Menopausal Hormone Therapy

Question 1

When is menopause officially diagnosed?

Answer 1

After 12 consecutive months of amenorrhea (no periods).

Question 2

What is premenopause?

Answer 2

The time period of endocrine changes before cessation of menstruation.

Question 3

What is perimenopause?

Answer 3

The climacteric period of endoctine changes surrounding menopause.

Question 4

What is postmenopause?

Answer 4

The time period of endocrine changes after cessation of menstruation.

Question 5

What is premature menopause?

Answer 5

AKA premature ovarian insufficiency (POI), it is menopause occuring before age 40, often resulting from hysterectomy, radiation therapy, or chemotherapy.

Question 6

When do the worst symptoms of menopause occur?

Answer 6

During the first 1 - 2 years.

Question 7

How long do menopause symptoms last for most womenn?

Answer 7

7+ years

Question 8

Explain the two physiologic explanations for menopause.

Answer 8

1. Deterioration of the follicular cells and ova with aging.
2. Decreased estrogen and progesterone, leading to increased FSH and LH.

Question 9

Explain a surgical cause of menopause.

Answer 9

Ovary removal

Question 10

List 11 symptoms of menopause.

Answer 10

1. Hot flashes
2. Night sweats
3. Irregular menses
4. Episodic amenorrhea
5. Sleep disturbance
6. Mood changes
7. Fatigue
8. Vulvovaginal atropy (vaginal dryness, dyspareunia)
9. Urinary tract dysfunction
10. Sexual dysfunction
11. Urinary frequency/urgency

Question 11

What are the 6 long-term consequences of menopause?

Answer 11

1. Cardiovascular disease
2. Bone loss
3. Osteoarthritis
4. Body composition changes
5. Skin changes
6. Balance issues

Question 12

List 6 primary nonpharmacologic therapies for menopause treatment.

Answer 12

1. Smoking cessation
2. Limit alcohol/caffeine
3. Limit hot beverages
4. Limit spicy foods
5. Weight loss
6. Keep cool, dress in layers

Question 13

What are the 3 indications for menopausal hormone therapy?

Answer 13

1. Vasomotor symptoms
2. Vulvovaginal atrophy
3. Osteoporosis prevention

Question 14

List 6 absolute contraindications for menopausal hormone therapy.

Answer 14

1. Unexplained vaginal bleeding
2. Pregnancy
3. Estrogen-dependent malignancies (endometrial and breast cancer)
4. Stroke
5. Active thromboembolic disorders (or prior history)
6. Active liver disease

Question 15

List 8 relative contraindications for menopausal hormone therapy.

Answer 15

1. Uterine leiomyoma
2. Migraines
3. Seizure disorders
4. Diabetes
5. Hypertriglyceridemia (>400 mg/day)
6. Active gallbladder disease
7. High risk for heart disease
8. Family history of breast cancer

Question 16

When can estrogen monotherapy be used?

Answer 16

In women without a uterus.