Lecture 14: Menopause & Urogynecologic Conditions

Question 1

Definition of menopause

- when does spontaneous/natural menopause occur, how long must be w/out pds?

Answer 1

Menopause = last menstrual cycle + loss of ovarian follicular involvement

spontaneous menopause = age 45-55
- must have 12 consecutive mo w/out pd

Question 2

Definition of perimenopause?

3 Sxs of perimenopause

Answer 2

transition to menopause: natural decr in estrogen production

1. irreg cycles
2. incr episodes of amenorrhea
3. vasomotor Sxs

Question 3

What are the changes in HPO axis that result in perimenopause?

Answer 3

1. decr ovarian feedback of inhibin + estradiol
2. incr FSH
3. decr quanity/quality of follicles

Question 4

What is the best predictor of menopause stage?

What is the most sensitive initial test? result?

Dx: also see low estradiol

Answer 4

Menstrual cycle changes = best predictor of menopause stage

FSH assay –> incr FSH

Question 5

3 things on pelvic US that indicate Dx of menopause

Answer 5

1. little/no endometrial thickness
2. small atrophic ovaries
3. small uterus

Question 6

Hot flashes, night sweats, excess perspiration are examples of ______ Sxs in menopause

Answer 6

Vasomotor

Question 7

What is the mainstay of Tx for perimenopause

Answer 7

Tx for perimenopause = OCPs

Question 8

What is the main Tx for hot flashes + osteoporosis in menopause? two types?

how long must you be on these for there to be CI

Answer 8

HRT

• estrogen alone
• E+P

HRT > 3-5 yrs
ERT > 7 yrs

Question 9

What is Tx for hot flashes, osteo, vulvovaginal atrophy

Answer 9

SERMs

Question 10

Tx for hot flashes d/t menopause?

Answer 10

SSRIs/SNRIs

Question 11

Overall Tx:

2 options Tx of both hot flashes & osteoporosis

• med specifically for hot flashes
• med specifically for osteo

Answer 11

hot flashes AND osteoporosis

1. HRT
2. SERMs

hot flashes
- SSRI/SNRI

osteoporosis
- Bisphosphonates