Menopause Flashcards
Menopause
- one year without menses
- FSH > 30
Perimenopause
- age group near menopausal age, 54-55
- with symptoms - menopausal transition
Postmenopause
-beyond menopause or age > 55
End of reproductive life is?
43
- ovary continues to produce eggs sporadically, but they are abnormal
- with ovulation, estrogen is still being produced, but in lower amounts
- less estrogen produced, FSH rises
- menses becomes less frequent, lighter
Symptoms of Menopause
- most common: hot flashes
- probably due to gonadotropin spikes as much as estrogen deficiency
- may occur as a perimenopausal symptom
- skin changes/vasodilation have been documented
Menopause at Night
- wake up with sweats, then cooling effect
- may happen 5 times a night
- sleep disturbance
- if no treatment, will dissipate
FDA-Approved Indications for HT
-Estrogen: estradiol (pill, transdermal patch, gel)
conjugated estrogens (premarin)
-Progestin added (if has a uterus to prevent endometrial cancer)
medroxyprogesterone (side effects)
micronized progesterone
-treatment of moderate-to-severe vasomotor symptoms associated with menopause
Hormone Therapy in Women with Vaginal Symptoms Only
- dryness or dyspareunia
- preferred treatments are low doses of vaginal estrogen
- no need for progestins
Hormone Therapy in Women with a Uterus
- women who still have a uterus need to take a progestogen (progesterone or a similar product) along with the estrogen to prevent cancer of the uterus
- women with hysterectomy can take estrogen alone
Other Symptoms of Menopause
-vaginal atrophy: late effect, but can be treated with estrogens, vaginal or systemic
Symptoms not associated with menopause?
- depression
- lack of interest in sex
- going crazy
Medical Illnesses Associated with Menopause
- Osteoporosis
- Heart Disease
- Cancer
Osteoporosis: High Risk Groups
- caucasian/asian
- thin
- smoker
- alcohol use
- steroid use
- family history
Estrogen Therapy Approved for Prevention of Osteoporosis Not Treatment
- individual risk factors
screening: bone density measurements beginning at age 65 - have another indication for hormone therapy
- affects osteoclast and osteoblast activity
Loss of endogenous estrogen is associated with?
CVD
- oopherectomy & premature ovarian failure
- women are protected from CVD until menopause (compared to men)
Endogenous estrogen does what?
-increases smooth muscle proliferation, lowers cholesterol and improves vascular tone
History of CVD
- women aged 35 yrs: fatty streaks & minimal atherosclerotic plaques
- 45-55: active progression of lesions (menopausal transition)
- 5-8 post menopause, increased in plaques & intima-media thickening
- > 65: complications start to develop: Women’s rate equal to mens
- statins & ASA may not have benefit in women as they do in men*
Perimenopausal Use of Hormone Therapy
- positive effects on vascular remodeling of age
- decreased intimal thickening
- decreases the incidence of plaques
Postmenopausal Use of Hormone Therapy
- women >65
- plaques already formed
- estrogen with its thrombogenic effects, clots off the artery
- effect was in the first year of use: MIs in year 1
Hormone Therapy & Coronary Heart Disease
- ET/EPT is not recommended as single or primary indication for coronary protection in women of any age
- data do not support EPT in secondary prevention of CHD
Estrogen Does What?
-increased risk of DVT in women 50-59 (no increased risk of stroke for ET or EPT)
women 60-69: increased risk of stroke for ET
-estrogen decreased risk of colon cancer
Estrogen & Breast Cancer
- increases with use beyond 5 years
- it may be progestin that adds risk (small risk)
- risk decreases after hormone therapy is stopped
