Menopause Flashcards
What is the median age of menopause?
median age of 51.3 years; usually 45-52 y/o
- Avg. age onset of perimenopause-46 yrs usually 40-49 years-old
- Duration of perimenopause- 5 yrs (2-8 years avg for 95% of women)
Menopause prior to age 40; Occurs more frequently with an autoimmune disorder such as hypothyroidism, Graves’ disease, or lupus. Or if mother or sister experienced premature menopause.
Premature menopause
- Once process has started – unlikely to be reversed
- Women that have unsuccessfully tried to become pregnant for more than a year should be evaluated
- Best blood test is FSH– increases with menopause
Women in 40’s- menstrual cycles increase in length, anovulation occurs more often, and______ become less sensitive to hormonal stimulation from FSH.
Without stimulation and release of ovum, ______ is not produced by corpus luteum.
_________ levels become elevated due to attempt to stimulate a follicle to produce estrogen.
ovulation; Progesterone; Follicule Stimulating Hormone (FSH)
- irregularity in menstural cycle is first sign of perimenopausal symtoms
- smoking and non-bering women have earlier menopause
What are physical changes seen in menopause?
- Bleeding – Changes related to decreased corpus luteum functioning; Periods come very close together, Heavy bleeding, Spotting, Periods last more than a week
- Genital Changes – atrophy of vagina and urethra due to decreased estrogen; Decreased vaginal lubrication, thinning of vaginal tissue.
Less problems if sexually active; Can cause urinary frequency, dysuria, uterine prolapse, stress incontinence r/t decreased size of uterus, vulva, and urethra; Increased risk of UTI due to shortened urethra. - Vasomotor instability (Hot flashes & night sweats) - can occur 20-50x per day
What are ways to manage hot flashes?
- Dress in layers, and remove some when feeling a flash starting
- Use a fan in home or workplace.
- Try taking slow, deep breaths when a hot flash starts.
- If client is still having periods, low-dose oral contraceptives may help.
- Hormone Therapy or other medications used for epilepsy, depression, and high BP
- Transition from normal ovulatory cycles to cessation of menses with irregular cycles.
- Common symptoms:
Hot flashes, decreased libido, insomnia, night sweats, mood swings, irritability, depression - True menopause has not occurred until complete cessation of menses for 12 months
Perimenopause
term used to describe perimenopause through menopause – the whole transition
Climacentric
The cause of most menopausal and perimenopausal symptoms is a deficiency in what hormone?
Estrogen
- Both estrogen and progesterone, but estrogen is the overriding problem
Menopause refers to what event?
Complete cessation of menses for 12 months
What medications are used for hot flashes?
- Antidepressants: (SSRIs and SNRIs) like Paxil, Prozac, Effexor, and Celexa
- Neurontin: used for seizures and neuropathic pain
- _(ACE, ARBs?)__: used for high BP
Why do women have memory problems during menopause?
They don’t..
- No evidence of decr mental health
- due to insomnia and cultural perceptions
When is the greatest bone loss?
1st 5-6 yrs
Why is there increased risk of coronary heart disease following menopause?
- Estrogen has favorable effect on lipids and has anti-atherosclerotic effect on arteries.
- Postmenopausal women
Increased risk due to changes in lipid metabolism - decreased HDL and increased LDL - These lipid changes can be reversed by diet and exercise
Why did the Women’s Health Initiative study of combination progesterone-estrogen arm was halted in 2002?
participants were experiencing increased risk of invasive breast cancer
When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, education includes the risk of:
breast cancer
When discussing estrogen replacement therapy (ERT) with a perimenopausal woman, education includes the risk of:
breast cancer
what are the current guidelines for HRT?
- lowest dose for the shortest period of time
- appropriate dose, duration, regimen and route of administration should also be considered
- for instance, can continue to do topical application for vaginal dryness
What patients are contraindicated for HRT?
Women who:
- Think they are pregnant
- Have problems with undiagnosed vaginal bleeding
- Have had certain kinds of cancers (such as breast or uterine cancer) also any strong family Hx – need to evaluate for risk
- Have had a stroke or heart attack
- Have had a blood clot
- Have liver disease
- Have heart disease
The ACOG recommends the use of hormone replacement for whom?
management of menopausal symptoms and prevention of osteoporosis in those at significant risk
What should nutrition look like in menopausal women?
- Fewer calories required to maintain weight.
- Should choose low-calorie, low-fat foods that are nutrient dense.
- Calcium and vitamin content of foods is important as well: If supplementing w/Vit D 200-400 mu/day recommended; Calcium supplementation: 1200-1500 mg/day in divided doses w/food and 8 oz. glass H2O (not w/ caffeinated beverage)
What should exercise look like in menopausal women?
- Weight bearing exercise to maintain bone density and muscle mass.
- 30-60 min daily
