Menopause

Question 1

What is the definition of climacteric?

Answer 1

Phase in a woman’s reproductive life when a gradual decline in ovarian function results in decreased sex steroid production, and the associated sequelae

Question 2

Which phases of menopause do you see irregular menses?

Answer 2

Menopausal transition and perimenopause

Question 3

When is the menopausal transition? When is Perimenopause?

Answer 3

Menopausal transition: Incr. FSH–> FMP (final menstrual period)

Perimenopause: Incr. FSH–> 12mo after FMP

Question 4

When is a woman considered to be in menopause

Answer 4

12 months of amenorrhea after FMP in a woman > 45y/o in the absence of other biological or physiological causes

Question 5

Menopause typically occurse between what ages?

Answer 5

50-55

(51-52 in the US)

Question 6

S/s of what?

1. Changes is menstrual cycles (irregular, heavy)
2. Mood/emotional changes
3. Hot flashes
4. Night sweats
5. Breast changes (incr. tenderness early on)
6. Loss of libido
7. etc

Answer 6

Menopause

Question 7

What are the 4 hormonal chages found in menopause?

Answer 7

• Decr. estrogen
• Decr androgens ( see facial hair growth and decr. breast size)
• Decr. In progesterone (irreg vag bleeding)
• Incr. LH/FSH

Question 8

What are the 3 physical changes seen in menopause

Answer 8

1. Urogenital atrophy (vulvovaginal atrophy, etc)
2. Urinary stress incontinence
3. Skin collagen loss

Question 9

What 3 diseases are seen in menopause

Answer 9

1. Osteoporosis
2. CV disease
3. Dementia

Question 10

How do you treat atrophic changes, vaginal dryness in menopause?

Answer 10

• 1st line= non-hormonal vaginal moisturizers and lubricants
• most effective: Vaginal estrogen therapy
  
  • Ospemifene (a SERM)
  • Vaginal prasterone (DHEA)

Question 11

POPCORN

T/F: Women who still have a uterus should be given unopposed estrogen as tx for menopause

Answer 11

FALSE

Women who still have a uterus should NOT use unopposed estrogen!!

Question 12

What is the gold standard for relief of vasomotor sxs a/w menopause

Answer 12

Menopause Hormone Therapy (unopposed estrogen therapy or combined estrogen-progestin therapy)

Question 13

What are the 7 contraindications to menopause hormone therapy

Answer 13

1. H/o breast cancer
2. CHD
3. Prior VTE or stroke
4. Liver disease
5. Unexplained vaginal bleeding
6. High-risk endometrial cancer
7. TIA

Question 14

How should you prescribe Menopause Hormone Therapy?

Answer 14

the lowest effective dose for the shortest period of time

Question 15

The following are examples of what?

• Prempro, Prefest, Climara pro (estrogen/progestin)
• Estratest (estrogen/testosterone)
• Premarin, Femtrace, Climara (Estrogen only)
• Duavee (bazedoxifene/estrogen)

Answer 15

Menopause Hormone Therapy

Question 16

Which study showed increased risk of CHD, stroke, VTE and breast cancer with Menopause hormone replacement therapy, resulting in the discontinuation of MHT prescribing, however, was later found to not be a great study?

Answer 16

Women’s health initiative

Question 17

Clinical bottom line of Menopause HRT?

Answer 17

• Tx symptomatic women only
• Benefits > risks of women under 60
• Benefits > risks if < 10 years from menopause
• do NOT use MHT for prevention of chronic diseases (CHD, osteoporosis)

Question 18

How long should MHT be used for

Answer 18

< 5 years