Menopause

Question 1

Climacteric is?

Answer 1

Phase of ovarian fxn decline resulting in ↓ sex steroid prdxn

Question 2

Menopausal Transition is?

Answer 2

∆ in cycle length/↑ FSH -> FMP

Question 3

Perimenopause is?

Signs?

Answer 3

∆ in cycle length/↑ FSH -> 12 mo post FMP

Irreg cycles
Heavy flow/endom hyperplasia
Mood/emotional ∆s
Hot flashes, etc
Last 3-5yrs

Question 4

Menopause is?

Answer 4

amenorrhea for 12 mo post FMP
(U) 50-55yo
Before 40yo = premature ovarian fail

Question 5

Postmeno / early stage?

Late stage?

Answer 5

1st 5 yrs post FMP

> 5yrs

Question 6

Menopause hormonal ∆s? (4)

Answer 6

↓E2 (↓ovarian estradiol)

↓Androgens (P ↑ sensitivity to androgens = facial hair, ↓breast tissue)

↓Progesterone (↓ when ovulation ↓) = irreg bleed, endo hyperpasia, ↑endo CA

↑FSH/LH (LH -> hot flashes)

Question 7

Menop affects on bladder?

Answer 7

↓ elastic capacity = freq, urgent, incont, nocturia

Question 8

Menop DDX?

Answer 8

Hyperthyroid (mens ∆, sweats, moods)
Pregnancy
Hyperprolactinemia (mens ∆)
Meds
Pheochromocytoma (hot flash/night sweat)
CA

Question 9

Menop-caused vag atrophy/dryness tx?

Answer 9

1st line: Non-horm lube
2nd/Most effective: vag E2 (insert)
Other: SERM, Ospemifene

Question 10

Menop-causes vasomotor sxs tx?

Answer 10

HRT: (short-term/low-dose)
E2 if sans uterus
E2/Prog if uterus

Effexor, Paxil, Neurontin
Soy, St John, Black cohosh

Question 11

HRT contraindicated for?

Answer 11

Heart dz
Breast CA
VTE/Stroke Hx
Liver dz
High Riskers for the above

Question 12

Osteoporosis characteristics?

Answer 12

Low bone mass
Microarchitectural disruption
Skeletal fragility

Question 13

Osteoporosis clinical findings?

Answer 13

Spine and Femoral neck most C,

Loss of height > 1.5”

Question 14

Osteoporosis imaging?

Answer 14

DXA: >50yo w/ risks, o/w >65
T-score < -2.5 = osteoporosis
T-score b/w -1 and -2.5 = osteopenia

Question 15

Osteoporosis management: Meds

Use when?

Med types? (3)

Repeat DXA when?

Answer 15

If T-score < -2.5 and no risks or
T-score b/w -1 and -2.5 w/ risks

SERMs
Bisphosphonates
PTH/Calcitonin

Q 2yrs if on meds

Question 16

Osteoporosis management: Meds

SERMs?

Bisphos?

PTH?

Answer 16

SERMs: Evista
Prevents and treats
↓ vert fx but not hip
↓breast Ca

Bisphosphonates: Actonel, Fosamax, Boniva
Prevent and treat
Few s/e

PTH/Calcitonin: Forteo, Miacalcin
Refractory