Menopause Flashcards
What is perimenopause?
the time before, during and after menopause
What percent will have irregular menses for about 4 yeas?
90%
10% will just have an abrupt cessation of menses
WHen is menopause?
When they haven’t had menses for at least 1 year, with signs of hypoestrogenemia and FSH over 40
What is the median age?
51
When is it considered premature?
before age 40 (only 1%)
What are the concerns in the postmenopausal period?
hormone replacement osteoporosis CVD sexual fuction uterovaginal prolapse skin issues mood hot flashes vaginal atrophy incontinence
Ovaries stop producing follicles, so what hormones decrease?
inhibin, leads to FSH rise
eventually estradiol level decreases
What happens in response to the estradiol level decline?
endometrial development fails, so they ahve absence of menses
After menopause, where does the estrogen come from?
aromatization of androgens in the periphery - muscle and adipose
Progesterone production ceases, which increases risk for what?
endometrial cancer
Androgen production decreases from both the ovaries and adrenals. What is the effect of this?
maybe decrease libido
Why do we prefer to leave the ovaries in?
estrogen is heart protective
What happens to body mass?
weight and total body fat increase
increase in waist;hip ratio
Does hormone replacement therapy cause weight gain in and of itself?
no
What happens to the skin?
cdecreased collagen - thinning sin, tooth loss, atrophic vaginitis with poor uterovaginal support
What are the issues with poor uterovaginal support?
cystocele (bladder into vagina)
rectocele (rectum into vagina)
enterocele (cervix removed)
uterine prolapse
What are the urinary issues
incontinence, dysuria, frequency
What hormone are hot flashes related to?
directly related to estrogen levels (and indirectly to GnRH pulses from the hypohtalamus)
How long do hot flashes typically last?
30/day for 1-5 minutes
(5-10 per day is the average)
usually for 2-3 years, uncommon more than 5 years
WHat are some other general symptoms of menopause?
depression, anxiety, irritability, fatigue, insomnia, loss of libido, headaches, amenorrhea
What do you need to rule out with the menstrual irregularity here?
rule out pregnancy if they’re under 50
endometrial cancer
endometrial hyperplasia polyps cervical cancer fibroids adenomyosis
What are the general treatments for abnormal uterine bleeding?
medical with cyclic hormone replacement or OCPs
hysteroscopy/EM ablation/D&C
Hysterectomy
or none if the woman is fine with abnormal bleeding after ruliing scary stuff out
post-menopause bone density decreases by about hat percent per year?
1-2% per year (esp in whites and asians)
At age 60, what percent will have spinal compression fractures?
25%
At age 80, what percent will ahve a hip fx?
20%
After a hip fx, 15% die in how long?
6 months
What’s treatment fo rosteoporosis?
HRT bisphosphonates calcitonin SERMs calcium vitamin D
What are the indications for HRT?
hot flashes
vaginal atrophy
osteoporosis
osteopenia
What are the contraindications for HRT?
pregnancy
undiagnosedvaginal bleeding
active VTE
current gallbladder disease
liver disease
unopposed estrogen replacement if they still have a uterus
CVD - will increase risk for subsequent event
What are the relative contraindications for HRT?
history of breast cancer
history of VTE
What are the side effects of HRT?
vaginal bleeding
breast tenderness
mood changes
HOw can we give HRT?
orally, transdermally, parenteral, vaginal
What are the options for the hormone?
estrogen with progesterone (need both if they still have a uterus)
estrogen with metyltestosterone (more common in younger women who had their ovaries out and estrogen alone didn’t work)
estrogen alone
progesterone
What did the women’s health initiative part 1 find?
women with a uterus needing combined HRT (prempro)
after 4 years, saw an increase risk of breast cancer, CV disease, stroke, and VTE. 1/1000 women. but still NO increased mortality from all cause.
but it actually decreased colon cancer and hip fracture
What did the WHI Part 2 find?
women WITHOUT a uterus using ERT - premarin
went for 7 years
increased risk for embolic stroke 1/1000
VTE risk 1/500 (which is lower than BC and pregnancy)
still no increased mortality from all cause
no new heart disease
didn’t help colon cancer or hip fracture
actually decreased breast cancer but not statistically significant
