Menopause

Question 0

What’s going on in the ovary between infancy and menarche?

Answer 0

Waves of follicular development and atresia are happening - there’s just no ovulation / hormone production because not getting FSH / LH from the pituitary.

Question 1

Other than infertility, what are 4 morbidities associated with menopause (both pre-mature and normal)?

Answer 1

CV disease
Osteoporosis
Urogenital atrophy (see atrophic vaginitis on wikipedia)
Reduces Quality of Life

Question 2

Does the rate of follicular atresia stay constant post-menarche?

Answer 2

Nope, it accelerates 10-15 years before menopause (correlated with decreased fertility).

Question 3

How is menopause defined? Is it often abrupt?

Answer 3

12 months of amenorrhea.
No, abrupt cessation of periods is rare, there’s often a perimenopausal transition with irregular periods / menopause symptoms.

Question 4

What’s the mean age of menopause, across many different studies?

Answer 4

About 51 years old.

Question 5

What are biochemical characteristics of menopause?

Answer 5

High FSH and LH, low estrogen.

Question 6

4 factors affecting age of menopause onset?

Answer 6

Smoking (hastens onset by about 1.5 yrs)
Family Hx
Dietary (vegetarians hit menopause earlier)
Alcohol (may delay menopause)

Question 7

Effect of menopause on CV risk factors?

Answer 7

LDL and total cholesterol increases approaching and after menopause.
Metabolic syndrome rates go way up post-menopause.

Question 8

Is post-menopausal osteoporosis a big problem?

Answer 8

Yes.

Question 9

5 types of symptoms associated with menopause?

Answer 9

Hot flash
Urogenital atrophy
Musculoskeletal symptoms
Disordered sleep
Mood

Question 10

3 risk factors for menopause symptoms? (MoA for one of them?)

Answer 10

Smoking -> revs up p450 enzymes that degrade estrogen.
Race -> AA have more symptoms vs. white and Asian.
Obesity.

Question 11

Best treatment for menopause symptoms?

Other treatments?

Answer 11

Hormone replacement therapy appears to be best.

SSRIs, antihypertensives, behavioral changes (diet, exercise, etc.)

Question 12

How is premature ovarian insufficiency defined?

Answer 12

Cessation of ovarian function before age 40.

Question 13

How is premature ovarian insufficiency diagnosed?

Answer 13

2 separate measurements 1mo apart of elevated FSH and LH with decrease estrogen.

Question 14

5 causes / risk factors for premature ovarian insufficiency?

Answer 14

Genetic/cytogenetic abnormalities.
Autoimmune disorders.
Metabolic.
Iatrogenic (chemo / radiation Tx)
Smoking

Question 15

One notable chromosomal etiology of premature ovarian insuffiency?

Answer 15

Turner syndrome: 45X

or 45X mosaicism

Question 16

Turner’s syndrome? But what about the lyonization of 1 X chromosome?

Answer 16

Both X chromosomes are needed for ovarian function - neither is lyonized there.

Question 17

What cells may be most damaged by chemotherapy? What chemotherapeutic agents seem to be worst?

Answer 17

Early granulosa cells of primordial follicles may be most susceptible.
Alkylating agents seem to do the most damage.

Question 18

Major risk of hormone replacement therapy?

Answer 18

Increased risk of DVTs.

Question 19

Ways to preserve fertility prior to chemo / radiation? (3 things)

Answer 19

IVF + embryo cryopreservation.
Oocyte cryopreservation.
Oophoropexy (surgical repositioning of the ovaries out of the way of radiation)