Menopause Flashcards
Menopause:
- definition
- median age
- pathophys
- types
- time of menopause influenced by what?
Definition:
-permanent cessation of menses for 12months and indefinitely.
Median age: 51YO
Pathophys: depletion of ovarian follicles manifested by low estrogen production, elevated FSH and loss of natural reproductive ability
*ovaries continue to make testosterone
Types:
- surgical
- natural
- premature ovarian insufficiency (menopause before age 40)
Influenced by genetics and smoking.
what is perimenopause? sx
Perimenopause = menopausal transition of about 4 years beginning around age 47
Sx: wide fluctuations of estrogen which leads to hot flushes, decreased ovulation, and irregular menses
Menopause:
-signs and sx
- hot flashes or night sweats that last 2-4minutes sometimes followed by chills
- represents thermoregulatory dysfunction at hypothalamus
- BMI influences the severity of sx, those who have lower BMI tend to have more dramatic sx.
- palpitations
- mood and memory changes
- decreased skin thickness and elasticity
- increased facial hair
- osteoporosis
- sleep disturbances
- lipid changes: decreased HDL and increased LDL
- urogenital atrophy: –vaginal dryness leading to dyspareunia
- -atrophic urethritis causing dysuria and frequency
- -loss of pelvic organ support and increased prolapse
Menopause:
-dx
Dx:
- women greater than 45YO:
- -menstrual hx w/ or w/o menopausal sx
- women 40-45:
- -menstrual hx but also get lab to r/o other explanations for menstrual changes: TSH, prolactin, and hCG
-women with hysterectomy/endometrial ablation
Menopause Tx of Hot flashes
SSRI and SNRIs
- venlafazine (Effexor/SNRI)
- Paroxetine (Paxil)
- Fluoxetine (prozac)
Gabapentin (for predominantly night sx)
Cetirizine (Zyrtec)
Clonidine
Estrogen** (pills, transdermal, intravaginal)
NOTHING WORKS AS WELL AS ESTROGEN!
Menopause Hormone Therapy:
- benefits of estrogen
- effects of PO estrogen on liver
- time to effects of estrogen
Benefits:
- control vasomotor sx (hot flashes)
- relief fro urogenital atrophy sx
- maintain bone density
- may be topical for less systemic effects. Its safer (avoids first pass though liver=lower risk of VTE and stoke, less stimulation of clotting proteins)
Liver: PO estrogen INCREASES production of: -TBG (pt may need increased dose of synthroid) -CBG (cortisol binding globulin) -SHBG (less free testosterone -Triglycerides -HDL -clotting factors
Time to effect: 4-6wks
Menopause Hormone Therapy:
-examples of progestins
medroxyprogesterone acetate (MPA)
micronized oral progesterone* (Prometrium)
Levonorgestrel (Mirena or Skylar)
Estrogen has anti-inflammatory effect if you continue estrogen from premenopause throughout menopause. If you havent had estrogen during this time period and then take MHT it has inflammatory effect.
True.
Why does a woman with a uterus using estrogen need to also use progestin?
To protect endometrium from unopposed estrogen which increases risk of hyperplasia and cancer
When is endometrial sampling indicated?
- before starting therapy in a woman with irregular bleeding
- any woman on continuous therapy who spots or bleeds after 6 months
- bleeding or spotting after a year of amenorrhea in woman not on hormones
- endometrial hyperplasia or CA can occur within 6 months of starting unopposed estrogen
