Menopause Flashcards

1
Q

Earliest hormonal sign of peri-menopause

A

Decreasing inhibin levels

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2
Q

DHEA and DHEA-S in menopause

A

Dramatic decrease (70% less DHEA, 75% less DHEA-S)

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3
Q

Hormones produced by post-menopausal ovary

A

Androstenedione and testosterone

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4
Q

Androstenedione in menopause

A

Approximately 50% of the pre-menopausal level (precursor for peripheral conversion is decreased)

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5
Q

Testosterone in menopause

A
Changes minimally (may increase) 
Production by the ovary is increased (gonadotropins driving androgen production) – however primary source of testosterone is peripheral conversion of androstenedione (which is reduced) [testosterone 25% lower]
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6
Q

Estradiol in menopause

A

Circulating levels 10-20 pg/ml (derived from peripheral conversion of androgens/androstenedione)

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7
Q

Insulin in menopause

A

increases (or least likely to decrease)

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8
Q

Hypothyroidism in menopause effect on cholesterol

A

Hypothyroid causes increase in cholesterol due to decrease in cell membrane LDL receptors

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9
Q

T4 in menopause

A

With aging, metabolism of T4 decreases but thyroxine secretion also decreases

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10
Q

T4 -> T3 and TSH production in menopause

A

Conversion of T4 to T3 inside anterior pituitary cells decreases (primary action on nuclear receptor) – reduces TRH receptors and decreases production of TSH

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11
Q

Most important component of STRAW (stages of reproductive aging workshop) Criteria

A

Menstrual cycle remains most important criteria given lack of standardization of biomarker assays

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12
Q

Cardioprotective effects of E2 therapy (or before menopause)

A

o Increase in NO synthase (vasodilatory)
o Increase prostacyclin (vasodilatory)
o Inhibits oxidation of LDL
o Increase in HDL

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13
Q

Atherosclerotic plaques with E2 therapy

A

o Beneficial in prevention of atherosclerotic plaques
o May be harmful in women with established atherosclerotic plaques  estrogen induces matrix metalloproteinase production or activity

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14
Q

WHI intervention and population

A
  • E/P (conjugated estrogens 0.625mg/MPA 2.5mg, if uterus present) vs EE (conj est 0.625mg) vs Placebo
  • 27k age 50-79 (avg 63), “healthy,” 5 year f/u
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15
Q

WHI findings mortality

A

No increase in E/P or EE vs placebo

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16
Q

WHI findings ASCVD

A

E/P increase in 1st yr, not over entire study; Conclusion: No clear benefit of HRT for ASCVD;
Benefit for age <60 and <10 year post-menopause? (“window of opportunity” hypothesis)

17
Q

WHI findings breast cancer

A

Increased risk with E/P, EE neutral

18
Q

WHI findings colon cancer

A

Decreased risk with E/P, EE neutral

19
Q

WHI findings CVA

A

E/P and EE increase risk of CVA (age > 65)

20
Q

WHI findings VTE

A

E/P has twice the risk of EE

21
Q

WHI findings osteoporosis

A

Both E/P and EE decrease fractures

22
Q

Testosterone replacement goal

A

Use a testosterone product that can be titrated; goal total testosterone = 20-80 ng/ml

23
Q

Benefits of androgen therapy in menopause

A
  • Improvement in psychological well being
  • Increase in sexually motivated behavior
24
Q

SEs of testosterone administration

A
  • Virilization = hirsutism, acne, alopecia
  • Negative effect on lipids
  • Hyperestrogenic (peripheral conversion to estrogen) + androgens do not protect endometrium = potential risk of endometrial/breast cancer
  • Long term effects unknown
25
Q

Dosing/administration of testosterone

A
  • Transdermal – 150-300 ug/day
  • Testosterone skin gel (marketed for men) – 1 g/day (5 g/day in men)
26
Q

Leptin in menopause

A

decreases

27
Q

Which hormones INCREASE most with age?

A
  • Cortisol
  • Norepinephrine
  • Insulin
28
Q

GH in menopause

A

decreased

29
Q

Why does E2 increase thrombosis?

A

Decreased fibrinogen, Factor VII, Antithrombin III

30
Q

Estrogen’s % reduction in colon ca

A

30%

31
Q

Overall Benefits (5) vs Risks (5) of HRT

A

(not shown - reduction in T2DM)