196- Menopause and HRT

Question 1

Are ovaries of postmenopausal women completely quiescent? What still works? Do they have estrogen?

Answer 1

No, although follicle depletion leads to decrease in estradiol production. LH can still stimulate androgen production. Estrone (extra-gonadal) is predominant estrogen in post-menopausal women

Question 2

Changes is late reproductive years: hormonal? cycle length?

Answer 2

inhibin decreases, FSH increases, E levels maintained, P level decline. Follicular phase shortens (14–>10 days)

Question 3

Average age of perimenopause onset? duration?

Answer 3

47, 4 years

Question 4

What happens to FSH levels during perimenopause? After menopause?

Answer 4

fluctuate a lot. Near the final period the FSH increase becomes sustained but eventually declines

Question 5

what is on the DDx with menopause? How is menopause diagnosed?

Answer 5

hyperthyroid is main one. Also pregnancy, hyperprolactinemia. Retrospectively after 12 months of amenorrhea.

Question 6

what are the current indications for HRT? Contraindications?

Answer 6

short term management of vasomotor flushes. Hx of breast CA, coronary heart dz, stroke,

Question 7

Does Estrogen therapy increase or decrease risk of the following: CAD, colorectal cancer, osteoporosis, stroke, PE/DVT

Answer 7

increase, decrease, decrease, increase, increase

Question 8

do low dose OCPs prevent ovulation and pregnancy in women with POI?

Answer 8

no

Question 9

What is POI? treatment

Answer 9

cessation of menstruation before 40. HRT/OCPs