Menopause Flashcards
definition: menopause
what is it evidenced by?
- permanent cessation of menses after significant decrease of ovarian estrogen production
- evidenced by 12 consecutive months with no menstrual bleeding
definition: perimenopause
period before menopause that is the transition from the reproductive to the nonreproductive years during which ovarian estrogen production may fluctuate unpredictably
definition: climacteric
time period during which the changes of menopause occur
what is the most significant change in perimenopause?
menstrual irregularity
what is the mean age of menopause?
51
how does (heavy) alcohol use affect menopause?
delays it
what are the endocrine transitions during menopause?
- menopausal transition
- progesterone production stops (PMS symptoms disappear)
- androgen production decreases as well as SHBG
during menopausal transition, what happens to the ovarian follicles? what is the effect on estrogen?
- 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
what is the effect of the cessation of progesterone production during menopause?
- 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
what are the signs and symptoms of menopause?
- alteration of menstrual function
- changes in mood / behavior
- vasomotor instability
- urogenital atrophy (loss of collagen, normal pH, lubrication)
menopause is characterized by the lack of menses for how many months?
12
what is the cause of the vasomotor instability during menopause?
changes in NTs and PGs cause sympathetic activation and regional dilation
what is the #1 MORBIDITY in menopausal women?
osteoporosis
what is the best test for osteoporosis?
DEXA
is serum evaluation for bone markers a good indicator of osteoporosis?
no
how does estrogen therapy affect osteoporosis?
estrogen therapy is a potent antiresporptive agent for decreasing osteoclastic activity
what is the #1 MORTALITY in menopausal women?
CVD
how does lack of estrogen during menopause impact risk for CVD?
lack of estrogen causes changes in lipids that predispose to atherosclerosis
- decreased HDL
- increased TGs
- ratio of cholesterol to HDL over 4
what are the treatment options for menopause?
- estrogen therapy (if no uterus)
- combined estrogen and progesterone therapy (with uterus)
- alternatives to hormone therapy
what are the benefits of hormone therapy?
- 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
what are the contraindications for hormone therapy?
- 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
what is the ACOG recommendation for hormone therapy?
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
what are the estrogen side effects of hormone therapy?
- vaginal bleeding
- breast tenderness
- mood changes
- weight gain / water retention
what are the progestin side effects of hormone therapy?
- affective symptoms
- weight gain
what are SERMs? what are their effects on lipids / bone, breast, and uterus?
- selective estrogen receptor modulators
- estrogen like effect on lipids and bone
- estrogen blocking effect on breast
- estrogen effect on uterus varies depending on agent
what are the two SERM agents? what are their effects on the uterus?
tamoxifen - proliferative effect
raloxifen - no proliferation
what are the two general non-estrogen alternatives to hormone therapy? what are the specific agents?
- steroids (progestins, danazol)
- non-steroidal (clonidine, vitamin E, SSRI)
what is the MOA of clonidine in the context of menopausal hormone therapy?
blocks adrenergic activity related to hot flashes
what is premature ovarian failure? what are the causes?
- menopause occurs spontaneously before 40
- secondary to natural causes, chemotherapy, or surgery
