Menopause

Question 1

what is the definition of menopause?

Answer 1

the permanent cessation of menstruation due to loss of ovarian follicles - 12 months of amenorrhea

Question 2

what is menstural transition?

Answer 2

the period of time where there is changes in menstrual pattern leading up to the menopause

Question 3

what is perimenopause?

Answer 3

changes in ovarian function 2-8 years preceding the menopause

Question 4

what is the threshold for premature ovarial function?

Answer 4

under 40 yo

Question 5

what is the effect of decreased oestrogen?

Answer 5

disturbed sleep and vasomotor hot flushes

irregular cycles - periods of amenorrhea

Question 6

why does decreased oestrogen cause amennorhea?

Answer 6

decrease in follicle number means decreased oestrogen –> therefore the endometrium does not build up

Question 7

how to treat the dry vagina symptom of the menopause?

Answer 7

oestrogen creams

Question 8

why is there impaired fertility in the menopause?

Answer 8

decease in follicle number increase in chromosome abnormalities - particularly anuplody
increased chance of miscarrige
impaired secretion of growth factors

Question 9

what is the pattern for decreased follicle number with age?

Answer 9

slow decline between 30 and 40
rapid decline from age 40
increase in apoptosis

Question 10

what is the mechanism for follicle death?

Answer 10

decreased AMH

increased FSH

Question 11

what is the mechanism for vasomotor hot flushes?

Answer 11

reseting of the thermoregulatory nucleus

decrease in seratonin

Question 12

what are the roles of inhibin A and B in menopause?

Answer 12

follicular phase length decreases
causing a decrease in inhibin B
there is an increase in FSH but a decrease in FSHr - so there is no LH surge great enough to increase GnRH - there is impaired recruitment of the dominant follicle - there is no ovulation

Question 13

what is the cause of heavy periods in the menopause?

Answer 13

prologued exposure to oestrogen as there is no selection of the dominant follicle - leads to thickening of the endometrium and heavy and irregular periods

Question 14

what is the action of HRT?

Answer 14

increased oestrogen to decrease hot flushes
prevention of heart disease
treatment of osteoporosis

Question 15

what are the risks of HRT?

Answer 15

Ca Breast
PE
Ischemic heart disease and CVA
increased risk of thromboembolic events - works if there are previous risk factors

Question 16

why is the information surrounding HRT biased?

Answer 16

the statistics are not fully significant due to cohort bias

Question 17

what must oestrogen be given with?

Answer 17

progesterone - in order to protect the uterus - as there is over proliferation with oestrogen - increased chance of Ca

Question 18

what are some alternative treatment options for the menopause?

Answer 18

gabapentin
SSRI
clodine
soy extract
black colush

Question 19

why may SSRIs be used in menopause treatment?

Answer 19

they do not have a thromboembolic risk - so are good for patients with high risk factors

Question 20

what is the treatment for premature menopause?

Answer 20

no risks - give oestrogen with POP IUD

as they have the lowest thromboembolic risk

Question 21

what is the meaning behind the bad press of HRT?

Answer 21

lack of clarity of symptoms
misconception that menopause is due to a single hormone deficiency
over reliance n short studies
no long term data was required 
drug reps over selling the product
bad press