

Other hot flash treatments

Answer 9

Progesterone; Black cohosh; Clonidine, SSRI’s, Gabapentin

Question 10

Dominant form of estrogen during menopause

Answer 10

Estrone; converted in peripheral fat

Question 11

Most potent form of estrogen

Answer 11

Estradiol

Question 12

Where is progesterone produced?

Answer 12

Corpus luteum

Question 13

What hormone are oocytes increasingly resistant to during perimenopause?

Answer 13

FSH

Question 14

A woman on estrogen & progestin HRT has increased risk of which diseases?

Answer 14

Heart disease; CVA; VTE; Breast CA

Question 15

SERMs are protective against what diseases?

Answer 15

Breast CA & Osteoporosis

Question 16

Drug interaction with SSRIs & SNRIs

Answer 16

Do not give with Triptans.

Question 17

What form of osteoporosis is caused by menopause?

Answer 17

Primary osteoporosis

Question 18

Should HRT be initiated for protective effects against cardiovascular dz?

Answer 18

NO

Question 19

What mechanism causes primary osteoporosis during menopause?

Answer 19

Estrogen loss sensitizes bone to respond highly to PTH. Decreased serum calcium causes PTH release to stimulate Vit. D production. High Vit D level stimulates calcium absorption and osteoclasts. WITH NO ESTROGEN, HIGH BONE CALCIUM RELEASE FOR SAME AMT OF PTH STIMULATION FURTHER WEAKENS THE STRUCTURE.