Menopause Flashcards
________ is the permanent cessation of menstruation caused by failure of ovarian follicular development in the presence of adequate gonadotropin stimulation
Menopause
What is climacteric?
The physiologic period in a women’s life during which there is regression of ovarian function
What is premature ovarian failure?
Cessation of menstruation due to the depletion of ovarian follicles before the age of 40
What is the median age of menopause onset?
51 years
Premature menopause is due to genetic abnormalities on which chromosome?
X-Chromosome
What are some things associated with an earlier onset of menopause?
Surgery (30%) Family History Smoking Precocious Puberty Left-Handedness
What are some things associated with a later onset of menopause?
Obesity
Higher socioeconomic status
How many follicles are present in women at birth?
At menopause?
Birth: About 1,000,00
Menopause: About 1,000
Most follicular loss is due to _____.
When does this onset?
Atresia, which onsets around age 37
During perimenopause, ovaries begin ______ (Increasing/decreasing) in size
Decreasing
What is the dominant estrogen during perimenopause?
Menopause?
Perimenopause: Estradiol (but its decreasing)
Menopause: Estrone
T/F: During perimenopause there is a decrease in inhibin production
True
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…..
By age 45, the risk of spontaneous miscarriage increases to __%
50%
T/F: Natural Pregnancy is NOT possible once menopause is reached
False
It is still possible
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
T/F: A normal day 3 FSH does NOT guarantee good egg quality and good ovarian reserve
True
During perimenopause, there is a ______ (shortening/lengthening) of the follicular phase with a _______ (higher/lower) number of follicles recruited per cycle
Shortening
Lower
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
Is there an increase or decrease in circulating testosterone levels at menopause?
Circulating testosterone levels actually remain the same
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
