Menopause Flashcards
What is natural menopause?
the permanent cessation of menses of 1 years duration secondary to lack of estrogen production by the ovaries
What is perimenopause?
the time period prior to menopause which is characterized by menstrual cycle irregularity, increased frequency of anovulatory cycles, & symptoms similar to menopause
-menopause transition
Differentiate early menopause and premature menopause.
early menopause: before age 45
premature menopause: before age 40
What is early natural menopause/primary ovarian insufficiency?
loss of ovarian function at a young age
POI: before 40yo, but still can have irregular or transient menstruation
What are people with early natural menopause/primary ovarian insufficiency at risk of?
symptoms from estrogen deficiency
What is recommended for women with early natural menopause/primary ovarian insufficiency?
restoring estrogen levels until natural age of menopause to prevent complications
-may require higher doses of estrogen
-also calcium, vit D, and exercise
What are some factors that may precipitate earlier onset of menopause?
smoking
exposure to toxins
chemotherapy
hysterectomy
Describe the hormonal changes in menopause.
there is an age related decrease in # and quality of ovarian follicles
-by menopause few/none remain
as a result, ovarian secretion of estradiol ceases & ovulation does not occur, so P concentrations also remain low
the pituitary increases FSH/LH in an attempt to initiate follicle development, but the ovaries cannot respond
end result: the ovaries cease to secrete E and P
this can be a slow, progressive decline over years, or a dramatic drop at once
Describe estrogen production pre-menopause.
E is mainly produced by the ovaries
other sites produce smaller amounts of E through conversion of androgens
Describe estrogen production post-menopause.
E production decreases to ~10% of premenopausal levels
the primary E is estrone
-1/3 estrogenic potency of estradiol
-produced in adipose via conversion of androstenedione
What are the symptoms of menopause?
vasomotor symptoms
sleep pattern changes
mood and cognition changes
genitourinary changes
bleeding changes
What are vasomotor symptoms?
hot flashes and night sweats
What are hot flashes?
the classic sign & major complaint of menopause
sudden onset of intense warmth that begins in the chest and may progress to the neck and face
often accompanied by visible red flushing
may also be accompanied by anxiety, palpitations, and profuse sweating
How long do hot flashes typically last?
are typically episodic and last on avg for 4 mins
What is the significance of VMS?
sweating - embarrassment
overheating - uncomfortable
night sweats - terrible sleep, terrible next day
VMS associated with:
-diminished sleep quality
-irritability
-difficulty concentrating
-decreased QoL
What causes hot flashes?
appears to be due to narrowing of the thermoregulatory system caused by changes in E levels
-postmenopausal women are thought to have narrowing of their “thermoneutral zone” - small changes in temp can stimulate the regulatory response of sweating or shivering
What are the risk factors for hot flashes?
less physical activity
family history/genetics
age of onset
induced menopause
What are the treatment options for VMS?
CBT
menopausal hormone therapy (MHT)
-estrogen
-estrogen + progestogen
-estrogen + bazedoxifene
-tibolone
nonhormonal therapy
What is the evidence for lifestyle modifications for VMS?
limited to no evidence but reasonable to suggest
What are some lifestyle modifications that can be made for VMS?
cooling techniques
-fans/AC, cool drinks, avoid hot/humid temps
avoidance of triggers
-caffeine, alcohol, spicy foods
exercise, yoga, relaxation training
-may improve overall well-being
weight loss in those who have extra weight
smoking cessation
hypnosis: limited evidence
vegan diet
What is CBT?
structured, short-term, goal-oriented form of psychotherapy
What are the benefits of CBT for VMS?
appears beneficial in reducing frequency, severity of VMS
appears beneficial for sleep
When is estrogen therapy used alone for VMS?
ET is used alone for VMS if women have had a hysterectomy
How should estrogen be used for women with VMS if they have a uterus?
combination with progestogen (EPT)