Menopause Flashcards
What immediately precedes menopause?
ovarian inactivity
How long must cessation of menses be before one has officially menopaused?
1 year
compare surgical vs. natural menopause
surgical - cessation of menses after surgical removal of both ovaries
while
natural - natural cessation of menses
T/F removal of uterus will necessarily lead to surgical menopause
F
T/F Perimenopause exclude normal ovulatory cycles before cessation of menses. It only includes anovulatory cycles.
F
When can perimenopause start?
5 years before menopause
What is the median age of menopause for Filipinos?
48 years
T/F age of menarche and age of menopause are directly correlated
F; no correlation
T/F mothers and daughters tend to experience menopause at the same age
T
Main hormone of reproductive age group
Estradiol
Main hormone of menopausal age group
Estrone
Describe the levels of FSH and LH during ovarian failure
both are elevated
After menopause what happens to androstenedione levels?
decrease to 1/2
Where is estrogen derived from?
peripheral conversion of androstenedione
Signs of early menopause (SHrIMP)
Sweating Hot flushes Insomnia Menstrual irregularity Psychological symptoms
Signs of intermediate menopause (DUVS)
Dyspareunia
Urge-stress incompetence
Vaginal atrophy
Skin atrophy
Signs of late menopause (OA2)
Osteoporosis
Atherosclerosis
Alzheimer’s
Changes in reproductive pattern include the following EXCEPT
a. disturbances in menstrual pattern
b. anovulation and reduced fertility
c. increased flow
d. irregular frequency of menses
e. eventual amenorrhea
C; decreased
How many ovarian follicles does a menopausal woman have?
<1000
[Increase/Decrease]
size and volume of ovaries
decrease
Describe hot flush
Sudden onset of reddening of the skin over the
head, neck and chest accompanied by the feeling
of intense body heat and sometimes concluded
by profuse sweating lasting for a few seconds to several minutes
T/F hot flushes are more severe in the morning
F; eveining and at times of stress
T/F Caucasians experience more severe hot flushes compared to Filipinos
T
Urinary difficulties such as urgency, frequency
and abacterial urethritis and cystitis may be due
to ____________________________
mucosal thinning of the urethra and bladder
General Skin Atrophy is due to ____________
Decline in skin collagen content and skin
thickness; skin dryness and wrinkling
What are the effects of estrogen on nervous system?
- Protects against neuronal cytotoxicity
caused by oxidation - Reduces amyloid P (glycoprotein found in
Alzheimers neurofibrillary tangles) - Increases synapses and neuronal growth
T/F loss of endogenous estrogen at menopause
coincides with a sharp increase in the risk of
cardiovascular disease and cardiovascular deaths in
women
T; nauuna ang males 5-10 years to have increased risk, but eventually, menopausal women catch up
Protective effect of estrogen in women include the ff EXCEPT
a. Increased vasodilation and NO levels
b. Inhibition of vascular injuries
c. Decreased inHDL and increase in LDL
d. Improves carbohydrate metabolism
e. Improves vascular activity in the coronary artery
f. reduction of coronary plaque
C
The ff statements are true EXCEPT
a. HRT should be initiated for women with
existing heart disease
b. HRT is cardioprotective if
started around the time of menopause and continued
long term
c. Estrogen is contraindicated for those above 60 y.o
d. In women less than 60, recently menopausal, without
prevalent CVD, HT does not cause early harm, and
may reduce CVD morbidity and mortality
A
T/F hot flushes are more severe in the morning
F; eveining and at times of stress
T/F Caucasians experience more severe hot flushes compared to Filipinos
T
Urinary difficulties such as urgency, frequency
and abacterial urethritis and cystitis may be due
to ____________________________
mucosal thinning of the urethra and bladder
General Skin Atrophy is due to ____________
Decline in skin collagen content and skin
thickness; skin dryness and wrinkling
What are the effects of estrogen on nervous system?
- Protects against neuronal cytotoxicity
caused by oxidation - Reduces amyloid P (glycoprotein found in
Alzheimers neurofibrillary tangles) - Increases synapses and neuronal growth
T/F loss of endogenous estrogen at menopause
coincides with a sharp increase in the risk of
cardiovascular disease and cardiovascular deaths in
women
T; nauuna ang males 5-10 years to have increased risk, but eventually, menopausal women catch up
Protective effect of estrogen in women include the ff EXCEPT
a. Increased vasodilation and NO levels
b. Inhibition of vascular injuries
c. Decreased inHDL and increase in LDL
d. Improves carbohydrate metabolism
e. Improves vascular activity in the coronary artery
f. reduction of coronary plaque
C
The ff statements are true EXCEPT
a. HRT should be initiated for women with
existing heart disease
b. HRT is cardioprotective if
started around the time of menopause and continued
long term
c. Estrogen is contraindicated for those above 60 y.o
d. In women less than 60, recently menopausal, without
prevalent CVD, HT does not cause early harm, and
may reduce CVD morbidity and mortality
A
LABORATORY TESTS and ANCILLARY
PROCEDURES for initial evaluation of menopause
o CBC o Urine screen o Fasting blood sugar o Lipid profile o AST, ALT o Thyroid Scan o Mammograph o Pelvic Ultrasound o DEXA bone scan o Pap smear o Fecal or Occult blood o Colonoscopy
[Identify]
Decreased bone mass, and bone tissue
deterioration leading to enhanced bone
fragility and increasing the risk of fractures
even with little or no trauma
Osteoporosis
How much bone mass is lost during menopause?
1-1.5% loss per year
To whom should progesterone + estrogen HRT be given?
menopausal women with intact uterus
Enumerate signs and symptoms of osteoporosis
Back pain
Decreased height and mobility
Fractures of the vertebral body, humerus, upper femur, distal forearm and ribs, oral alveolar bone loss (which can lead to loss of teeth)
When will progestines be given to hysterectomized women?
Pelvic endometriosis, Procedures with potential for residual endometrium, Stage 1 or 2 adenocarcinoma of the endometrium, Endometrioid carcinoma of the ovary Elevated triglyceride levels
Give 10 contraindications of hormonal therapy
• Current past or suspected breast cancer
• Known or suspected estrogen-dependent malignant tumors such as endometrial cancer
• Diagnosed genital bleeding
• Untreated endometrial hyperplasia
• Previous idiopathic or current venous thromboembolism (deep venous thrombosis, pulmonary embolism)
• Active or recent arterial thromboembolic disease (eg.
Angina, MI)
• Untreated hypertension
• Active liver disease
• known hypersensitivity to the active substance or to
any of the excipients
• Prophyria cutanea tarda- blistering of the skin after
exposure to sunlight
Hormone therapy can be used for
treatment of hot flushes,atrophy of reproductive tract, prophylaxis of osteoporosis,
What is the most effective treatment
for menopause related vasomotor symptoms?
HRT
HRT is protective against the ff except.
a. colon cancer
b. CV disease
c. cognition
d. urinary incontinence
e. Breast cancer
E
Enumerate adverse effects of HRT (TiMBerS)
Increased risk of thromboembolism, breast cancer, MI and stroke
Why is progesterone added in HRT?
to protect the endometrium
from hyperplasia/cancer due to unopposed estrogen
When will progestines be given to hysterectomized women?
Pelvic endometriosis, Procedures with potential for residual endometrium, Stage 1 or 2 adenocarcinoma of the endometrium, Endometrioid carcinoma of the ovary Elevated triglyceride levels
How much hormone levels should be given to a woman under HRT?
lowest possible dose without compromising symptom relief
What’s so special with using Tibolone?
Estrogenic effects: bone, vagina and hot flushes
Progetogenic effects : endometrium
Androgenic effects: Sexual enjoyment and libido
Atrophic Vaginitis treatment
Estrogen therapy therapy: o Oral o Topical o Transdermal o Vaginal
How often is local ET taken?
1s a day for 2-3 weeks
What will happen if ET is taken for a long time
increased risk of endometrial hyperplasia and endometrial cancer
What does vagina cream contain?
Estriol (ovestin cream)
Example of meds for osteoporosis
Raloxifin, bisphosphonates, strontium ranelate
and parathyroid hormone
Non-hormonal alternative to HRT for vasomotor problems
o SSRIs (selective serotonin reuptake inhibitors)
o Clonidine
o Gabapentin
Enumerate Natural/AlternativeTherapies
Phytoestrogens, Isoflavones, Coumestans, Lignans
How to screen for osteoporosis?
Measuring bone density
o DEXA(Dual-EnergyX-rayAbsorptiometry)
o Measures bone density in 3sites: radius, hip and
spine
Who should be screened for osteoporosis?
Postmenopausal >65, or postmenopausal <65 but with 1 or more risk factors, Postmenopausal women who have had fracture after 45 y.o
first–line therapy for preventing
bone loss and fractures in postmenopausal women
age 50-60 years
hormone therapy
T/F >60 years, the initiation of standard dose HT is
not recommended for the sole purpose of the
prevention of fractures
T
Example of meds for osteoporosis
Raloxifin, bisphosphonates, strontium ranelate
and parathyroid hormone
Inhibits bone resorption and Binds to bone mineral making bone less susceptible
to osteoclastic action
Biphosphates
Reduces the risk of subsequent nonvertebral
fractures by at least ___ and vertebral fractures by
___ in the first 3 years of treatment
30%; 90%
T/F even if under HRT already, one may still need biphosphates
F; kung HRT na, okay na ‘yun
T/F Accelerated bone loss after discontinuous biphosphates
F
Adverse effects of biphosphates
esophagitis, esophageal ulcers
When should biphosphates be taken?
empty stomach; ideally in the morning
Mixed estrogen agonist-antagonist action on specific
target tissues. Prevents bone loss, comparable with estrogen and
bisphosphonate therapy
Selective Estrogen Receptors Modulators
T/F there is no evidence that SERMs can reduce hip or wrist fractures; no proliferative effect on endometrium
T
Which statement is false
a. HRT is the best therapy for hot flushes
b. No role in primary and secondary prevention of
heart disease
c. HRT use to improve cognition is still inconclusive
but may be promising
d. Only form of prevention of osteoporosis
D
How much calcium and vit D should menopausal women take as supplement?
o 800-1000mg Ca per day
o 800 IU of Vit D supplementation
Contraindications for SERMs
women with previous thromboembolic event
T/F [SERMs]
Reduction in the incidence of estrogen receptorpositive breast cancer
T
T/F [SERMs]Favorable effects on HDL-cholesterol, fibrinogen, and lipoproteins, no effect on LDL-cholesterol
F; LDL… HDL
