Menopause

Question 1

Natural Menopause

Answer 1

permanent cessation of menstrual periods, determined RETROSPECTIVELY, after a woman has experienced 12 months of amenorrhea with out any pathological or physiological cause

Question 2

Median age of menopause

Answer 2

51.4

Question 3

Ovarian follicular depletion results in this during menopause

Answer 3

HYPOestrogenemia and HIGH follicle stimulating hormone (FSH) concentrations

Question 4

Primary ovarian insufficiency

Answer 4

menopause before age 40, also called premature ovarian failure- considered to be abnormal

Question 5

Perimenopause - when and what are the s/s

Answer 5

after the reproductive years but before menopause usually 4 years before the last menstrual period – characterized by irregular menstrual cycles, endocrine changes and hot flashes, sleep disturbances, mood symptoms, vaginal dryness, and changes in lipids and bone loss

Question 6

Most common menopausal symptom

Answer 6

hot flashes seen in up to 80 percent of women

Question 7

Late reproductive years s/s

Answer 7

serum inhibin B decreases, FSH increases slightly, estradiol is preserved, luteal phase progesterone declines as fertility potential declines. follicular phase before ovulation SHORTENS. Typically in their 40s.

Question 8

Perimenopause s/s and age of onset

Answer 8

ovarian follicular depletions leads to a change in intermentrual interval (lengthened) cycle usually 25-35 days between but now 40-50 days. and a change in bleeding pattern, and hormonal s/s. Usually age 47. FSH > 25 but will fluctuate

Question 9

Late transition

Answer 9

one to three years before the final menstrual period, lengthened intermentrual interval with skipped cycles, amenorrhea episodes, and an increased in anovulatory cycles

Question 10

the more irregular the cycle the more dramatic fluctuation in

Answer 10

FSH and estradiol, may be high FSH with menopause but then a return to normal premenopausal range

Question 11

Increase risk of what during the year leading to the final menstrual period

Answer 11

accelerated bone loss, cardiovascular risk. With 3 months of amenorrhea can expect their FMP within the next 4 years.

Question 12

Hallmark s/s of perimenopause and menopause

Answer 12

hot flash, also a/w new onset depression, vaginal dryness and sleep disturbances

Question 13

Hot flashes sensation

Answer 13

heat on the upper chest and face, rapidly becoming generalized 2-4 mins with profuse sweating, palpitations, anxiety. can have one per hour each day, very common at night. untreated stop within 4-5 years of onset.

Question 14

Sleep disturbances

Answer 14

arousal from sleep from hot flashes

Question 15

Anxiety/depression

Answer 15

can lead to sleep disturbances as well. can also have restless leg or sleep apnea.

Question 16

Depression risk

Answer 16

significant increase risk of new onset depression during menopausal transition. perimenopausal 2.5x more likely than premenopause – estrogen therapy to treat

Question 17

Vaginal dryness

Answer 17

epithelium of vaginal walls is estrogen dependent and deficiency leads to thinning and dryness – vaginal atrophy, on exam vagina will appear pale. can be itchy and women often experience dysparenia

Question 18

Sexual function

Answer 18

estrogen deficiency leads to decrease in blood flow to the vagina and vulva, leads to decrease vaginal lubrication and sexual dysfunction, vagina may lose elasticity and become shorter – responds to estrogen therapy, also cervix can atrophy and become flush with the top of the vaginal vault

Question 19

Cognitive changes

Answer 19

memory loss, difficulty concentrating, estrogen beneficial in cognitive function

Question 20

caution

Answer 20

not totally protected from pregnancy until amenorrhea for >12 mos or CONSISTENTLY elevated FSH >30

Question 21

not all hot flashes are from estrogen deficiency- other differentials?

Answer 21

pheochromocytoma (worst it could be)
leukemia’s
thyroid malfunction
psychosocial symptoms

Question 22

first measurable sign of reproductive ageing

Answer 22

FSH elevation >10 IU/L in early follicular stage (days 2- 5 of the mentrual cycle)

Question 23

most follicular loss results from what?

Answer 23

atresia, NOT ovulation

Question 24

climacteric

Answer 24

phase in a women’s aging process marking the transition from reproductive to non reproductive states, is a process, not a point in time

Question 25

vasomotor symptoms

Answer 25

aka hot flashes, hallmark sx of perimenopause/ climacteric, worse at night, interrupts sleep. can continue even in post- menopause

Question 26

making the definitive diagnosis of menopause

Answer 26

no ONE test, woman has reached menopause when FSH are consistently >30 (caveat- levels often inconsistent for a temporary span of time)

Question 27

if dx of menopause is not clear..

Answer 27

Rule out other DD