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Reproductive Medicine Exam 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

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2
Q

What is climacteric?

A

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

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3
Q

What is premature ovarian failure?

A

Cessation of menstruation due to the depletion of ovarian follicles before the age of 40

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4
Q

What is the median age of menopause onset?

A

51 years

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5
Q

Premature menopause is due to genetic abnormalities on which chromosome?

A

X-Chromosome

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6
Q

What are some things associated with an earlier onset of menopause?

A 
Surgery (30%) 
Family History
Smoking
Precocious Puberty
Left-Handedness
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7
Q

What are some things associated with a later onset of menopause?

A

Obesity

Higher socioeconomic status

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8
Q

How many follicles are present in women at birth?

At menopause?

A

Birth: About 1,000,00

Menopause: About 1,000

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9
Q

Most follicular loss is due to _____.

When does this onset?

A

Atresia, which onsets around age 37

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10
Q

During perimenopause, ovaries begin ______ (Increasing/decreasing) in size

A

Decreasing

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11
Q

What is the dominant estrogen during perimenopause?

Menopause?

A

Perimenopause: Estradiol (but its decreasing)

Menopause: Estrone

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12
Q

T/F: During perimenopause there is a decrease in inhibin production

A

True

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13
Q

What is inhibin?

A

Inhibin is produced in the gonads, pituitary, placenta, and corpus luteum….

Its release is stimulated by FSH and then is secreted by the follicles to suppress FSH and LH……

As follicle age they produce less inhibin…..

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14
Q

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

A

50%

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15
Q

T/F: Natural Pregnancy is NOT possible once menopause is reached

A

False

It is still possible

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16
Q

When working up menopause…..

When is FSH drawn?

How would you know that ovarian reserve is reduced?

A

FSH is drawn on day 3 of the cycle (baseline FSH)

If FSH is elevated at that time (>11) then ovarian reserve is considered decreased

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17
Q

T/F: A normal day 3 FSH does NOT guarantee good egg quality and good ovarian reserve

A

True

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18
Q

During perimenopause, there is a ______ (shortening/lengthening) of the follicular phase with a _______ (higher/lower) number of follicles recruited per cycle

A

Shortening

Lower

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19
Q

Why are there decreased levels of progesterone and estrogen production during menopause?

A

The ovaries are no longer capable of responding to pituitary gonadotropins

There is also a degeneration of the granulosa and theca cells which typically would produce estrogen in response to the pituitary gonadotropins

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20
Q

Is there an increase or decrease in circulating testosterone levels at menopause?

A

Circulating testosterone levels actually remain the same

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21
Q

What are the only levels that INCREASE during menopause?

A

Peripheral aromatization of DHEA to estrone

22
Q

What are the normal estrogen values for the following cycle phases…..

Mid-Follicular?
Periovulatory?
Mid-Luteal?
Postmenopausal?

A

Mid-Follicular: 27 - 123

Periovulatory: 96 - 436

Mid-Luteal: 49 - 294

Post-menopausal: 0 - 40

23
Q

What are the androgenic changes of menopause?

A

Defeminization
Hirsutism
Virilism
Voice Deepening

24
Q

Why do menopausal women develop facial hair?

A

Due to the increase in circulation levels of 5-DHT

25
Q

What is the “E3” form of estrogen?

A

Estriol

Placenta form of estrogen, seen in large amounts during pregnancy

26
Q

What is the “E2” form of estrogen?

A

Estradiol

The predominant form of estrogen after puberty and prior to menopause

27
Q

What is the “E1” form of estrogen?

A

Estrone

The predominant form of estrogen during menopause

28
Q

Which is more potent…..

Estrone or Estradiol?

A

Estradiol

29
Q

How is estrone produced?

A

Peripheral conversion (in fatty tissues) of androstenedione

30
Q

What ‘organ systems’ respond to estrogen?

A 
Cardiovascular
Urogenital 
Bone / Teeth
Skin
Brain
31
Q

What symptoms are related to decreased levels of estrogen?

A 
Vasomotor Instability 
Altered Menstrual Function
Vaginal Atrophy
Urinary Tract Symptoms 
Osteoporosis
32
Q

What symptoms may accompany ‘hot flashes’?

A 
Night Sweats
Dizziness
Nausea
Headaches
Palpitations
33
Q

How are vasomotor flushes characterized?

A

A rise in skin temperature, dilation in peripheral vessel, transient increase in HR followed by…..

A temperature drop and profuse perspiration typically in the face, neck,and chest

34
Q

What is the gonadal theory of hot flashed?

A

Hot flashes are caused by the removal of sex hormones….

Examples:

Absences of estrogen in women
Orchiectomy in men

35
Q

What is the pituitary theory of hot flashes?

What are arguement’s against this theory?

A

The extreme rise of FSH/LH causes hot flashes

Arguements:

Turner’s Syndrome and Kallman’s Syndrome have chronically elevated levels of FSH/LH but no hotflashes

36
Q

What is the hypothalamic theory of hot flashes?

A

Inhibition of hypothalamic catecholamines (norepinephrine) are the cause of hot flashes

37
Q

T/F: Catecholamine receptors on the hypothalamus are greatly affected by presence of estrogen

A

True

38
Q

When estrogen levels decline, the number of catecholamine receptors in the hypothalamus _______ (Increase/decline)

A

Decline

39
Q

Hot Flashes occur when the hypothalamus’ __________ zone becomes much narrower than typical.

What receptor dysfunction is associated with this?

A

Thermoneutral zone

Associated with dysfunctional norepinephrine receptors

40
Q

What percent of hot flashes onset prior to menopause?

A

10%

41
Q

What percent of hot flashes onset after cessation of menses?

A

50%

42
Q

What is the most significant change in the cardiovascular system in post-menopausal women?

A

Serum Cholesterol levels significantly increase 1-2 years after menopause

Increase Triglycerides
Increase LDL
Decreased HDL

43
Q

What is the most common change in the genitourinary system during menopause?

What are some additional changes in this system?

A

Atrophy of the vaginal epithelium

Additional changes…..

Decent of the uterus
Drop in urethral closure pressure
Atrophic Urethritis
Atrophic Cystitis

44
Q

in post-menopausal women there is a ___% drop in urethral closing pressure at rest and in times of stress

A

30%

45
Q

__% of women have radiological evidence of osteoporosis by the age of 60.

A

25%

46
Q

15% of women with hip fracture after age 80 will die of complications within __ months.

A

6 Months

47
Q

Where are the most common sites of fracture in postmenopausal women?

A

Vertebrae
Distal Radius
Neck of the femur

48
Q

In post-menopausal women, healing of the skin is generally ______ (quicker/slower)

A

Slower

49
Q

T/F: Post-menopausal estrogen supplementation maintains pre-menopausal levels of collagen synthesis to prevent skin thinning/wrinkling

A

True

50
Q

What is the most common clinical treatment for menopause symptoms?

A

PO Estrogen +/- Progesterone

51
Q

Why shouldn’t you give unopposed estrogen in a women with a uterus?

A

This will increase the risk of disordered growth, neoplasia, and cancer

52
Q

What side effects are associated with vaginal estrogen?

A

Abnormal Bleeding
Breast Pain
nausea

Reproductive Medicine Exam 3 (10 decks)

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