Menopause

Question 1

What is perimenopause?

Answer 1

Perimenopause is the time surrounding menopause; its onset is marked by the beginning symptoms of menopause and ends with the cessation of menses.

Question 2

What is the average onset of perimenopause?

Answer 2

The average age of onset of perimenopause is 40 to 45 years; this occurs earlier in cigarette smokers.

Question 3

How long does perimenopause last?

Answer 3

Perimenopause lasts an average of 4 years but can range from a few months to 10 years.

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Question 4

What is menopause?

Answer 4

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.

Question 5

What is average of women in north america to have menopause?

Answer 5

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.

Question 6

During menopause. can you still get pregnant?

Answer 6

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.

Question 7

What are the symptoms of perimenopause?

Answer 7

possible. Hot flashes and sleep problems are usually worse in the week before the menses

Question 8

What happen during perimenopause? What is normal and high?

Answer 8

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.

Question 9

What happen when the menopausal increases? What happen to LH and FSH, estrogen, progesteron and androsterone?

Answer 9

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.

Question 10

Who have more symptoms; surgical induced menpause or naturally occuring menopause?

Answer 10

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

Question 11

Why do pre-menopausal and menopausal women have urogenital atrophy?

Answer 11

Estrogen receptors are found in high concentrations in the vulva, vagina, urethra, and trigone of the bladder.

Question 12

Where do you find low concentration of estrogen receptor?

Answer 12

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.

Question 13

What are the other vasomotor symptoms caused by menopause?

Answer 13

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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Question 14

What is most effectively way to manage hot flashes?

Answer 14

Hormonal therapy ( good)

(ok) other ways– SSRI ( zoloft, proxetine)

, SNRI ( Venlafaxine,

Question 15

FDA approves use of high dose or low dose of hormonal therapy to reduce hotflashes?

Answer 15

Low dose for 8 to 12 weeks.

High dose ( 1mg) for 4weeks

Question 16

Why low dose of hormonal therapy (estrediol) as compared with high dose?

Answer 16

Reduces the sign breast tenderness and uterine bleeding caused by high dose of hormonal therapy

Question 17

What are the possible adverse reaction caused by hormonal therapy?

Answer 17

Endometrium cancer

Question 18

Who should not take hormonal ( estrediol therapy)

Answer 18

history of cardiovascular disease, breast cancer. cervical cancer. venous thromboembolytic events and hepatic problem

Question 19

Oral hormonal or transdermal hormonal therapy is better to reduce the risk of thromboembolytic episode?

Answer 19

Transdermal hormonal therapy

Question 20

Hormonal therapy may cause atropic vaginitis, what should you do?

Answer 20

estrogen containing vaginal cream. ring or tablet should be used/

Question 21

Menopause cause vaginal dryness, what should you do?

Answer 21

Apply vaginal lubricant or moisturizer

Question 22

What is the effective way to manage vasomotor symptoms associated with menopause

Answer 22

Gabapentin ( neutontin)

Question 23

Management for women who menstruate, but also have significant amount of perimenopausal symptoms?

Answer 23

low dose combined oral contraceptive

Question 24

why menopausal women have osteoporosis?

Answer 24

low estrogen level/

Question 25

Management for osteoporosis related with menopause ?

Answer 25

Contraceptive ( not recommended due to adverse effect).

Calcium supplemet

Question 26

Management for UTI related to menopause?

Answer 26

vaginal or local estrogen to increase periurethral and perivaginal colonization with lactobacili

Question 27

Other nonpharmcological management of hot flashes due to menopause?

Answer 27

high dose of vitamin E ( 800 IU/DAY)

Question 28

Non pharmacologiccal management of menopause?

Answer 28

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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Question 29

Trigger of hotflashes?

Answer 29

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

Question 30

Modifiable management of hotflashes?

Answer 30

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.

Question 31

Contraindication of hormonal therapy?

Answer 31

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)

Question 32

Sign and symptoms of Menopause?

Answer 32

—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

Question 33

What medication can you given for high fat?

Answer 33

OMEGA 3