B8-027 CBCL Menopause Flashcards
menopause is confirmed after […] of no menstrual bleeding
1 year
premature menopause occurs before age […]
40
perimenopause begins with variation in cycle greater than […] days associated with increased […]
seven
FSH
which phase of menopause is the most symptomatic for women?
perimenopause
average age of onset of menopause
51
FSH consistently elevated over […] is considered diagnostic for menopause
30
menopause before age 40 suggests
primary ovarian failure
cause early induction of menopause
radiation
chemotherapy
bilateral oophorectomy
source of estrogen after menopause
peripheral conversion of androgens
what would you expect to see for FSH, LH, GnRH, and estrogen in a menopausal female?
FSH very high
LH high (no surge)
estrogen low
GnRH high
symptoms of menopause
Hot flashes
Atrophy of
Vagina
Osteoporosis
Coronary artery disease
Sleep disturbances
causes HAVOCS
how can early menopause result in shorter cycles?
as follicles decrease –> decreased inhibin –> less negative feedback on hypothalamus –> more FSH released
when the cycle length shortens, it is called
LOOP: luteal out of phase
what leads to the loss of LH surge in menopause?
GnRH pulses slow, but more GnRH is released
alterations of GnRH pulse cause this
is AMH useful in predicting when menopause will occur?
no
in premenopause […] is the dominate estrogen type
however, in post menopause it is […]
estradiol
estrone (formed via peripheral metabolism)
(ratio reverses after menopause)
most common cause of AUB
bleeding due to anovulation
in the workup of AUB endometrial biopsy is important to rule out [2]
endometrial hyperplasia
malignancy
most common symptom of menopause
sudomotor symptoms (hot flashes)
physiologic mechanism of hot flashes
estrogen narrows the thermoneutral zone
serum estrogen levels [are/are not] predictive of hot flash frequency
are not
treatment of hot flashes
lifestyle modifications
SSRI, gabapentin, clonidine
the sudomotor symptoms of menopause tend to […] over time, while the vulvo-vaginal symptoms […]
get better
progressively worsen
people with surgical menopause [are/are not] considered to have POI
are not
diagnosis of POI requires a minimum of […] bleeding abnormally and at least […] FSH levels drawn at least 1 months apart
4 months
2
why should patients with POI not desiring pregnancy still be on contraception?
ovary can occasionally ovulate
HT used to protect women with a uterus from endometrial cancer
estrogen-progesterone therapy
HT consisting of hormones chemically identical or very similar to those made in the body
bioidentical hormone therapy
(generally not recommended by ACOG unless dosing is not commercially available or there is an allergy)
HT useful for perimenopausal transition to treat symptoms and prevent bleeding and pregnancy
hormone contraception
primary estrogen during reproductive years
estradiol
primary estrogen circulating after menopause
estrone
estrogen produced primarily by the placenta during pregnancy
estriol
estrogen that comes from granulosa cells in dominant follicles
estradiol
estrogen that comes from aromatization in body fat
estrone
estrogen found in estrogen containing contraceptives
ethinyl estradiol
used to prevent endometrial cancer in women on estrogen therapy
progesterone
hormonal contraception is contraindicated in women over […] who smoke
35
menopausal EPT will not suppress ovulation in perimenopausal women and can result in […]
unpredictable bleeding
factors to consider in duration of HT use
severity of symptoms
effectiveness of other treatments
risk of osteoporosis
risk of CAD
risk of cerebrovascular event
risk of DVT
risk of breast cancer
does EPT or ET have a higher risk of breast cancer?
EPT
effect of oral estrogen on liver
increases fibrinogen, factors VII and X, triglycerides, and platelet aggregation
decreases: antithrombin III
there is less risk of thromboembolism with […] estrogen delivery
non-oral
(transdermal)
women who initiate HT older than […] are at a higher risk of cardiac event
60
there is some evidence that ET has antidepressant effects in what phase of menopause?
perimenopausal
mood changes are a side effect of […] therapy that can worsen in patients with PMS or PMDD
progestin
in women with POI, it is recommended to continue HT until
average age of menopause
system of nomenclature for reproductive aging
STRAW staging system
evaluation of AUB after age 45 should include [3]
endometrial biopsy
transvaginal US
pregnancy test
3 major hormones synthesized in the ovary
estrogen
progesterone
testosterone
adverse effects of exogenous estrogen [4]
DVT
stroke
endometrial cancer
postmenopausal bleeding
absolute contraindications for estrogen therapy
breast cancer
thromboembolic event
CVD
vasomotor symptoms typically occurs in […] menopause
early
urogenital atrophy typically occurs in […] menopause
late-post menopause
term used to describe menopausal transition and 12 months after FMP
perimenopause
menopause that occurs before age 40
premature menopause
does an ovarian sparing hysterectomy carry the risk of early menopause?
yes, hastens menopause by 2-3 years
major hormones secreted by the ovary during the follicular phase
estradiol
inhibin B
predominant hormone secreted by the ovary in the luteal phase
progesterone
what can early follicular phase FSH tell you about a patient’s ovarian reserve?
an ovary with a decreasing number of follicles will release lower levels of inhibin, so early follicular phase FSH will be elevated
risk factors of endometrial cancer [4]
age
obesity
infertility
unopposed estrogen
risk factors for increased vasomotor symptoms [3]
obesity
smoking
decreased physical activity
caffeine, smoking, and spicy foods can worsen […] symptoms
vasomotor
what would you expect to see on histologic examination of the vaginal epithelium during menopause?
loss of mature epithelial cells
increase in parabasal cells
first line treatment for women with genitourinary syndrome
lubricants/moisturizers
(then low dose estrogen if those don’t work)
second line treatment for women with genitourinary syndrome
vaginal estrogen cream
levonorgestrel-releasing intrauterine system (Mirena) is FDA approved for contraception and […]
abnormal uterine bleeding
often used in peri-menopause to regulate menses and help with vasomotor symptoms while providing contraception
oral contraceptive pills
[…] estrogen therapy is associated with a higher risk of DVT
oral
risk of DVT with estrogen therapy [is/is not] dose dependent
is
paroxetine is FDA approved to treat […] symptoms without risk of thromboemolic event
vasomotor
unopposed estrogen increases risk for
endometrial cancer
if a patient has both vasomotor symptoms and GSM, what is the best treatment option?
systemic non-oral ET (patch) and progestin
start […] estrogen therapy for GSM only symptoms
local
(cream or vaginal ring)
