Menopause Flashcards
What is Menopause? Perimenopause?
Cease in Estrogen production of ovaries. Evid. by 12 consecutive months with no period.
Peri: Estro fluctuates unpredictably before Meno.
What is climacteric
Period of time during transition into menopause.
WHat happens to FSH during menopause?
FSH increases to try and stimulate Estrogen production
What happens to Progesterone in menopause? Effects?
Decreases => PMS symptoms dissappear
What are the signs and symptoms of menopause?
Alterations in menstrual flow Changes in mood and behavior -Depression -Anxiety and irritability -Loss of Libido Vasomotor Instability -Hot flashes and Night Sweats Dec in REM sleep Change in serotonin Change in ST memory Urogenital Atrophy -Dec Estrogen, loss of collagen, normal pH, Lubrication
What are the long term effects of Menopause?
OSTEOPOROSIS (#1 Morb)
Card Vasc Dis (#1 Mort)
What test is noe to assess for bone density?
DEXA Scan
When should you screen for bone density before the age of 65?
Hx of fragility fractures (or FHx)
BW
What are the Tx options for Menopause?
Estrogen therapy (no Uterus)
Estrogen + Progest (w/ Uterus)
Alt to Hormone therapy
What are the risks of Standard HRT?
Endometrial Hyperplasia Breast Cancer HTN Stroke and MI Venous Thrombosis
What are the benefits of Hormone Therapy?
Relief ot vasomotor symptoms Impr. of mood and Well being Imp of urogenital atrophy Imp of Osteoporosis/Hip Frac Dec in Colon cancer Imp in dental health
What are the contraindications of HT?
Br CA in last 5 yrs Est dependent neoplasm UVB Thrombo disease Active liver disease Preggo
What are ACOG recc for HT?
Short term relief of menopausal symptoms
What are the routes of HT?
Estrogen: Oral, TransD, IM, TV
Combined: Oral, TD, Combo
What are the SE of Estrogen?
Bleeding
Br Tenderness
Mood Changes
Wt Gain/Water retension
What are the SE of Progestin?
Depression
Wt gain
What are strategies for coping with symptoms?
Good diet with Ca++ Wt Loss Avoid Ca++, EtOH, tobacco Wt bearing exercise (30 min 3x per week) Stress reduction
What are the benefits of SERMs?
Est effects on lipids and bone
Est Blocking on Breast
Tamoxifen- Prolif effect on uterus
Raltoxifen- No prolif on uterus
What are the non-estrogen Alternatives?
Steroids: Progestins Non-steroidal: Clonidine- Dec adr activity (HF) Vit E SSRI Acupuncture: HF Natural Remedies: -Phytoestrogens have same benefits and risks as estrogen
What is Premature ovarian failure?
Menopause occurs spontaneously before 40 years of age
