Menopause

Question 1

What is Menopause defined as?

Answer 1

One yr without menses. Happens most often at age 51

Question 2

What is perimenopause?

Answer 2

The onset of symptoms around menopause onset, typically between the ages of 45-55.

Question 3

T or F. Hot flashes typically occur before periods cease

Answer 3

T.

Question 4

Question 5

The end of reproductive life is around age ____

Answer 5

43. After this time, ovaries continue to produce eggs sporadically, but they are abnormal and estrogen is produced in lower amounts

Question 6

What is the effect of less amounts of estrogen being produced during the perimenopause phase?

Answer 6

FSH rises due to a lack of negative feedback and menses become less frequent and lighter (the FSH during menopause is 30+)

Question 7

What diseases increase after menopause?

Answer 7

increased risk of heart disease and osteoporosis due to loss of estrogen

Question 8

What are the symptoms of menopause?

Answer 8

Hot flashes are most common probably due to gonadotropin spikes as much as estrogen deficiency (This may occur as a perimenopausal symptom)

Skin changes/vasodilation

Question 9

Question 10

Menopausal symptoms are most common in what races?

Answer 10

Question 11

What are the indications for HT in postmenopausal women?

Answer 11

Treatment of moderate-to-severe vasomotor symptoms associated with menopause

Treatment of vulvar and vaginal atrophy*

Prevention of postmenopausal osteoporosis (The FDA encourages the consideration of non-estrogen medications when HT is prescribed solely for the prevention of postmenopausal osteoporosis)

Question 12

Question 13

Why would the tx of menopausal sympotms be different in a women who has had a hysterectomy vs one that has a uterus still?

Answer 13

Women with a uterus should be given progestin as well to prevent the risk of endometrial cancer from unopposed estrogen

Question 14

Question 15

The FDA suggests that topical vaginal products should be considered when prescribing HT solely for the treatment of symptoms of ________

Answer 15

vulvar and vaginal atrophy. So when this is the only symptom, go with low doses of vaginal estrogen. Dont give systemic estrogen and there is no need for progestins

Question 16

What are other symptoms of menopause?

Answer 16

•Vaginal atrophy/dryness/thin- late effect after hot flashes and usually only occur after the pt. has been deprived of estrogen for a while,

but can be treated with estrogens, vaginal or systemic

Question 17

What are some other symptoms common in postmenopausal women not associated with menopause?

Answer 17

• Depression
• Lack of interest in sex
• Going crazy

Question 18

Answer 18

Overall, the study found that:

34% of women had evidence of vaginal atrophy

Vaginal atrophy was related to menopausal age (P < .001)

40% of sexually active women reported dyspareunia—2/3 superficial, 1/3 deep (bar graph shows superficial dyspareunia)

Dyspareunia correlated with advancing menopausal age (P < .02)

Question 19

Osteoporosis in post-menopausal women is a major source of morbidity and mortality. What are the risk factors?

Answer 19

• Caucasian/Asian
• Thin
• Smoker or Alcohol Use
• Steroid Use
• Family Hx

Question 20

T or F. Estrogen therapy is approved for prevention of osteoporosis, not treatment

Answer 20

T. Even low doses prevent osteoporsis. After the diagnosis of osteoporosis is made, need to go to bisphosphonates

Question 21

T or F. Postmenpausal estrogen prevents heart disease

Answer 21

T. BUT if you already have heart disease, being placed on estrogen actually raises the risk of heart attack

Want to start estrogen within 10 yrs of menopause to lower risk of heart disease

Question 22

Answer 22

Question 23

Question 24

Answer 24

Question 25

So it might just be EPT therapy (and progestin specifically) that raises the risk

Question 26