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Reproductive System > Menopause > Flashcards

Menopause Flashcards

1
Q

What is menopause?

A
  • Final menstrual period
    • usually confirmed when a woman has missed her period for 12 consecutive months
  • It reflects complete or near complete depletion of ovarian follicles and absence of ovarian estrogen secretion
    • ​permanent end of fertility
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2
Q
  • What is the average age of menopause?
  • What can influence the onset of menopause?
A
  • Average age: 51
    • age ranges from 40 to early 60s
  • Age of menopause influenced by genetics, ethnicity, smoking, and reproductive history
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3
Q

Definition: Perimenopause/Menopause Transition

A
  • Transition phase
  • Begin several years before the final menstrual period.
  • Can last 6 years or more
  • Ends 1 year after the final menstrual period
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4
Q

Definition: Postmenopause

A

All the years beyond menopause

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5
Q

Definition: Premature Menopause

A

Menopause that occurs before age 40 yrs

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6
Q

Transition to Menopause (Late Reproductive - Postmenopasue)

  1. Menstrual cycle
  2. FSH
  3. AMH
  4. Vasomotor symptoms
A
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7
Q

What is good evidence for menopause?

A
  1. Vasomotor symptoms (60-85%)
  2. Vaginal dryness (30-60%)
  3. Sleep disturbances (30-50%):
    • 2-fold increase
  4. Depressed mood 25-35%:
    • 2-fold increase
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8
Q

What are the consequences of estrogen deficiency in the postmenopausal years?

A
  1. Increased risk of osteoporosis
  2. Increased risk of diabetes
  3. Increased risk of CHD and CVD
  4. Changes in body composition
    • increased fat mass
    • decreased lean body mass
  5. Skin changes
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9
Q

What is the general consensus on menopausal hormone treatment (MHT)?

A

MHT is indicated primarily for the relief of vasomotor symptoms and is not indicated for the prevention of chronic disease

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10
Q

What are the current indications for MHT?

A
  • Younger symptomatic postmenopausal women less than a decade from final menstrual period and without increased risk for CHD and breast cancer
    • Lowest possible effective dose
    • safest route
    • shortest duration for treatment of moderate to severe vasomotor symptoms
    • vaginal dryness
    • osteoporosis prevention and treatment
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11
Q

What are the therapeutic effects of combining CEE with Bazedoxifene?

A
  1. relieves VMS and relieves vaginal atrophy
  2. blocks bone resorption
    • approved for prevention of osteoporosis
  3. BZA provides endometrial protection and an alternative to progestogen therapy for women with a uterus who are averse to vaginal bleeding, breast tenderness, or altered mood.
  4. No additive risk of VTE than CEE or BZA alone
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12
Q

What should be avoided with MHT?

A
  1. Unexplained vaginal bleeding
  2. Stroke
  3. TIA
  4. MI
  5. Breast cancer
  6. Endometrial cancer
  7. Pulmonary emboli
  8. VTE
  9. Acute liver disease
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13
Q

When should you use caution with MHT?

A
  1. Diabetes
  2. Hypertriglyceridemia
  3. Active gall bladder disease
  4. Increased risk of breast cancer
  5. Increased risk of CVD
  6. Migraine with aura
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14
Q

What can be used for isolated GU symptoms?

A
  1. vaginal estrogen
  2. ospemifene
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15
Q

When can vaginal estrogen be used?

A
  • For isolated vaginal symptoms
    • systemic and vaginal estrogens are effective
    • vaginal dryness
    • dyspareunia—given its potent local effect (creams, gels, etc.) and minimal degree of systemic absorption
  • Progestin therapy not required with these very low dose vaginal estrogens
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16
Q

What is **ospemifene **and when is it used?

A

SERM taken orally for atrophic vaginitis and dyspareunia

17
Q

What are non-hormonal alternatives for vasomotor symptoms (VMS)?

A
  1. SSRI/SNRI-paroxetine, venlafaxine, etc
  2. Gabapentin
  3. Clonidine
18
Q

Pearls:

  1. Estrogen has important systemic effects affecting the risk of:
  2. Estrogen is the most effective treatment for _________ _________
  3. Estrogen therapy is safe for:
  4. Unopposed estrogen is contraindicated in ….
  5. MHT or HRT is not advised in ___________ _______ for disease prevention
A
  1. Estrogen has important systemic effects affecting the risk of:
    • cardiovascular disease
    • osteoporosis
    • endometrial and breast cancer
  2. Estrogen is the most effective treatment for vasomotor symptoms
  3. Estrogen therapy is safe for:
    • majority of symptomatic, younger, healthy postmenopausal women
    • short term use for treatment of vasomotor symptoms
    • osteoporosis prevention and treatment
  4. Unopposed estrogen is contraindicated in women with a uterus
  5. MHT or HRT is not advised in asymptomatic women for disease prevention

Reproductive System (35 decks)

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