Menopause Flashcards
most common estrogen in menopause
estrone (weak)
Androgens in menopause
Androstenedione decreases by 50%
DHEAS decreases by 75%
Testosterone decreases by 25%
Testosterone in menopause
ovaries increase T production but overall T is decreased because most is produced by peripheral conversion from androstenedione
Menopause and bone
low estrogen increases osteoclastic activity
low calcium intake or absorption increases PTH and stimulates osteoclasts so calcium is mobilized from the bone
Vitamin D production increases calcium absorption
Osteoclasts
resportion of bone
Bone mass over lifetime
most bone mass acquired in hip and vertebrae by age 18
slow loss of BMD after age 30 (0.7% per year)
What determines osteoporosis?
Bone mass achieved at maturity
rate of loss after menopause
Risk factors for Osteoporosis
genetics, medical conditions (Hyperthyroidism, RA, hyperparathyroidism), race, body habitus, lifestyle, habits and medications (smoking, diet, alcohol), medications (eg. steroids)
T score
standard deviation between bone mass of patient and average young adult at peak bone mass
Z score
standard deviation between bone mass of patient and individual at same age and weight
first DEXA
65 yo or less than 65 if there are major risk factors or a high frax score
Menopause
cessation of ovulatory function/12 months amenorrhea . Mean age 51-52 years
* Occurs when oocyte ct 100-1000
STRAW Staging
Reproductive (-5/-4/-3), Menopausal transition (-2/-1), Postmenopause (+1/+2)
o No [ ] of FSH/E2 specific to particular stage
o AMH is best predictor of impending menopause
Raloxifene
SERM. Agonist at bone, lipisd. Decreased ER+ BrCa risk, neutral endometrium
Increased risk VTE, VM sx
Bazedoxifene
SERM. Reduces risk osteoporosis. Unclear if reduces fx risk
E2 + BZA
