Menopause Flashcards
When is menopause recognized to have occurred?
after 12 mos of amenorrhea w no pathological cause
menopause = single point in time, the last menstrual period (FMP)
What is perimenopause?
begins w stage 2 and ends 12 months after FMP (last menstrual period) = menopausal transition
What is the menopausal transition?
begins with early stage 2 and ends late stage 1
begins w variation in menstrual cycle length from rise in FSH and ends w FMP
What is postmenopausal?
FMP to death
stage +1 and +2
stage 1+ is w/i 5 yrs of FMP - further dampening of ovarian hormone fxn and accelerated bone loss
What is premature ovarian failure?
cessation of menses at least 6 mos before 40
has elevated serum FSH usually >40
transient or permanent (premature menopause)
What are the four major factors affecting the age of menopause?
current smoking can cause 1-2 yrs earlier
chemotherapy and pelvic irradiation
any procedure altering ovarian blood flow
mother’s age somewhat determines daughter’s
About how many oocytes are there at: 5 months gestation birth puberty perimenopause
7 M
2 M
500,000
100-1000
What are the symptoms of menopause?
menstrual irregularity hot flashes night sweats insomnia irritability mood swings
What are the signs associated w menopause?
vaginal atrophy
loss of urogenital integrity
loss of skin elasticity
What are diseases associated w menopause?
osteoporosis
CV dz
Alzheimers
Cancers
Increased macular degeneration or periodontal dz
decreased hearing, balance, quality of life
Which perimenopausal women should have a biopsy?
if long (>7 days) or heavy bleeding periods - could mean endometrial hyperplasia/cancer skipping periods etc. don't need biopsy
What is thought to be the main reason for hot flashes in menopause?
decline in estrogen - estrogen therapy?
Why does vaginal dryness occur during menopause??
mucosal lining of vagina and urethra sensitive to estrogen - loss of endogenous estrogen during menopause
What causes the rise in FSH and LH levels around menopause?
follicle depletion and loss of estrogen –> reduced negative feedback to hypothalamus –> GnRH release and maximal frequency and amplitude
What is the controversy in the use of HT in postmenopausal women?
replacement of estrogen though to help w many symptoms (esp heart dz and osteoporosis)
but some studies found increased risk of endometrial cancer w just estrogen (& not progesterone) therapy or lack of help
no real consensus
current recommendations = use estrogen for vasomotor and urogenital symptoms w lowest dose for shortest time, can prevent osteoporosis but not primary therapy, not used for chronic dz prevention
What are the indications for hormone replacement therapy?
menstrual irregularities (OCPs)
vasomotor symptoms = primary indication
vaginal symptoms (estrogen)
osteoporosis (ET and EPT)
dementia and cognitive decline (early estrogen admin)
colorectal cancer (EPT)
progestogen indications = prevent endometrial hyperplasia - may promote breast cancer, women w/o uterus should just get estrogen
What are the possible risks of hormone replacement therapy?
coronary heart dz
venous thromboembolism and stroke
breast cancer
What are contraindications to HT?
undiagnosed vaginal bleeding hx of stroke or MI estrogen sensitive cancers liver dz hx of DVT or PE
