Menopause Flashcards
def. meno
12 months of amen
- associated with permanent cessation of ovarian function
def. perimenopause
transtitional period prior to menopause: from end of normal ovulatory cycles to cessation of menses
- heralded by menstrual irregularities
what is mech of perimeno
- by mid 40s, cycle is longer due to less E prolonging foll. phase - defines onset
- when length over 42 days can predict within 1-2 years
what are normal and premature ages
normal - 51yo
early meno
where does E come from in meno
peripheral conversion of andro to E
- correlates with body wieght
3 key points
- meno is clinical diagnosis
- not biochem
- no ultrasound diagnosis
why is it important to define
any bleeding post meno is abnormal - endo CA until proven otherwise
4 causes of PMB
- atrophic endometriosis/vaiginitis - 43%
- endo CA - 29%
- endo/cerv polyps
- other - trauma, sarcoma
what is first test
endo biopsy
what is impact of menopausal E deprivation
- vasomotor Sx
- urogential atrophy
- cog. changes
- CV changes
what is hot flush
sudden increase in redness and heat
- second s to minutes
- more often at night and in warm env
what is patho of hot flush
- poorly understood
- probably due to hypothalmus in assoc. with E deprivation
prevalence of hot flush
perimeno -10-25%
meno - 50-85
10 years past -
2 main treatments
firstline - lifestyle
Est - gold standard, but high placebo effect
what is urogenital atrophy
E deprivation
- cuases loss of collagen and thinning and friable
therapy of atrophy
- sexual activity
- lubricant
- local E - more effective that systemic
3 Sx attributable to E deprivation
- hot flushes
- decreased sleep
- urogenital atrophy
2 types of HRT
- estrogen - lower doses than OCP
2. progestin - only from endo CA protection
pre 2002 risk and benefits
benefits - vasomotor, osteo, cardo
risk - DVT, brest CA?, CVD?
probs with old lit
healthy user bias
what was major finding in new lit
increased risk of CAD
what was problem
old women in study
what is effect on HRT
if there is one, it is small - 25%, but low numbers
***what is attrubtable risk
8/10000 - not big
what are HRT guidlines
- use only for disabling vasomotor Sx
- can safely be used for 5 years out of menopause
