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RGU 1 > Menopause > Flashcards

Menopause Flashcards

1
Q

*** What is menopause?

A
  • 12 consecutive months of amenorrhea, for which there is no other obvious pathologic or physiologic cause.
  • this a normal, natural event, defined as the final menstrual period (FMP).
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2
Q

What hormone changes occur during menopause?

A
  • decrease in estrogen due to lack of ovary production from ceased ovulation (aka there are no more eggs).
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3
Q

*** What symptoms are associated with menopause?

A
  • VULVOVAGINAL ATROPHY (VVA)= dysuria (burning), urgency, dysparuneia, postcoital spotting, and vaginal dryness (hypoestrogenic state that leads to thinning of vaginal epithelium).
  • VASOMOTOR Sx (VMS)= hot flashes (may persist until age 82), night sweats..
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4
Q

How do we treat menopause?

A

estrogen supplement

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5
Q

*** What is the average age of menopause?

A

51

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6
Q

Why does menopause occur?

A

due to programmed loss of ovarian follicles during aging process.

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7
Q

How many eggs are girls born with?

A

millions

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8
Q

*** Will a nulliparous woman (woman who has never given birth) go through menopause earlier or later?

A
  • EARLIER
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9
Q

What are the 3 types of menopause?

A
  1. natural or spontaneous
  2. induced= surgical (bilateral oopherectomy/BSO), chemotherapy, or radiation therapy.
  3. premature= less than 40 y/o natural or induced.
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10
Q

Why don’t we take out the ovaries with surgeries (even in postmenopausal women) anymore?

A

because it increases the risk of heart disease

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11
Q

What can cause premature ovarian insufficiency?

A
  • idiopathic
  • autoimmune
  • turner’s syndrome
  • Fragile X syndrome (FMR1)
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12
Q

How do we diagnose premature ovarian insufficiency?

A
  • FSH greater than 40 mIU/mL 2 times a month apart.
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13
Q

Does family hx of early menopause confer higher risk of early menopause?

A

YES

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14
Q

What does smoking do to age of menopause?

A

reduces age of menopause by 2 years

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15
Q

What is perimenopause?

A
  • around menopause time period. Begins in transition period (stage -2) and ends at 12 months of amenorrhea (stage +1)
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16
Q

*** What happens during perimenopause?

A
  • decreased number of follicles.
  • decreased production of inhibin B
  • INCREASED FSH (but remaining follicles respond poorly to it).
  • erratic ovulation= irregular menstrual cycle and heavy bleeding (menorrhagia).
  • hot flashes
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17
Q

Do you still need contraception during perimenopause?

A

YES

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18
Q

What is postmenopause?

A
  • Stage +1= first 5 years after the final menstrual period, and includes further ovarian function dampening, hot flashes and accelerating bone loss.
  • stage +2 begins at 5 years after LMP and ends with death.
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19
Q

What does chronic anovulation + progesterone deficiency lead to?

A
  • endometrial hyperplasia
20
Q

What is the standard of surveillance for endometrial cancer?

A
  • endometrial biopsy

* However, if transvaginal ultrasound shows stripe less than 4 mm, deferring biopsy is acceptable.

21
Q

What happens to the pH of the vagina with menopause?

A
  • increased to 6-7.5 from normal range of 4-4.5.
22
Q

What are the urinary symptoms of menopause?

A
  • atrophic urethritis
  • diminished urethral mucosal seal.
  • loss of urethral compliance.
  • urethral irritation
  • all predispose to stress and urge urinary incontinence.
23
Q

Despite all the bad things of menopause, what is good about it?

A

hypoestrogenism=

  • fibroids (leiomyomas) will decrease in size and symptoms.
  • adenomyosis symptoms will decrease.
  • endometriosis symptoms will decrease.
24
Q

What will menopause (hypoestrogenism) do to sexual function?

A
  • decrease genital blood flow and thus decreased lubrication.
  • reduced clitoral sensation and/or dyspareunia.
  • cervical atrophy and vaginal narrowing.
25
Q

Are changes in sexual function due to menopause reversible with estrogen therapy?

A

YES!

26
Q

Is there a strong relationship between menopause and depression?

A

YES

27
Q

Do women in early menopause have more mood symptoms than those not in early menopause?

A

YES

28
Q

What causes breast pain during early menopause?

A

glandular decreases in breast tissue that is replaced with fatty tissue.

29
Q

What skin changes will occur with menopause?

A
  • collagen is reduced by estrogen deficiency, leading to wrinkles.
30
Q

Will women get join pain with menopause transition?

A

YES

31
Q

What bone changes occur with the transition to menopause?

A

accelerates in stage +1: you go to osteopenia and then to osteoporosis.
*combat with 1200 mg/day of calcium and 800 IU/day of vitamin D supplements.

32
Q

What should you have done at age 65 or younger to evaluate bone density?

A

DEXA scan

*Dr. Monzo suggests right at menopause.

33
Q

What medications will help with severe bone loss?

A
  • Raloxifene, bisphosphonates, calcitonin, estrogen, PTH…
34
Q

Why does dementia occur with menopause?

A
  • estrogen protects neurons from toxicity and estrogen receptors are found densely within the basal forebrain (relative to cognitive function).
35
Q

*** What did the Women’s Health Initiative (WHI) tell us?

A

controversial RCT that forever changed OB/GYN and women’s health care by taking nearly all women off of HRT (hormone replacement therapy). The study had to be stopped prematurely due to increase in CHD and breast cancer in those women taking HRT.

36
Q

What is the best approach to diagnosing menopause?

A
  • menstrual cycle journal or through history
37
Q

What are some DDx you must consider with possible menopause?

A
  • hyperthyroidism= irregular menses, sweating, and mood changes.
  • pregnancy, hyperprolactinemia
  • medication side effect
  • carcinoid, pheochromocytoma, malignancy
38
Q

What lifestyle changes can we have menopausal women do to decrease their vasomotor symptoms?

A
  • reduce core body temp
  • exercise
  • weight management
  • smoking cessation
  • avoid known triggers
39
Q

What treatments can we provide for women with moderate to severe vasomotor symptoms (hot flashes and night sweats)?

A
  • estrogen therapy is most effective

* local estrogen cream is recommended to treat vulvovaginal atrophy (less systemic absorption).

40
Q

If we are going to start hormonal treatment for menopause symptoms, when should we start it?

A
  • soon after menopause.

* remember, oral HRT will increase your risk for VTE, CHD, and breast cancer.

41
Q

If a woman doesn’t have her uterus, does she need progesterone?

A

NO, because there is nothing there for it to help.

42
Q

Should you give a woman who would benefit from HRT progestogen if she has her uterus?

A

YES, otherwise you are placing them at risk for endometrial hyperplasia and cancer.

43
Q

What are bio-identical hormones?

A
  • Bio-identical is just the marketing term for hormones that are structurally similar to endogenous hormones.
  • main point is they are NOT FDA APPROVED, and therefore we don’t really know what is in them. Many docs use this, and you can, just make sure the pts are aware that what’s in that bottle is unknown and we don’t know what risks may come with it.
44
Q

If a woman starts HT, what can she expect if she stops it?

A
  • symptoms may return
45
Q

What are some off-label uses for VMS?

A
  • SSRI, SNRI, clonidine, or gabapentin
46
Q

What are some complementary alternative medicines for VMS?

A
  • Yoga
  • paced respiration
  • acupuncture
  • Black cohosh (BEST for Hot flashes)
  • isoflavones

RGU 1 (17 decks)

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