61. Climacteric.Hormon replacement therapy. Osteoporosis.

Question 1

what is climacteric ?

Answer 1

amenorrhea for more than 12 months

Question 2

what does climacteric usually occur ?

Answer 2

between 49 and 52 years of age

Question 3

what are the signs and symptoms in climacteric ?

Answer 3

years before menopause :
menopause transition, the menstrual cycles remain regular but the interval between cycles begins to lengthen. Hormone levels begin to fluctuate. Ovulation may not occur with each cycle

then dysfunctional uterine bleeding -metroraghia

Hot flashes are a form of flushing due to reduced levels of estradiol - intense heat with sweating and rapid heartbeat, and may typically last from 2 to 30 minutes

vaginal dryness
increase in vaginal PH - susceptibility to infection

atrophic vaginitis

weight gain

dysuria , incontinence

Bone mineral density decreases, especially of the vertebrae

depression, memory loss

joint pain

Question 4

what are the causes of menopause ?

Answer 4

Induced menopause occurs as a result of medical treatment such as chemotherapy, radiotherapy, oophorectomy, or complications of tubal ligation, hysterectomy

menopause occurs early in those who smoke, endometriosis, polycystic ovary syndrome, cancer of the reproductive organs

Premature ovarian failure (POF) is when the ovaries stop functioning before the age of 40 years due to autoimmune disorders, thyroid disease, diabetes mellitus

At the physiological level,
exhaustion of follicles and less follicles maturing
and decrease in the ovaries’ production of the hormones estrogen and progesterone.Due to this there is a positive feedback to increase FSH
eventually desensitising the follicles to FSH

Question 5

how to diagnose menopause ?

Answer 5

premenapause - hormone levels are stable but slowly narrowing

perimenapuse - oestrogen levels is higher than premenapuase with wide fluctuation

post menopause - the FSH levels are really high

Question 6

when is hormone replacement therapy used ?

Answer 6

premature ovarian failure

osteoporosis

Climacterium after operations or radiation

atrophic changes of genetelia

severe psychovegetative complaints

Question 7

what is the hormone replacement therapy in an indivual without a uterus ?

Answer 7

just oestrogen

Question 8

what is the hormone replacement therapy in an individual with a uterus ?

Answer 8

estrogen and progestin

Question 9

HRT risks ?and its contraindications are ?

Answer 9

the risks for hormone replacemnet therapy increase risk for people who have cardiovascular disease or thromboemebolic or hypertension , but does not increase in those whoo does not have it

also contraindicated in liver disease

cancer of te breat of endometrium 5 years ago

Question 10

menopause causes and increased risk of what?

Answer 10

increased risk of atherosclerosis.The risk of acute myocardial infarction and other cardiovascular diseases r

Question 11

symptomatic treatment of menopause ?

Answer 11

osteoporosis prophylaxis
→ calcium and Vit. D

Selective estrogen receptor modulators

Raloxifene exhibits oestrogen agonist activity on bone and lipids, and antagonist activity on breast and the endometrium

therapy and exercise

beta blocker if hot flashes , sweating , dizziness

Question 12

HRT is relatively contraindicated in ?

Answer 12

severe diabetes mellitus