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REPRO TEST 3 > Menopause > Flashcards

Menopause Flashcards

1
Q

the permanenet cessation of menstration is due to..

A

failure of ovarian follicular development in the presence of ADEQUATE gonadotropin stimulation

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2
Q

climacteric

A

physiologic period in which there is regression of ovarian fxn

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3
Q

peramture ovarian failure

A

cessation of menstruation due to depletion of ovarian follicles less than 40 yo

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4
Q

average age of menopause

A

51.4 range 48-55

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5
Q

average for perimenopause

A

47.5 y/o average length about 4 yrs

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6
Q

premature menopause

A

genetic abnormalities on long and short arm of X chormosome

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7
Q

RF for early menopause

A 
Surgical causation 
FHx early 
cigarette smoking 
blindness 
chromosome defect 
precocious puberty 
left handedness
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8
Q

RF for later age menopause

A

obesity, higher SES

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9
Q

___ number of follicles at birth and at menopause

A

1 million follicles at birth and 1000 left by menopause

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10
Q

what is most follicular loss due to ?

A

atresia not ovulation

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11
Q

when does atresia rate accelerate?

A

age 37

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12
Q

atresia definition

A

closure of tubal structure, death of unfertilized follicles?

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13
Q

6 changes to ovaries in perimenopause

A
  1. ovaries shrink in size
  2. estradiol secretion amount decreases
  3. number of follicles decrease substantially
  4. production of inhibin lowers
  5. remaining follicels respond poorly to high FSH and LH
  6. erratic ovulation results in menstrual cycle irregularity
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14
Q

where is inhibin produced

A

gonads, pituitary glands, placenta, corpus luteum, other organs

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15
Q

FSH stimulates secretion of __ from granulosa cells of ovarian follicles

A

inhibin

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16
Q

inhibin does what

A

suppresses FSH

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17
Q

if inhibin secretion gets lower with each cycle…___ gets higher

A

FSH secretion

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18
Q

t/f elevations of FSH at the start of a cycle are predictive of perimenopause and of the fertility of the remaining ova

A

true

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19
Q

at age 45 risk of spontaneous miscarriage is__

A

up to 50%

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20
Q

what is day 3 FSH testing

A

a routine way to measure ovarian reserve

if FSH high on day 3 cycle, indicates ovarian reserve is low = low egg quality / reserve

21
Q

normal day 3 FSH level is..

A

less than 9

22
Q

diminished reserve when FSH on day 3 is over

A

11

23
Q

what occurs in perimenopause?

A
  1. shortening of menstrual cycle

2. shorting of follicular phase w/ lower # of follicles recruited per cycle

24
Q

w/ menopause ovary is no longer able to…

A

respond to pituitary gonadotropins low estrogen and progesterone perduction

25
Q

what 4 things decrease with menopause

A
  1. circulating estrogen
  2. ratio of estrogen to androgen
  3. sex hormone binding globulin secretion
  4. E2 to E1 ratio
26
Q

what hormone is increased in menopause

A

increased peripheral aromatization of DHEA to estrone

27
Q

what hormone level stays same in menopause

A

circulating bioavailable testosterone

28
Q

what cells make estrogen

A

theca and granulosa cells of ovaries

as these atrophy.. get less estrogen secretion = high FSH and LH

29
Q

e1 estrone

A

predominant e in menopause
from aromatization of androstenedione in fatty tissue

less potent than E2

30
Q

E2: estradiol

A

predominant E of women after puberty but before menopause

31
Q

E3: estriol

A

placental E only seen in large amounts w/ preg
least potent of all E
from fetal adrenal gland in form of DHEA sulfate
placenta turns that into estriol

32
Q

postmenopausal women main E

A

E1 made in periphery

33
Q

cause of hot flash

A

unknown ..related to estrogen, LH and NEpi

34
Q

what is gonadal theory of hot flashes?

A

hot flash is caused by removal of sex hormones after the body has been exposed to them for a period of time..a dynamic loss of sex hormones

35
Q

3 arguments to back up gonodal theory

A

no estrogen = hot flash
orchiectomy = hot flash in many men
hot flashes go away if hormone replaced

yet what is exact MOA?

36
Q

pituitary theory of hot flashses

A

extreme rise in FSH and LH cause them

37
Q

2 arguments for pit theory of hot flash

A
  1. seen pulse or surge of LH prior to hot flash

2. even if surge does not happen, seem to happen near an LH peak

38
Q

evidence against pit thoery

A

ppl with chronically high FSH and LH (turners / kallmans) do not have hot flashes

39
Q

hypothalamic theory behind hot flashes

A

inhibiting hypothalamic catecholamines (NE) causes hot flashes

when E levels drop so do the drop of NE receptors
when E is low.. those remaining receptors may be stimulated abnormally

40
Q

CVD risks with menopause

A

6-10 yrs after CAD rates equal men and women

cholesterol increase 1-2 yr after menopause (less HDL higher TG and LDL)

41
Q

genital changes in menopause

A
  1. atrophy of vaginal epithelium
  2. decent of uterus due to collagen in uterosacral ligament
  3. urologic .. decrease in urethral closure pressure
  4. atrophic urethritis
    atrophic cystitis
42
Q

atrophic urethritis sx

A

urgency, frequency, dysuria, suprapubic pain without UTI

43
Q

atrophic cystitis sx

A

urge incontinence, frequency, dysuria, nocturia

44
Q

3 most common fx in postmenopausal women

A

vertebral, distal radius, neck of femur

45
Q

in what circumstance can a premenopausal women be exposed to unopposed estrogen?

A

if she doesn’t have a uterus

46
Q

estrogen and progestin HRT tx risks

A

increased: MI, stroke, blood clots, breast CA
lower: colorectal CA, decreased risk fx

47
Q

ex of combo hrt tx

A

Premarin with Provera

48
Q

tx vaginal atrophy

A

topical vaginal estrogen

ADR: breast pain, N = some systemic absorption

REPRO TEST 3 (7 decks)

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