16. The Climacteric Flashcards
Define the Climacteric Stage
Transition from reproductive to non-reproductive state
Define menopause
Permanent cessation of menstruation
When does menopause occur
After 12 consecutive months of amenorrhea for which there is no other pathologic or physiologic cause
At which median age does menopause occur
51.4 yrs
Is menopause before 40 normal?
No it is pathological and is termed premature
When does the Climacteric start
4 yrs prior to the last menstrual period
At which stage in utero do females have 6-7 million primordial follicles?
16 weeks
By 16 weeks in utero, there are how many primordial follicles in the female baby
6-7million
Approximately how many oocytes does the average female have at puberty
300,000
True or false
The number of follicles in the ovary determines the age at which the menopause takes place
True
True or False
Oral Contraceptives affect the number of oocytes present at a stage of life
False
List eight sites of Oestrogen Receptors
Urogenital Tract Breasts Bones Skin Most connective tissue Cardiovascular system Liver CNS
What happens to FSH and LH levels 2-3 yrs before menopause
Levels increase
FSH and LH levels increase how long before the onset of menopause
2-3yrs
What is the effect of menopause in Estradiol levels
Levels decline
Estradiol levels decline how long before menopause
6 months
After menopause what happens to FSH and LH levels
The levels continue to rise
(X20 increase in FSH)
(X3 increase in LH)
Peaks 1-3 yrs after menopause onset
What is the effect of menopause on Androgen producing Theca cells
They continue to produce androgens, they just produce less
Decrease in which hormone contributes to the decreased sexual function in post menopausal women
Decreased Androgens
What is the normal menstrual cycle for ovulatory women
28+/- 7 days
Lasting 5+/- 2 days
True or False
Menopause is consistently proceeded by a period of prolonged cycle intervals
True
What is the role of estrogen in the menstrual cycle
Inhibits FSH
:. During menopause there is decreased estrogen and the pituitary gland “flogs” the struggling ovary with as much FSH possible to stimulate growth
During the Climacteric before menopause the menstrual cycle increases from 25-35 days to …
Uo to 40-50 days and the periods appear skipped
What are two vasomotor symptoms of Menopause
Hot flashes and Night sweats
What is the most common symptom of menopause
Hot flashes
Describe the term Hot Flashes
Sudden onset of a sensation of heat, sweating, and flushing
How long do hot flashes last
2-4 minutes
What are “Night Sweats”
Hot flashes that occur at night usually while a woman is sleeping
Which risk factors of a female affects the severity of the Vasomotor Symptoms Associated with menopause
Ethnicity (African and Latin America more than Asian women)
Early age of menarche and menopause onset
History of irregular menses
Increased BMI
Social drugs (alcohol and cigarette use)
How long does it take for Postmenopausal sympotoms to spontaneously resolve
The symptoms resolve spontaneously within 5yrs
Vasomotor symptoms of Menopause persists for decades or becomes lifelong in what percentage of women
10-15%
What is the most effective treatment available for hot flashes
Hormone Replacement Therapy
(alpha adrenergic agonists, and serotonin reuptake inhibitors can be used)
What are two urogenital effects of vaginal dryness
Itching, dyspareunia
What are two Urogenital Symptoms of Menopause
Vaginal Dryness
Urinary Incontinence
What leads to urinary incontinence in Menopausal women
Atrophy of the urethral mucosa and the trigone, resulting in less control over bladder function
What causes the decreased lubrication of vagina and vulva in menopause
Low estrogen levels which cause decreased blood flow to vulva and vagina
What change is seen in the cervix during menopause
The cervix atrophies and becomes flush with the vaginal vault, less cushioning
What changes are seen in the vagina during menopause
Decreased elasticity with vagina becoming shorter and shorter
True or False
Depression occurs more frequently in women
True
Women lose what percentage of their trabecular bone during their lifetime
Approximately 50%
Women lose what percentage of their cortical bone during their lifetime
Approximately 30%
Half of the bone material lost during the lifetime of a female is lost when?
During the first 10 years after menopause
There is about what percentage increase in Low Density Lipoproteins in Postmenopausal women
6%
What value of Serum FSH in UI/ml implies menopause
> 50 IU/ml
When is FSH test for menopause taken (which day of the cycle)
Day 2 or 3
Oestradiol can be measured using which samples
Serum
Urine
Saliva
A serum estradiol level less than what value can diagnose Menopause
<50pg/mL
Hormonal Replacement Therapy treatment for Menopause, uses which Hormone
Estrogen
Estrogen therapy for menopause treats menopausal symptoms by:
Reducing the frequency of hot flashes by 77%
Decreasing symptoms associated with vulvovaginal atrophy
What are the administration methods for Hormonal Replacement Therapy
Transdermal patch
Oral
Topical as creams
If a patient opting for Hormonal Replacement Therapy with Estrogen has a uterus, the Estrogen should be administered with what?
Progestin
To prevent endometrial hyperplasia
NB//
Estrogen should be started on low doses and used for less than a 1yr/2 yr period and then tapered off the Medicine
Okay😉
The decision to use Hormone Replacement Therapy depends on what factors?
Current Health Status
Personal Health History
Family Health History
Here are a few ABSOLUTE contraindications for Hormonal Replacement Therapy
Breast Cancer. (Current, past or suspected) Estrogen-sensitive malignant conditions (known or suspected) Undiagnosed genital bleeding Untreated Endometrial hyperplasia Venous Thromboembolism Thromboembolic disease Untreated hypertension Active Liver Disease
List 7 complementary and alternative medicine (CAM) therapies that exist
Stress management Nonprescription remedies Chiropractic and Naturopathic care Massage Therapy Dietary soy Herbs Acupuncture
List one conventional drug used to treat Postmenopausal symptoms
Clonidine
Which 2 selective serotonin re-uptake inhibitors are used in Alternative therapy treatment for Postmenopausal symptoms
Gabapentine
Venlaxafine
List four herbs/ natural sources of estrogen
Soy
Yams
Evening Primrose
Red Clover
What is the result of an overall decrease in Androgen levels in the Postmenopausal woman
Decreased libido Decreased sexual response Decreased sense of well being Poor concentration Fatigue
List three pharmacologic products that are effective in fracture prevention of the Postmenopausal woman
Bisphosphates
Parathyroid hormone
Calcium plus Vitamin D
List two non pharmacologic intervention of fracture prevention in Postmenopausal women
Regular Exercise
Reduce risk for fractures secondary to osteoporosis
Postmenopausal women should be screened for:
Cardiovascular disease
Cancer
Osteoporosis
Which cancers should Postmenopausal women be screened for
Colon
Ovarian
Uterine
Breast
