Aging and menopause Flashcards
What are the 3 interventions in basic mechanisms of aging?
Diet - Caloric restriction; antioxidants
Lifestyle - exercise
Hormones?
What are the 3 major age-related diseases?
Cardiovascular disease
Cancer
Osteoporosis
What are the 3 hormones used in anti-aging hormonotherapy?
Estradiol
Progesterone
Testosterone
In recent years, years of active life in women AFTER menopause has (increased/decreased)
Increased
What happens to hormone levels of [FSH, LH, Estrone, Estradiol] after menopause?
FSH, LH: shoot up
Estrone, Estradiol: drop down
What are sources of Estrogen before menopause?
Ovaries (mainly) and Adipose tissue (a bit)
What are the sources of estrogen after menopause?
Adipose tissue (only)
How does estrogen exert effects on cells?
Enters cells
Binds to estrogen receptor
Enters nucleus
Changes DNA transcription with coactivators
Which tissues are affected by estrogen? (6)
Brain Heart Breast Liver Uterus Bone
How does each Isoform of Progesterone act on a cell? Which way is faster?
Isoform A enters nucleus directly to exert transcriptional changes
Isoform B acts on membrane receptors to activate secondary messengers
Secondary messengers much faster than Genomic changes
What are the targets of Progesterone action?
CNS Hypothalamus/Anterior Pituitary Metabolism Vagina Mammary glands
What are the two types of Menopausal hormone therapy?
HRT - Estrogen-progestin combination
ERT - Estrogen-alone (post hysterectomy)
What is the time course of Menopause-related Symptoms?
Weeks-months: -Hot flashes -Insomnia -Moodiness Months-Years: -Vaginal atresia Bladder Dysfunction Skin Atrophy Years-Decades Cardiovascular disease Osteoporosis
Can HRT reduce the amount of weekly hot flashes?
Yes
How can you treat vaginal dryness during menopause?
Treat with low dose local estrogen
How does estrogen affect bone remodelling?
Decreases effect of Osteoclasts - increases bone formation
During menopause, decreased estrogen increases osteoclast activity causing increased bone resorption
Can HRT help maintain spinal bone density?
Yes
What is a non-hormonal way to prevent fractures in elderly women?
Vitamin D3/Calcium
But also diet, exercise, etc
What do bisphosphonates such as alendronate do?
Inhibit osteoclast function
What are SERMs and what are they used for?
Selective Estrogen Receptor Modulators
Pharmacologic therapy for osteoporosis
What are the 5 characteristics of the “ideal” SERM?
Strengthens bones Lowers LDL cholesterol and raises HDL cholesterol Relieves Hot Flashes Reduces Breast cancer risk Reduces uterine cancer risk
How does Raloxifene modulate Bone, Lipid, Breast, and Endometrium Estrogen receptors?
Bone & lipids: agonist
Breast & endometrium: Antagonist
Between HDL and LDL, which is the Good cholesterol and which is the bad?
How does Estrogen affect levels of each?
HDL: good
LDL: bad
Estrogen increases HDL while decreasing LDL
Can estrogen containing HRT decrease Cardiovascular disease?
Maybe
Does HRT put you at risk of stroke?
Yes but it’s rare
Does HRT decrease your risk of colon cancer?
Yes but
Does HRT benefit post-menopausal symptoms of cognitive aging, dementia or depression?
No
Does HRT decrease your risk of Breast cancer?
It’s complex…
When should you prescribe HRT?
When the benefits outweigh the risks
Do we know much about testosterone in aging men?
Not really, more research is being done on women
