Menopause

Question 1

Define premature menopause

Answer 1

Final menstrual period before age 40

Question 2

Duration of menopausal transition

Answer 2

• 1-3 years (but variable)
• Overlaps with late reproductive stage
• Extends to 12 months after menopause

Question 3

Pathophys of menopausal transition

Answer 3

• Decline in quantity and quality of follicles

- Decline in serum inhibin B and estrogen

Question 4

Perimenopause clinical presentation

Answer 4

• Hot flashes
• Irregular menses
• Vaginal dryness

Question 5

What is the only risk factor a/w early menopause?

Answer 5

Smoking

Question 6

When is menopause officially diagnosed?

Answer 6

After 12 months of amenorrhea

Question 7

Physical changes of reproductive tract in menopause

Answer 7

• Atrophy
• Vaginal wall becomes smooth
• Endometriosis/adenomyosis resolves (if present)

Question 8

Physical changes of urinary tract in menopause

Answer 8

• Atrophic changes of lining of bladder and urethra

- May lead to atrophic cystitis

Question 9

What is atrophic vaginitis?

Answer 9

• Atrophy of epithelium w/decreased blood supply
• A/w menopause
• Tx with moisturizers, lubricants, Vit E oil, estrogen vaginal creams or ring

Question 10

Role of HRT in preventing CV disease after menopause?

Answer 10

No longer recommended - more risks than benefits

Question 11

When is HRT indicated after menopause?

Answer 11

• Prevention of osteoporosis
• Treatment of vasomotor symptoms
• Treatment of vulvovaginal atrophy

Question 12

Relationship between HRT and breast cancer

Answer 12

HRT increases risk of breast cancer after at least 5 years of continuous therapy

Question 13

What is the effect of estrogen alone in postmenopausal women with an intact uterus?

Answer 13

Increases risk of endometrial cancer

Question 14

Hormonal changes in menopause

Answer 14

• Decreased progesterone and estradiol

- Increased LH/FSH