Menopause

Question 1

When is menopause recognized to have occurred?

Answer 1

after 12 mos of amenorrhea w no pathological cause

menopause = single point in time, the last menstrual period (FMP)

Question 2

What is perimenopause?

Answer 2

begins w stage 2 and ends 12 months after FMP (last menstrual period) = menopausal transition

Question 3

What is the menopausal transition?

Answer 3

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

Question 4

What is postmenopausal?

Answer 4

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

Question 5

What is premature ovarian failure?

Answer 5

cessation of menses at least 6 mos before 40
has elevated serum FSH usually >40
transient or permanent (premature menopause)

Question 6

What are the four major factors affecting the age of menopause?

Answer 6

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

Question 7

About how many oocytes are there at:
5 months gestation
birth
puberty
perimenopause

Answer 7

7 M
2 M
500,000
100-1000

Question 8

What are the symptoms of menopause?

Answer 8

menstrual irregularity
hot flashes
night sweats
insomnia
irritability
mood swings

Question 9

What are the signs associated w menopause?

Answer 9

vaginal atrophy
loss of urogenital integrity
loss of skin elasticity

Question 10

What are diseases associated w menopause?

Answer 10

osteoporosis
CV dz
Alzheimers
Cancers
Increased macular degeneration or periodontal dz
decreased hearing, balance, quality of life

Question 11

Which perimenopausal women should have a biopsy?

Answer 11

if long (>7 days) or heavy bleeding periods - could mean endometrial hyperplasia/cancer
skipping periods etc. don't need biopsy

Question 12

What is thought to be the main reason for hot flashes in menopause?

Answer 12

decline in estrogen - estrogen therapy?

Question 13

Why does vaginal dryness occur during menopause??

Answer 13

mucosal lining of vagina and urethra sensitive to estrogen - loss of endogenous estrogen during menopause

Question 14

What causes the rise in FSH and LH levels around menopause?

Answer 14

follicle depletion and loss of estrogen –> reduced negative feedback to hypothalamus –> GnRH release and maximal frequency and amplitude

Question 15

What is the controversy in the use of HT in postmenopausal women?

Answer 15

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

Question 16

What are the indications for hormone replacement therapy?

Answer 16

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

Question 17

What are the possible risks of hormone replacement therapy?

Answer 17

coronary heart dz
venous thromboembolism and stroke
breast cancer

Question 18

What are contraindications to HT?

Answer 18

undiagnosed vaginal bleeding
hx of stroke or MI
estrogen sensitive cancers
liver dz
hx of DVT or PE