Menopause

Question 1

definition: menopause

what is it evidenced by?

Answer 1

• permanent cessation of menses after significant decrease of ovarian estrogen production
• evidenced by 12 consecutive months with no menstrual bleeding

Question 2

definition: perimenopause

Answer 2

period before menopause that is the transition from the reproductive to the nonreproductive years during which ovarian estrogen production may fluctuate unpredictably

Question 3

definition: climacteric

Answer 3

time period during which the changes of menopause occur

Question 4

what is the most significant change in perimenopause?

Answer 4

menstrual irregularity

Question 5

what is the mean age of menopause?

Answer 5

51

Question 6

how does (heavy) alcohol use affect menopause?

Answer 6

delays it

Question 7

what are the endocrine transitions during menopause?

Answer 7

• menopausal transition
• progesterone production stops (PMS symptoms disappear)
• androgen production decreases as well as SHBG

Question 8

during menopausal transition, what happens to the ovarian follicles? what is the effect on estrogen?

Answer 8

• become resistant to FSH stimulation

- estrogen secretion falls, but there is still a lot in the periphery due to conversion in muscle and adipose tissue

Question 9

what is the effect of the cessation of progesterone production during menopause?

Answer 9

• normally progesterone production protects the endometrium from hyperstimulation
• lack of progesterone in association with circulating levels of estrogen may increase a woman’s risk of endometrial hyperplasia

Question 10

what are the signs and symptoms of menopause?

Answer 10

• alteration of menstrual function
• changes in mood / behavior
• vasomotor instability
• urogenital atrophy (loss of collagen, normal pH, lubrication)

Question 11

menopause is characterized by the lack of menses for how many months?

Answer 11

12

Question 12

what is the cause of the vasomotor instability during menopause?

Answer 12

changes in NTs and PGs cause sympathetic activation and regional dilation

Question 13

what is the #1 MORBIDITY in menopausal women?

Answer 13

osteoporosis

Question 14

what is the best test for osteoporosis?

Answer 14

DEXA

Question 15

is serum evaluation for bone markers a good indicator of osteoporosis?

Answer 15

no

Question 16

how does estrogen therapy affect osteoporosis?

Answer 16

estrogen therapy is a potent antiresporptive agent for decreasing osteoclastic activity

Question 17

what is the #1 MORTALITY in menopausal women?

Answer 17

CVD

Question 18

how does lack of estrogen during menopause impact risk for CVD?

Answer 18

lack of estrogen causes changes in lipids that predispose to atherosclerosis

• decreased HDL
• increased TGs
• ratio of cholesterol to HDL over 4

Question 19

what are the treatment options for menopause?

Answer 19

• estrogen therapy (if no uterus)
• combined estrogen and progesterone therapy (with uterus)
• alternatives to hormone therapy

Question 20

what are the benefits of hormone therapy?

Answer 20

• relief of vasomotor symptoms
• improvement in mood and well being
• improvement in urogenital atrophy
• prevention and treatment of osteoporosis / hip fractures
• decrease in colon cancer
• improvement in dental health

Question 21

what are the contraindications for hormone therapy?

Answer 21

• breast cancer within 5 years
• estrogen dependent neoplasm
• undiagnosed vaginal bleeding
• active, recent, or history of hormone related thromboembolic disease
• active liver disease or liver dysfunction
• known or suspected pregnancy
• hypersensitivity to hormone therapy preparations

Question 22

what is the ACOG recommendation for hormone therapy?

Answer 22

should be used for short term (5 years) relief of menopausal symptoms of hot flashes, night sweats, vaginal dryness, and should by individually tailored to a woman’s need for treatment

Question 23

what are the estrogen side effects of hormone therapy?

Answer 23

• vaginal bleeding
• breast tenderness
• mood changes
• weight gain / water retention

Question 24

what are the progestin side effects of hormone therapy?

Answer 24

• affective symptoms

- weight gain

Question 25

what are SERMs? what are their effects on lipids / bone, breast, and uterus?

Answer 25

• selective estrogen receptor modulators
• estrogen like effect on lipids and bone
• estrogen blocking effect on breast
• estrogen effect on uterus varies depending on agent

Question 26

what are the two SERM agents? what are their effects on the uterus?

Answer 26

tamoxifen - proliferative effect

raloxifen - no proliferation

Question 27

what are the two general non-estrogen alternatives to hormone therapy? what are the specific agents?

Answer 27

• steroids (progestins, danazol)

- non-steroidal (clonidine, vitamin E, SSRI)

Question 28

what is the MOA of clonidine in the context of menopausal hormone therapy?

Answer 28

blocks adrenergic activity related to hot flashes

Question 29

what is premature ovarian failure? what are the causes?

Answer 29

• menopause occurs spontaneously before 40

- secondary to natural causes, chemotherapy, or surgery