Menopause

Question 1

12 months of amenorrhea defines

Answer 1

menopause - permanent cessation of ov activity

Question 2

Perimenopause is characterized by

Answer 2

irregular menstruation

Question 3

In majority of women, cycle lengthens to how long

Answer 3

35 days - tiring ovary

Question 4

What defines the onset of perimenopause

Answer 4

Prolonged follicular phase

Question 5

When do you define anovulatory…

Answer 5

when cycle length > 42 days

Question 6

what % of women cease menses without going through prior menstrual irregularity

Answer 6

10%

Question 7

Median age of onset of perimenopause is

Answer 7

45 yo, duration ~ 5 years

Question 8

menopause < 40 yo is

Answer 8

premature ovarian failure

Question 9

What happens to FSH at Menopause

Answer 9

FSH > 40, no conception possible > 20

Question 10

4 causes of post menopausal bleeding

Answer 10

1. atrophic endometritis, vaginitis
2. endometrial cancer/hyperplasia
3. endometrial/cervical polyps
4. cervical ca, uterine sarcoma, trauma

Question 11

Women not on HRT, endometrial thickness should be

Answer 11

<= 0.5mm

Question 12

What should be part of the work up for PMB

Answer 12

BIOPSY! NOT US

Question 13

4 consequences of menopausal estrogen deprivation

Answer 13

1. vasomotor
2. urogenital atrophy
3. cognitive changes
4. CV changes

Question 14

vasomotor hot flush occurs more frequently when?

Answer 14

• at night, warmer environment

Question 15

prevalence of vasomotor symptoms in perimenopause vs menopause

Answer 15

10-25% at perimenopause

50-85% at menopause

Question 16

first line therapy in treating vasomotor symptoms

Answer 16

lifestyle modification, then estrogen!

Question 17

What are alternative drug therapies effective in treating vasomotor symptoms

Answer 17

SSRIs

Question 18

3 effects of estrogen deprivation of urogenital area

Answer 18

1. thinning of vaginal walls
2. dryness
3. loss of tissue flexibility

Question 19

therapy for urogenital atrophy includes

Answer 19

lubricants

- local estrogen therapy

Question 20

3 types of local estrogen therapy

Answer 20

1. premarin
2. vagifem - tablets
3. estring

Question 21

2 symptoms less certainty attributable to estrogen deprivation

Answer 21

mood changes

memory loss

Question 22

3 symptoms attributable to estrogen deprivation

Answer 22

1. hot flushes
2. urogenital atrophy
3. POOR QUALITY OF DEEP SLEEP

Question 23

what is the role of progestin in HRT?

Answer 23

prevent endometrial cancer

Question 24

WHat did the WHI study show in the HRT group

Answer 24

increased risk of CAD

and invasive breast cancer (25%)

Question 25

main issues with the WHI study

Answer 25

• average age of women 63

- only 16% of women within 5 years of menopause

Question 26

Roussouw study showed in 2007 JAMA that

Answer 26

increased risk of CAD is women in their 70s who were started on HRT

Question 27

The increase in risk of HRT in breast cancer is seen

Answer 27

5 years after use - less than risk when late age at first pregnancy ! same as alcohol use!

Question 28

Risks for CVD are only elevated when? after menopause

Answer 28

> 20 yrs out of menopause