Menopause

Question 1

what is menopause?

Answer 1

absent menstrual periods in 12M period
permanent end of menstrual cycles for at least 12M

Question 2

at what age is menopause most common?

Answer 2

45-56Y

Question 3

what is the period before menopause? and what does it look like?

Answer 3

Perimenopause (menopause transition)
4 yrs before final menstrual period

Missed/irregular menstrual cycles with changes in bleeding patterns (heavy, prolonged, light)

Question 4

what is it called when women get menopause before age 40?

Answer 4

premature ovarian insufficiency

Question 5

why might someone have premature ovarian insufficiency?

Answer 5

chromosomal abnormalities
autoimmune processes
cancer treatment
surgery
idiopathic

Question 6

what is iatrogenic menopause?

Answer 6

the etiology for menopause is surgery, chemotherapy, and radiation

Question 7

what is the overall patho for menopause?

Answer 7

1. ovarian follicular depletion ➔ less responsive cells to FSH and LH
2. decreased or cessation of estrogen and progesterone
3. decreased negative feedback on the hypothalamus bc decreased estrogen
4. increased bursts of GnRH
5. increased FSH and LH
6. still no estrogen production
7. no ovulation

Question 8

what s/s would be looking for with menopause?

Answer 8

s/s of estrogen deficiency
- vasomotor instability - hot flashes, night sweats, sleep disturbances (more common in early years of menopause)
- vulvovaginal atrophy ➔ dyspareunia (pain with intercourse), urinary tract dysfunction
- osteoporosis, joint and muscle pain
- skin wrinkling and skill thinning
- mood instability and decline in cognitive

decrease protective effects of estrogen: increased risk of CVD, osteoporosis, and bone fracture

Question 9

how do you ix menopause?

Answer 9

don’t need to w/u if >45 with s/s of menopause and 12M amenorrhea

if <45 and irregular or absent menstrual cycles could w/u FSH, LH, and estradiol levels and r/o endocrine disorders (hyperprolactinemia, hypothyroidism, and pregnancy)

Question 10

what are some red flag s/s you want to work up in a menopausal pt?

Answer 10

new vaginal bleeding ➔ r/o cancer w/ biopsy and imaging
B-symptoms ➔ r/o cancer

worsening vasomotor s/s ➔ r/o progressing CAD etc.

Question 11

how do you tx menopause?

Answer 11

1. hormone therapy ➔ can give estrogen and progestin to help ease the vasomotor s/s
2. local hormone therapy ➔ vaginal atrophy
3. lubricants re: vaginal dryness
4. lifestyle changes: urogenital health
5. re: risk of osteoporosis ➔ vitamin D, calcium, bisphosphonates, wt bearing exercise, smoking cessation

Question 12

how is estrogen protective against CVD?

Answer 12

it reduces atherosclerosis by helping the body remove inflamed cells which would otherwise contribute to new plaques

Question 13

what is the HAVOCS pneumonic for menopause

Answer 13

H - hot flashes
A - Atrophy of
V - vagina
O - osteoporosis
C - cardiovascular disease
S - sleep impairment