Menopause

Question 1

What is a silent complication of menopause?

Answer 1

osteoporosis

Question 2

Climacteric

Answer 2

transition from reproductive life

Question 3

Menopause

Answer 3

cessation of menses

Question 4

What is the average age of menopause in the US?

Answer 4

51-52

Question 5

Premature menopause

Answer 5

cessation of menses prior to age 35 due to spontaneous or surgical circumstances

Question 6

What are the clinical manifestations of menopause?

Answer 6

amenorrhea
hot flashes
vaginal dryness
sleep disturbances
mood changes

Question 7

What is the etiology of the mood changes?

Answer 7

loss of reproductive capacity
empty nest syndrome
disconnect from spouse or partner
career stress

Question 8

osteoporosis

Answer 8

period of rapid bone loss begins 1 year before final menses and lasts 3 years

Question 9

What goes into a diagnostic evaluation for menopause?

Answer 9

pregnancy test
TSH
FSH!!
BMD

Question 10

Osteopenia

Answer 10

low bone mass

Question 11

t score

Answer 11

compares BMD to young population

Question 12

z score

Answer 12

compares BMD to age matched population

Question 13

interpretation of BMD

Answer 13

normal- at or above 1.0 SD
osteopenia- -1.0-2.5 SD
osteoporosis- below 2.5 SD

Question 14

What are some consequences of osteoporosis?

Answer 14

VERTEBRAL COMPRESSION FRACTURES
nerve root injury
loss of height
HIP FRACTURE (immobility, PE, 3-6% mortality with initial hospitalization)

Question 15

Menopause supportive measures

Answer 15

nutritional counseling

psychological counseling and treatment of depression (SSRI, Venlafaxine, Bupropion)

Question 16

Lifestyle modifications with menopause

Answer 16

exercise (aerobic and muscle strengthening)
weight reduction
stress reduction
cessation of smoking

Question 17

What are proven benefits of HRT

Answer 17

decrease in hot flashes
decreased vaginal dryness
improvement in sleep disturbances
decreased risk of colorectal cancer (37%)
decreased risk of hip and vertebral fracture (33%)

Question 18

HRT adverse effects

Answer 18

Increased risk of coronary artery disease (29%)
Increased risk of CVA (41%)
Increased risk of DVT/PE (2x)
Increased risk of breast cancer (26%)

absolute risk is still low!!! (8/10,000 cases)

Question 19

Other treatments for osteoporosis

Answer 19

Calcium supplementation (1200mg daily)
Vitamin D (600 IU daily)
Exercise (aerobic and weight bearing), flexibility- preserve agility and prevent falls; muscle strengthening
selective estrogen receptor modifiers (SERMs) - do not relieve hot flashes
Anti-resorptive agents- bisphosphonates (highly effective in improving BMD and preventing fractures)

Question 20

Types of bisphosphonates

Answer 20

alendronate (fosamax)- 70 mg weekly
risedronate (actonel) - 35 mg weekly
ibandronate (boniva)- 150 mg monthly
zoledronic acid (reclast)- 5 mg IV yearly

Question 21

T/F: HRT does not prevent heart disease or alzheimer’s.

Answer 21

True

Question 22

What are the mainstays in therapy for osteoporosis?

Answer 22

exercise and anti-resorptive agents

Question 23

What is the best test to confirm the diagnosis of menopause?

Answer 23

FSH

Question 24

What is the best test to confirm the diagnosis of osteopenia or osteoporosis?

Answer 24

BMD