LM 17.1: Menopause Flashcards
what is STRAW?
states of reproductive aging workshop
this classification incorporates what the female experiences as it relates to symptoms of changes in the mesntrual cycle, vasomotor symptoms and urogenital atrophy as well as the endocrinology changes
previously this system was not recommended for smokers, BMI > 30, heavy aerobic activity, chronic menstrual irregularity, uterine/ovarian abnormalities or significant illness like cancer
what is the definition of menopause?
no menses for 12 months in the absence of hormonal treatment
indicates the depletion of ovarian follicles
it’s diagnosis based on historical information
what happens in perimenopausal?
reduced ability of aging follicles to secrete inhibin from granulosa cells of the follicles
decreased inhibin decreases negative feedback to anterior pituitary so there’s increased FSH and estrogen levels rise
what happens during menopause?
once all the follicles die, there’s decreased estrogen too which results in really high levels of GnRH, LH, and FSH
what causes hot flashes? how does estrogen play a role?
disfunction of the thermoregulatory nucleus of the hypothalamus which regulates sweating and vasodilation normally
it is thought that women with hot flashes have a narrow thermoregulatory zone because the withdrawal or rapid fluctuations in estrogen levels lead toa decrease in norepinephrine and serotonin which lowers the thermoregulatory set point –> this which means that minimal changes in temperature can cause a hot flash that results in sweating to try and cool off the body because the thermoregulatory zone has been narrowed causing a lower threshold to trigger the physiologic response of “I’m too hot”
also it is hypothesized that a drop in estrogen increases neurotransmitter concentrations in the hypothalamus which creates a narrower thermoregulatory zone; NE and serotonin may also decrease the thermoregulatory set point
why does osteoporosis happen during menopause?
in normal bone remodeling there’s osteoclasts and osteoblasts that breakdown and build bones
osteoblasts make RANK-L and OPG –> RANK-L binds to RANK on the osteoclast progenitor cells which promotes osteoclast formation and bone resorption –> OPG binds to RANK-L which prevents it from binding to RANK and activating osteoclasts
in menopause there’s lower estrogen and RANK-L production outnumbers OPG so bone resorption is favored without OPG there to inhibit osteoclast formation
what is the best treatment for hot flashes?
menopausal hormone therapy can help with hot flashes and bone fractures!
however you want to use the minimal dose and for the shortest amount of time
why do women taking hormone therapy with a uterus need progestin too?
for women with an intact uterus, progestin therapy must be added to prevent endometrial hyperplasia and cancer
what are the risks associated with combined estrogen/progesterone hormone therapy?
- breast cancer
- stroke
- CVD
- venous thromboembolism
what are the risks associated with estrogen hormone therapy?
- stroke
- venous thromboembolism
this is only given to women without a uterus
what is the alternate treatment for hot flashes other than hormone replacement?
- gabapentine
- clonidine
- SSRIs/SNRIs
how does clonidine help with hot flashes?
clonidine is an alpha2 adrenergic agonist so it inhibits release of NE
without NE, the thermodynamic set point results to normal
how many oocytes does a woman have?
6-7 million at 20 weeks in utero
1 million at birth
400,000 at puberty
200-300 at menopause
what are the symptoms of perimenopause?
- shortening or lengthening of cycles
- variable follicular phase
- hot flashes
how is the uritogenital system effected during menopause?
vaginal atrophy and dryness
pelvic organ prolapse and atrophic urethritis can happen too when the tissues supporting them atrophy which can lead to dyspareunia and incontinence
lack of estrogen can lead to:
1. urethritis with dysuria not due to UTI
- increased risk of UTI due to decreased vaginal pH
- increased incidence of urethral caruncle
- incontinence
- frequency
- not a cause of pelvic prolapse
how do you know if irregular uterine bleeding is due to menopause?
irregular bleeding due to the menopause transition is a diagnosis of exclusion
what hormones do granulosa cells produce? what do they do?
estrogen and inhibin
inhibin B is negative feedback to FSH
estrogen also provides negative feedback but inhibin is the bigger contributor as estrogen replacement in postmenopausal women does not change the FSH
what happens to the dominant follicle with age?
with increased age, the FSH rescue of the dominant follicle from atresia occurs with less frequency and requires higher levels of FSH as the ovarian reserve declines
decline in ovarian follicles results in decline in estrogen and inhibin production which first leads to shorter menstrual cycles due to a shorter follicular phase
sometimes there’s skipped menses when no dominant follicle is rescued and ovulation doesn’t even occur
what is the genitourinary syndrome of menopause?
vulvar and vaginal tissues are estrogen sensitive so with the absence of estrogen:
- vagina decreases in collage and adipose as well as water retention, vaginal walls shrink and rug flatter or disappear, decreased ratio of superficial squamous cells:basal cells, decrease in pH with loss of lactobacilli, dyspareunia due to loss of elasticity and moisture
- vulva decreased activity of sebaceous glands, decreased adipose deposition, decrease in size of labor
how is cardiac health effected by menopause?
the decrease in estrogen negatively effects the lipid profile leading to increase in LDL and subsequent increase in CVD
