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RGU Exam 1 > Menopause > Flashcards

Menopause Flashcards

1
Q

Menopause

A
  • Cessation of menses for 12 months; with no obvious pathologic or physiologic cause
  • Diagnosed retroactively
  • Avg. age is 51.4
  • Occurs due to programmed loss of ovarian follicles during aging process
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2
Q

Menopause NAMS Definition

A
  • Menopause is a normal, natural event defined as the final menstrual period (FMP)
  • It represents the permanent cessation of menstruation resulting from loss of ovarian follicular function usually due to aging
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3
Q

Cause of Menopause

A
  • Aging of female reproductive tract is a continuum that begins at birth
  • Loss of oocytes from atresia does not occur at steady rate (increases at 37)
  • Reflective of nearly complete depletion of ovarian follicles, and near cessation of ovarian estrogen production
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4
Q

Types of Menopause

A
  • Natural or spontaneous (12 consecutive months of amenorrhea)
  • Induced:

*surgical (B/L oopherectomy/BSO)

*chemo

*radiation therapy

  • Premature: <40 y/o natural or induced
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5
Q

Premature Ovarian Insufficiency

A
  • Loss of ovarian function <40 y/o resulting in amenorrhea (usually permanent)
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6
Q

Premature Ovarian Insufficiency Cause

A
  • Etiology:

*idiopathic

*autoimmune

*turner’s syndrome

*fragile X syndrome (FMR1)

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7
Q

Premature Ovarian Insufficiency Diagnosis

A
  • FSH>40 mIU/ML (x2 a month apart)
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8
Q

Age of Menopause

A
  • Avg: 51.4
  • Late: >55
  • Early: 40-45
  • Premature ovarian faiure and deserves workup: <40
  • Genetics, ethnicity, smoking and reproductive history all play a role
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9
Q

Genetic variants affecting age of menopause

A
  • BRSK1, MCM8
  • Variations in estrogen receptor gene
  • Family history of early menopause confers higher risk
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10
Q

Factors that result in earlier menopause

A
  • Genetics
  • Earlier in hispanics, later in japanese americans compared to caucasian americans
  • Smoking reduces age of menopause by 2 years
  • Nulliparas (no kids) will tend toward earlier menopause
  • Galactose consumption, DM1, DES exposure may also cause earlier menopause
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11
Q

Perimenopause

A
  • Occuring right before menopause
  • Decreased # of follicles
  • Decreased production of inhibin B
  • Increased production FSH
  • Remaining follicles response poorly to FSH
  • Shorter follicular phase
  • Estradiol variable
  • Decrease luteal phase progesterone
  • Erratic ovulation results in menstrual cycle irregularity
  • Hot flashes
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12
Q

Perimenopausal Treatment

A
  • Low-dose OCPs, if not contraindicated
  • Higher dose hormone than menopausal HT
  • Stop OCPs early 50’s
  • FSH unreliable
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13
Q

Menopausal Transition

A
  • Elevated FSH
  • Variable cycle lengths
  • Progresses to skipped cycles. At least 2 skipped cycles and at least 60 days of amenorrhea, +/- hot flashes
  • Ends w/ final menstrual cycle (cannot be recognized until 12 months later)
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14
Q

Postmenopause

A
  • First 5 years after the final menstrual period, and includes further ovarian function dampening, hot flashes and accelerating bone loss
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15
Q

Chronic anovulation + progesterone deficiency results in?

A
  • Endometrial hyperplasia
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16
Q

Endometrial biopsy

A
  • Standard surveillance when women present w/ abnormal bleeding regardless of whether you think they’re just going through perimenopause
17
Q

Heavy or irregular bleeding treatment

A
  • After ruling out cancer w/ biopsy can treat w/ low dose OCP or intermittent progestins
18
Q

2 major symptoms of menopause

A
  • Vasomotor (VMS)

*hot flashes (mild, moderate, severe)

*night sweats

  • Vulvovaginal atrophy (VVA)

*genitourinary symptoms; vaginal dryness, etc.

19
Q

Menopausal Vasomotor Symptoms

A

Hot Flashes

  • Very common; 75% of women
  • Usually limited to 1-5 years duration, but some may persist beyond age 70
  • Last 2-4 min. ea. w/ sweating, palpitations and anxiety; occur mostly during the night, up to several times in 24hrs
  • Exact cause is unknown
20
Q

Menopausal vulvovaginal symptoms

A
  • Vaginal Dryness

*Hypestrogenic state leads to thinning of vaginal epithelium, itching, dyspareunia

  • Pale mucosa w/ loss of rugae, pH increased to 6.0-7.5 from normal of 4.0-4.5
  • Dysuria
  • Urgency
  • Dyspareuenia
21
Q

Urinary symptoms of menopause

A
  • Hpoestrogenism results in atrophy of the urethral epithelium
  • Atrophic urethritis
  • Diminished urethral mucosal seal
  • Loss of urethral compliance
  • Urethral irritation
  • UTI is more common postmenopausal

All predispose to and urge urinary incontinence

22
Q

Hypoestrogenism beneficial effects

A
  • Fibroids will usually decrease in size and symptoms
  • Adenomyosis will decrease in symptoms
  • Endometriosis will decrease in symptoms
23
Q

Chief complaints from menopausal women

A
  • Palpitations
  • Panic attacks
  • Depression

*incidence 20%

*increased sx during menopause transition

*decreased sx after menopause

24
Q

Menopausal Side Effects

A
  • Palpations
  • Panic attacks
  • Depression
  • Breat pain: common in early menopause then tends to fade; ultimately will decrease in glandular tissue w/ fatty replacement
  • Menstrual migraines: cluster at the onset of menses; tend to worsen during menopausal transition
  • Skin changes: collagen content of teh skin is reduced by estrogen deficiency, leading to wrinkles
  • Joint pain
  • Bone loss
  • Dementia
  • Cardiovascular disease
25
Q

Menopausal Bone Loss

A
  • Begins during the transition
  • Early postmenopausal bone mass loss approx. 2%/yr in spine and 1%/yr in hip
26
Q

Menopausal Bone Loss Treatment

A
  • At least 1200mg/day calcium and 800 iu/day Vitamin D dietary intake or supplements
  • DEXA beginning at age 65, or younger w/ increased personal risk factors
  • Raloxifene, bisphosphonate, calcitonin, estrogen, PTH all therapies for more severe bone mass depletion
27
Q

Menopausal dementia

A
  • Estrogen receptors are found densely within the basal forebrain, an area relevant to cognitive function
  • Estrogen protects neurons from excitotoxicity and shields them from free radicals
  • BUT… it is also linked to inflammation and risk of stroke
  • Estrogen certainly plays a role in supporting cognitive function, but complex
28
Q

Menopause and Cardiovascular disease

A
  • Earlier age of menopause may be assoc. w/ increased CHD
29
Q

WHI Study

A
  • Controversial, polarizing RCT forever changed OB/GYN and women’s health care
  • Primary endpoint CHD
  • Stopped prematurely: breast ca > stopping rules
  • Impact

*discontinuation of HRT

*confusion

*fear

*litigation

30
Q

Diagnosing Menopause

A
  • Best approach is menstrual cycle journal or thorough history
  • Serum markers (FSH, estradiol, inhibin, etc) can be helpful, but are not recommended for making a firm diagnosis
  • Serum markers can be affected by timing of ovulation and cycle day, or even hour-to-hour changes, and are not always reliable
31
Q

Menopause Differentials

A
  • Hyperthyroidism; irregular menses, sweating, mood changes
  • Pregnancy, hyperprolactinemia
  • Medication reaction or side effect
  • Carcinoid, pheochromocytoma, malignancy
32
Q

Mild VMS Treatmet

A

Lifestyle modifications

  • Regular exercise
  • Weight management
  • Smoking cessation
  • Avoidance of known triggers
33
Q

Moderate to Severe VMS Treatment

A

Treatment of hot flashes, night sweats

  • Hormonal treatment
  • Estrogen therapy most effective treatment for mod to severe symptoms of vulvar and vaginal atrophy
34
Q

Timing of Hormonal Therapy

A
  • Soon after menopause
  • Starting HT remote from menopause may increase CHD risk
  • Both ET and EPT appear to

*increase ischemic stroke risk

*have no effect on hemorrhagic stroke risk

35
Q

Hormonal Therapy Risk

A
  • Venous thromboembolism (VTE)
  • VTE risk emerges soon after HT initiation (1-2yr); decreases over time
  • Lowe VTE risk w/ either EPT or ET in women <60
  • Possible lower VTE risk w/ transdermal than with oral ET
  • Lower HT doses may be safer than higher doses
36
Q

Estrogen Therapy Risk

A
  • Unopposed systemic ET assoc. w/ increased endometrial cancer risk related to dose and duration of use
  • Concomitant progestogen recommended for women w/ intact uterus
37
Q

Off-Label Use for VMS medication

A
  • SSRI
  • SNRI
  • Clonidine
  • Gabapentin

RGU Exam 1 (14 decks)

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