211 Menopause and HRT

Question 1

What is menopause?

Answer 1

final menstrual period, made retrospectively after 12 months of amenorrhea

• average age is 52*
• considered abnormal under age 40 (primary ovarian insufficiency)*

Question 2

What major hormone changes trigger menopause?

Answer 2

follicular depletion leads to decreased inhibin B, increased FSH, and falling levels of estradiol due to inadequate ovarian response

Question 3

Is bleeding ever normal after menopause?

Answer 3

no, should always be evaluated

Question 4

What diseases are associated with menopause?

Answer 4

depression, coronary heart disease, osteoporosis

Question 5

How is perimenopause treated?

Answer 5

depends on severity of symptoms and risk/benefit profile

may need low doses of estrogen/progesterone therapy (lowest dose for shortest amount of time)

Question 6

What are major contraindications to estrogen therapy?

Answer 6

unexplained vaginal bleeding, active liver disease, deep VTE or pulmonary embolism, untreated htn, known thrombophilia, estrogen-dependent neoplasia, history of CHD/stroke/TIA

Question 7

What drugs besides hormone replacement can help with symptoms of menopause?

Answer 7

SSRIs, SNRIs, gabapentin, clonidine