Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Repro. Med 3 > Menopause > Flashcards

Menopause Flashcards

1
Q

___ is the permanent cessation of menstruation, caused by failure of ovarian follicular development in the presence of adequate gonadotropin stimulation

A

Menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

____ is the physiologic period in a women’s life during which there is regression of ovarian function

A

Climacteric

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

_____ is cessation of menstruation due to depletion of ovarian follicles < 40 y/o

A

Premature Ovarian Failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the average age for menopause to occur?

A

Median –> 51.4 y/o

range of 48-55 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the average age for the start of Climacteric to occur

A

47.5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the average length of time for the transition from Climacteric–> menopause to occur

A

Median length of 4 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

____ is caused by genetic abnormalities on the long and short arm of X chromosome

A

Premature menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

~___% of women who go through early menopause is due to surgery

A

30%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is associated w/ earlier menopause?

A 
FHx of early menopause
Smoking
Blindness
Abnormal chromosome karyotype
Precocious puberty
Left-handedness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What contributes to a later onset of menopause?

A

Obesity

Higher socioeconomic class

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the 2 types of menopause?

A

Physiologic

Iatrogenic (surgery, radiation, chemotherapy)

Autoimmune ovarian tissue destruction

Infection/tumor ovary killers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Most follicular loss is due to ____, not ovulation

A

atresia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Ovarian atresia accelerates at around age ___

A

37 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

T/F: Loss of viable ovaries is the prime causative agent for the decrease in fertility for women

A

F: Age-related UTERINE changes also contribute to decreased fertility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Fill in the Blank!

During perimenopause…
The ovaries begin decreasing in __1__.
__2__ is still the dominant estrogen but the amount secreted decreases.
Number of follicles __3__ substantially.
Production of __4__ decreases.
Remaining follicles respond poorly to elevated __5a_ and _5b__
Erratic ovulation results in menstrual cycle __6__

A
  1. size
  2. Estradiol
  3. decreases
  4. inhibin
    5a. FSH 5b. LH
  5. irregularity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Do perimenopausal women need contraception?

A

YES!

*natural pregnancy is possible until menopause if reached

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

___is produced in the gonads, pituitary gland, placenta, corpus luteum and other organs.

A

Inhibin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What stimulates the secretion ofinhibinfrom the granulosa cells of the ovarian follicles in the ovaries?

A

FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What suppresses the production of FSH?

A

Inhibin!

yep, they control each other…

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

As follicles age, they become less capable of making ____

A

Inhibin

** this is a sign that follicles are more difficult to stimulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the job of inhibin?

A

It inhibits (haha) secretion of FSH and LH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What will happen in each cycle if inhibin gets lower and lower?

A

FSH and LH remain high

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What are elevations of FSH predictive of, particularly at the beginning of a cycle? What does it therefore impact?

A

Perimenopause

Fertility of remaining ova

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

When does fertility begin to wane?

A

35-37 y/o

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

By age 45, risk of spontaneous miscarriage increases to __%

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When during the cycle do you perform the FSH test?

A

Day 3 of cyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What does it mean if the FSH is elevated on day 3 of the cycle?

A

Ovarian reserve is reduced

  • few eggs remain
  • egg quality is also reduced

**FSH increases w/ age!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Normal Day 3 FSH < __

Diminished reserve when FSH >__

A

<9
<11

  • *Normal FSH does NOT guarantee good egg quality and ovarian reserve
  • *Abnormal day 3 FSH is highly predictive of poor reserve/quality
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Perimenopause is characterized by the shortening of _____, and/or the presence of _____ cycles.
Shortening of the ____ phase with a lower number of follicles recruited per cycle

A

Menstrual cycle length

anovulatory/ prolonged

follicular

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Subtle hormonal changes occur during the ___ (decade)

Sx noticeable during the ___ (decade)

A

30s

40s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Most women menstruate ~___ (#) times between menarche and menopause

A 
400 
#Gross
#ThatsALotOfTampons
32
Q

With menopause, the ovary is no longer capable of responding to pituitary gonadotropins → so there is a ↓ production of ___ and ___

A

estrogen and progesterone

33
Q

What happens to the following serum hormone levels at menopause (↑/↓/=)
___Circulating estrogens

___Ratio of estrogen to androgen

___Sex hormone-binding globulin secretion

___Peripheral aromatization of DHEA to estrone

___E2:E1 ratio

___Circulating bioavailable testosterone

A

↓ Circulating estrogens

↓ Ratio of estrogen to androgen

↓ Sex hormone-binding globulin secretion

↑ Peripheral aromatization of DHEA to estrone

↓ E2:E1 ratio

= Circulating bioavailable testosterone

34
Q

What cells make estrogen?

A

Granulosa

Theca

35
Q

Explain the pathophysiology in a stepwise manner to describe the decrease of estrogen and increase of FSH + LH

A
  1. Degeneration of granulosa and theca cells
  2. Failure to respond to endogenous gonadotropins
  3. ↓ Estrogen
  4. ↑ FSH and LH
36
Q

T/F: Estrogen levels are a good indication of ovulation, fertility and the start of menopause?

A

F!
Estrogen levels fluctuate wildly
It is impossible to predict ovulation, the date of the cycle, fertility, or how soon menopause will arrive based on estrogen levels

37
Q

What test is used to determine the start of perimenopause/menopause?

A

FSH

38
Q

What are normal lab values for serum estrogen during the mid-follicular/periovulatory/mid-luteal phase?

What are normal estrogen values for post menopausal women?

A

30-450 ish (see all the details in the study guide)

0-40

39
Q

What endocrine things contribute to the androgen effects of menopause?

A

testosterone (overall levels are decreased but less is converted to estrogen)

5-DTH - more circulating due to changes in binding proteins in the blood stream

40
Q

____ is the placental estrogen and it is only seen in large amounts during pregnancy. High levels of ______ reflect fetal well being. It is the least potent of all estrogens. It originates from the fetal adrenal gland in the form of DHEA Sulfate and then is finally transformed to _____ in the placenta by the sulfatase enzyme. (Same answer in all blanks)

A

Estriol

41
Q

___ is the predominant estrogen of women after puberty and prior to menopause. It has the highest effect on receptors

Where is this made?

A

Estradiol

Ovaries

42
Q

___ is the predominant estrogen present in menopause. It is produced by aromatization of androstenedione in peripheral (fatty) tissue. It is less potent than Estradiol.

Where is this made?

A

Estrone

peripheral conversion of androstenedione

43
Q

What are the target organs of estrogen? (x5)

A 
CV System
Urogenital system
Bone and teeth
Skin
Brain
44
Q

What sx are related to ↓ estrogen (x6)

A 
Vasomotor instability
Altered menstrual function 
Vaginal atrophy 
Skin thinning 
Urinary tract sx 
Osteoporosis
45
Q

____ are characterized by a rise in skin temperature, dilation of peripheral blood vessels, increased blood flow in the hands, increased skin conductance, and transient increase in heart rate followed by a temperature drop and profuse perspiration over the area of flush distribution.

A

Vasomotor flushes/flashes

46
Q

What other sx may accompany a hot flash?

A 
Night sweats
Dizziness
Nausea
HA
Palpitations
47
Q

Where/What is the “thermostat” of the body?

A

Hypothalamus

***thermo neutral zone becomes narrow w/ menopause, which has to do w/ feedback at the NE receptor of the hypothalamus, which is affected by decreased estrogen.

48
Q

What are probable causes of hot flashes?

A

Ovary - estrogen thing
Pituitary - LH decrease
Hypothalamic - norepinephrine

49
Q

The ____ theory says that hot flashes are caused by the removal of sex hormones after the body has been exposed to them for a period of time–> IOW, “dynamic” loss of sex hormones

A

Gonadal

50
Q

What are arguments for the gonadal theory

A
  • low E
  • orchiectomy = hot flashes in men
  • hot flashes go away if hormone is replaced
51
Q

The ___ theory states that extreme rise(s) in FSH/ LH are the cause of hot flashes

A

Pituitary theory

52
Q

What are arguments for the pituitary theory

Against?

A

FOR
- high LH related to hot flash

AGAINST
- Turners and Kallman pts alwasy ahve high FSH and LH but they dont haev hot flashes

53
Q

The ___ theory states that inhibition of hypothalamic catecholamines (such as _____) are the cause of hot flashes

A

Hypothalamic

norepinephrine

54
Q

The onset of hot-flashes occurs in…
__% prior to menopause (up to 1 year or more)
__% after cessation of menses

A

10%

50%

55
Q

Hot flashes usually have an ___ onset and last anywhere from __ sec – __ min

A

abrupt

30 sec- 5-10 min

56
Q

___ is the leading cause of death in the US – twice as many women die of from this rather than of CA

A

CV disease

57
Q

By 6-10 years after menopause, incidence rates of coronary heart disease are in (higher/lower/equal) women and men

A

about equal

58
Q

____ increases significantly at 1-2 yrs or more after the menopause, and becomes less cardioprotective

A

Serum cholesterol

59
Q

What genital changes occur during menopause?

A 
Atrophy 
Descent of the uterus 
30% drop in urethral closure pressure 
Atrophic urethritis 
Atrophic cystitis
60
Q

Genital changes can lead to what sx?

A

Atrophy–> itching, burning, dysparunia

Descent of the uterus –> prolapse

drop in urethral closure –> incontinence

Atrophic urethritis/cystitis –> urgency, frequency, dysuria

61
Q

What are the 3 most common fx in postmenopausal women?

A

vertebrae
distal radius
neck of femur

62
Q

__% of women have radiological evidence of osteoporosis by 60

After age 65 ___ have a vertebral fx

By age 80, ___ have fractured a hip

A

25%

1/3

1/4

63
Q

____% of women with hip fx after 80 y/o will die of complications within 6 months

A

15% of women w/ hip fx after 80 y/o will die of complications w/in 6 months

64
Q

Initial period of up to 4-5 years after menopause, there is accelerated loss of bone at rate of ___% per year– mainly ____ bone at first, and later, ____ bone as well.

A

1-2%
trabecular
cortical

65
Q

What are RF for osteoporosis? (FYI)

A 
White/Asian
low BMI
early menopause 
FHx
low Ca++ diet 
high caffeine/alcohol/protein/smoking 
endocrine stuff
66
Q

What are neurologic sx of menopause?

A 
Anxiety/depression
irritability
fatigue
HA
tiredness/lethargy
nervousness
sleep difficulties
inability to concentrate
67
Q

Postmenopausal women have lower level of plasma ____ which may contribute to the neurologic sx of menopause

A

β-endorphin

68
Q

What is the tx for menopausal sx?

A

low doses of estrogen +/- progesterone (depending on whether your patient has a uterus or not).

69
Q

What is the #1 rule in HRT for women in menopause?

A

DO not give unopposed estrogen to a woman with a uterus

**Give the lowest dose that will effectively tx sxs

70
Q

Females have a __ chance of developing breast CA in their life

A

1/8

71
Q

What factor is responsible for the highest increased risk of developing breast CA?

A

FHx of breast CA

72
Q

Compared w/ the placebo, estrogen + progestin resulted in an increase in? (x4)

Decrease in? (x2)

A

Increased risk

  • heart attack
  • stroke
  • blood clots
  • breast cancer

Reduced risk

  • colorectal CA
  • Fx

**No protection against mild cognitive impairment and increased risk of dementia

73
Q

Compared w/ the placebo, estrogen alone resulted in:

A

Increased risk

  • stroke
  • blood clots

Reduced risk of fx

Uncertain effect for breast CA
No difference in risk
- heart attack
- colorectal cancer

74
Q

What are the benefits of using vaginal estrogen therapy?

What doesn’t it help?

A

Helps

  • local sxs
  • doesn’t absorb as well (less systemic effects)
  • Helps both vaginal and urethral sxs

Won’t help hot flashes

75
Q

What are some side effects of vaginal estrogen?

A

abnormal vaginal bleeding
breast pain
N

Repro. Med 3 (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions