Menopause Flashcards
What is perimenopause?
Perimenopause is the time surrounding menopause; its onset is marked by the beginning symptoms of menopause and ends with the cessation of menses.
What is the average onset of perimenopause?
The average age of onset of perimenopause is 40 to 45 years; this occurs earlier in cigarette smokers.
How long does perimenopause last?
Perimenopause lasts an average of 4 years but can range from a few months to 10 years.
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What is menopause?
Menopause, when the final menstrual period occurs
By definition, a woman is in menopause when she has had no naturally occurring menstrual period for 12 months.
What is average of women in north america to have menopause?
The average age for a North American woman at menopause is 51.3 years, with some women living one-third of their lives after this time. n.
During menopause. can you still get pregnant?
During perimenopause, menstrual irregularity is common, with the interval between periods becoming longer or shorter and flow becoming heavier or lighter. Ovulation becomes more erratic, but pregnancy is still possible.
What are the symptoms of perimenopause?
possible. Hot flashes and sleep problems are usually worse in the week before the menses
What happen during perimenopause? What is normal and high?
During this stage, estrogen levels are usually normal, but FSH levels are elevated.
As mentioned, the woman often notes hot flashes or flushes during the week before the onset of the menses, a time by the FSH surge.
Although low estrogen levels have often been implicated as the cause of perimenopausal symptoms, the shifting levels of multiple biological substances is likely implicated.
What happen when the menopausal increases? What happen to LH and FSH, estrogen, progesteron and androsterone?
As the menopausal period progresses, LH and FSH levels increase dramatically as the anterior lobe of the pituitary sends out an abundance of these substances in an attempt to induce ovulation; the ovaries fail to respond with ovulation, sometimes leading to heavy, anovulatory menstrual bleeding.
Levels of estrogen forms (estradiol, estrogen) and androgens (testosterone, progesterone, androsterone, and dehydroepiandrosterone) are reduced.
Who have more symptoms; surgical induced menpause or naturally occuring menopause?
Compared with naturally occurring menopause, women with surgical menopause usually have more severe symptoms, likely because the hormonal shifts are more rapid and dramatic. Estrogen receptors are found in high
Why do pre-menopausal and menopausal women have urogenital atrophy?
Estrogen receptors are found in high concentrations in the vulva, vagina, urethra, and trigone of the bladder.
Where do you find low concentration of estrogen receptor?
These receptors are found in lower concentrations in the vascular bed, heart, brain, bone, and eye—areas of the body that also exhibit changes during perimenopause and menopause.
What are the other vasomotor symptoms caused by menopause?
Vasomotor symptoms can be debilitating, causing disturbed sleep, avoidance of social situations in which hot flashes occur, and numerous other problems.
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What is most effectively way to manage hot flashes?
Hormonal therapy ( good)
(ok) other ways– SSRI ( zoloft, proxetine)
, SNRI ( Venlafaxine,
FDA approves use of high dose or low dose of hormonal therapy to reduce hotflashes?
Low dose for 8 to 12 weeks.
High dose ( 1mg) for 4weeks
Why low dose of hormonal therapy (estrediol) as compared with high dose?
Reduces the sign breast tenderness and uterine bleeding caused by high dose of hormonal therapy
What are the possible adverse reaction caused by hormonal therapy?
Endometrium cancer
Who should not take hormonal ( estrediol therapy)
history of cardiovascular disease, breast cancer. cervical cancer. venous thromboembolytic events and hepatic problem
Oral hormonal or transdermal hormonal therapy is better to reduce the risk of thromboembolytic episode?
Transdermal hormonal therapy
Hormonal therapy may cause atropic vaginitis, what should you do?
estrogen containing vaginal cream. ring or tablet should be used/
Menopause cause vaginal dryness, what should you do?
Apply vaginal lubricant or moisturizer
What is the effective way to manage vasomotor symptoms associated with menopause
Gabapentin ( neutontin)
Management for women who menstruate, but also have significant amount of perimenopausal symptoms?
low dose combined oral contraceptive
why menopausal women have osteoporosis?
low estrogen level/
Management for osteoporosis related with menopause ?
Contraceptive ( not recommended due to adverse effect).
Calcium supplemet
Management for UTI related to menopause?
vaginal or local estrogen to increase periurethral and perivaginal colonization with lactobacili
Other nonpharmcological management of hot flashes due to menopause?
high dose of vitamin E ( 800 IU/DAY)
Non pharmacologiccal management of menopause?
Phytoestrogens are chemical substances similar to estrogen,
in particular estradiol, that are found in more than 300 plants, including apples, carrots, coffee, potatoes, yams, soy products, flaxseed, ginseng, bean sprouts, red clover sprouts, sunflower seeds, rye, wheat, sesame seeds, linseed, black cohosh, and bourbon.
These are active substances that bind to estrogen receptor sites and have mild estrogenic effects and some antiestrogenic activity in some areas by binding and blocking to sites in the breast, colon, and rectum.
Over-the-counter topical creams made of wild yam, a phytoprogesterone, are available and commonly used by women seeking relief from hot flashes. B
ecause of poor bioavailability, however, little of the product actually reaches circulation.
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Trigger of hotflashes?
Spicy foods, chocolate, other foods Alcohol use Elevated ambient temperature and humidity Tight, restrictive clothing Cigarette smoking Hot baths or showers Relaxation techniques, self-hypnosis
Modifiable management of hotflashes?
Keep food diary to track triggers.
Avoid triggers or eat in small amounts.
Note whether certain amounts of types of alcohol trigger hot flashes. Restrict or avoid use.
Control room temperature and humidity.
Using climate control to achieve a cool room with low humidity is particularly helpful in improving sleep quality.
Dress in layers that can be removed and replaced in response to hot flashes.
Tobacco use is associated with a marked increase in hot flashes. Smoking cessation improves overall health and reduces hot flash frequency and severity.
Taking a cool shower or bath minimizes hot flash risk. In many smaller studies, shown to be helpful in reducing hot flash severity and frequency.
Contraindication of hormonal therapy?
Contraindications to and Caution With Postmenopausal Estrogen
Therapy Absolute contraindication
- Unexplained vaginal bleeding
- Acute liver disease
- Chronic impaired liver function
- Thrombotic disease
- Neuro-ophthalmological vascular disease
- Endometrial cancer (controversial—short-term use for management of severe menopausal symptoms occasionally acceptable)
- Breast cancer current, past, or suspected (controversial—short-term use for management of severe menopausal symptoms occasionally acceptable)
Use with caution, considering whether benefit outweighs risk • Seizure disorder (owing to potential drug–drug interaction) •
Dyslipidemia, particularly hypertriglyceridemia (transdermal, intravaginal hormone therapy has limited lipid impact)
Sign and symptoms of Menopause?
Hot flashes
Sleep symptoms
¡Sleep disruption
¡Sleep latency
¡Linked to hot flashes, stress
Depressed mood
Cognitive symptoms
¡Transitory declines in
- Memory
- Concentration
- Learning
Pain symptoms
¡Back, muscles, joints
Sexual symptoms
¡Decreased desire
Urinary incontinence
Vulvovaginal symptoms
¡Vaginal dryness
Metabolic changes
¡Bone
÷Decrease in mass
÷Some progression to osteoporosis
¡Muscle
÷Decrease in mass
÷Loss of strength
¡Fat
÷Increase in mass; may trigger endocrine changes
Metabolic syndrome
¡Lipid patterns
•Lipids peak
¡Glucose and insulin
•Insulin resistance
¡Thrombotic changes
¡Inflammatory responses
Adaptation to stress
¡Increased stress response
What medication can you given for high fat?
OMEGA 3
