Menopause Flashcards by Zachary Schulz

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

Menopause

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What is climacteric?

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

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What is premature ovarian failure?

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

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What is the median age of menopause onset?

51 years

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Premature menopause is due to genetic abnormalities on which chromosome?

X-Chromosome

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

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

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

Obesity

Higher socioeconomic status

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How many follicles are present in women at birth?

At menopause?

Birth: About 1,000,00

Menopause: About 1,000

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Most follicular loss is due to _____.

When does this onset?

Atresia, which onsets around age 37

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

Decreasing

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What is the dominant estrogen during perimenopause?

Menopause?

Perimenopause: Estradiol (but its decreasing)

Menopause: Estrone

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

True

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What is inhibin?

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

50%

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

False

It is still possible

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When working up menopause…..

When is FSH drawn?

How would you know that ovarian reserve is reduced?

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

True

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

Shortening

Lower

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

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

Circulating testosterone levels actually remain the same

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What are the only levels that INCREASE during menopause?

Peripheral aromatization of DHEA to estrone

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

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

Mid-Follicular: 27 - 123

Periovulatory: 96 - 436

Mid-Luteal: 49 - 294

Post-menopausal: 0 - 40

What are the androgenic changes of menopause?

Defeminization
Hirsutism
Virilism
Voice Deepening

Why do menopausal women develop facial hair?

Due to the increase in circulation levels of 5-DHT

What is the "E3" form of estrogen?

Estriol Placenta form of estrogen, seen in large amounts during pregnancy

What is the "E2" form of estrogen?

Estradiol The predominant form of estrogen after puberty and prior to menopause

What is the "E1" form of estrogen?

Estrone The predominant form of estrogen during menopause

Which is more potent..... Estrone or Estradiol?

Estradiol

How is estrone produced?

Peripheral conversion (in fatty tissues) of androstenedione

What 'organ systems' respond to estrogen?

``` Cardiovascular Urogenital Bone / Teeth Skin Brain ```

What symptoms are related to decreased levels of estrogen?

``` Vasomotor Instability Altered Menstrual Function Vaginal Atrophy Urinary Tract Symptoms Osteoporosis ```

What symptoms may accompany 'hot flashes'?

``` Night Sweats Dizziness Nausea Headaches Palpitations ```

How are vasomotor flushes characterized?

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

What is the gonadal theory of hot flashed?

Hot flashes are caused by the removal of sex hormones.... Examples: Absences of estrogen in women Orchiectomy in men

What is the pituitary theory of hot flashes? What are arguement's against this theory?

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

What is the hypothalamic theory of hot flashes?

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

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

True

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

Decline

Hot Flashes occur when the hypothalamus’ __________ zone becomes much narrower than typical. What receptor dysfunction is associated with this?

Thermoneutral zone Associated with dysfunctional norepinephrine receptors

What percent of hot flashes onset prior to menopause?

10%

What percent of hot flashes onset after cessation of menses?

50%

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

Serum Cholesterol levels significantly increase 1-2 years after menopause Increase Triglycerides Increase LDL Decreased HDL

What is the most common change in the genitourinary system during menopause? What are some additional changes in this system?

Atrophy of the vaginal epithelium Additional changes..... Decent of the uterus Drop in urethral closure pressure Atrophic Urethritis Atrophic Cystitis

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

30%

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

25%

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

6 Months

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

Vertebrae Distal Radius Neck of the femur

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

Slower

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

True

What is the most common clinical treatment for menopause symptoms?

PO Estrogen +/- Progesterone

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

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

What side effects are associated with vaginal estrogen?

Abnormal Bleeding Breast Pain nausea