196b menopause and HRT

Question 1

menopause

Answer 1

retrospective dx after 12 months of amenorrhea

average age is 51.5 - genetics and lifestyle are things that can affect

hypo E and high FSH over several years then slowly decreases

Question 2

follicular atresia

Answer 2

begins before bith

max number at 20 wks gestation

Question 3

follicular maturation

Answer 3

FSH and LH
FSH follicular maturation and E2
with age, oocytes resistnat to FSH

Question 4

perimenopause

Answer 4

transition
after repro years but before menopanuse
4 yrs before menopause
hot flashes and irreg menstrual cycles
bone loss, lipids changes

unlike latre repro years, lengthening of cycle occurs (40-50 days); skip cycles; anovulatory cycles

Question 5

late repro years

Answer 5

inhibin decrease, FSH increases, follicular phase shorten but still ovulatory, variability

age ~40’s

Question 6

menopuase symptoms

Answer 6

hot flash –> w/ anxiety, a few minutes long, at night,

vaginal dryness –> vagina is E dep; lack causes thinning (atrophic vaginitis) ; pale and smooth; scarce pubic hair

sleep issues –> due to hot flashes at night

depression

sexual function - decreased blood flow due to low E; low lubrication; fixed with E therpay locally

Question 7

long term E deficiency

Answer 7

bone loss - especially startof menopause

CV disease - E deficiency causes increased LDL

dementia - E preseves overal cognitive fxn

Question 8

rx menopause

Answer 8

short term (2-3 years) for vasomotor flushes

no E for breast cncaaer, CAD, clots, liver disease

Esrogen is gold standard
P protects against endometriel hyperplasia and cancer

use E and P (unless hysterectomy)

Question 9

vaginal E

Answer 9

good for genitourinary symptoms

can be used long term

dont need P b/c low systemic absoprtion

Question 10

HRT - E and P risk

Answer 10

increased breast cancer, CHD, stroke, embolism at 5 years

do not apply to POI

Question 11

HRT use

Answer 11

rx for vasomotor symptoms

short time frame at lowest dose

stop when symtoms stop

Question 12

POI

Answer 12

menopause < 40 years

most common cause of primary amenorrhea

Question 13

POI causes

Answer 13

turner's 
FMR1 - fragile X (carriers and premutations)
autoimmune disease
smoking
chemo/radiation

Question 14

POI dx and rx

Answer 14

FSH, E2, TSH, PRL

karytotype –> if turners –> cv evaluation

rx - OCPs and HRT
OCPs dont protect against birth control