Menopause Flashcards
12 months of amenorrhea defines
menopause - permanent cessation of ov activity
Perimenopause is characterized by
irregular menstruation
In majority of women, cycle lengthens to how long
35 days - tiring ovary
What defines the onset of perimenopause
Prolonged follicular phase
When do you define anovulatory…
when cycle length > 42 days
what % of women cease menses without going through prior menstrual irregularity
10%
Median age of onset of perimenopause is
45 yo, duration ~ 5 years
menopause < 40 yo is
premature ovarian failure
What happens to FSH at Menopause
FSH > 40, no conception possible > 20
4 causes of post menopausal bleeding
- atrophic endometritis, vaginitis
- endometrial cancer/hyperplasia
- endometrial/cervical polyps
- cervical ca, uterine sarcoma, trauma
Women not on HRT, endometrial thickness should be
<= 0.5mm
What should be part of the work up for PMB
BIOPSY! NOT US
4 consequences of menopausal estrogen deprivation
- vasomotor
- urogenital atrophy
- cognitive changes
- CV changes
vasomotor hot flush occurs more frequently when?
- at night, warmer environment
prevalence of vasomotor symptoms in perimenopause vs menopause
10-25% at perimenopause
50-85% at menopause
first line therapy in treating vasomotor symptoms
lifestyle modification, then estrogen!
What are alternative drug therapies effective in treating vasomotor symptoms
SSRIs
3 effects of estrogen deprivation of urogenital area
- thinning of vaginal walls
- dryness
- loss of tissue flexibility
therapy for urogenital atrophy includes
lubricants
- local estrogen therapy
3 types of local estrogen therapy
- premarin
- vagifem - tablets
- estring
2 symptoms less certainty attributable to estrogen deprivation
mood changes
memory loss
3 symptoms attributable to estrogen deprivation
- hot flushes
- urogenital atrophy
- POOR QUALITY OF DEEP SLEEP
what is the role of progestin in HRT?
prevent endometrial cancer
WHat did the WHI study show in the HRT group
increased risk of CAD
and invasive breast cancer (25%)
main issues with the WHI study
- average age of women 63
- only 16% of women within 5 years of menopause
Roussouw study showed in 2007 JAMA that
increased risk of CAD is women in their 70s who were started on HRT
The increase in risk of HRT in breast cancer is seen
5 years after use - less than risk when late age at first pregnancy ! same as alcohol use!
Risks for CVD are only elevated when? after menopause
> 20 yrs out of menopause
