Menopause Flashcards
what must be done prior to initiating hormone therapy?
histopathalogic diagnosis consistent with benign endometrium or a pelvic ultrasound with an endometrial stripe of <4mm should be documented
What is necessary to prevent osteoporosis?
calcium absorption decreases with age because of a decrease in biologically active vitamin D; a positive calcium balance is necessary to prevent osteoporosis; calcium supplementation reduces bone loss and decreases fractures in individuals with low dietary intakes; in order to remain in zero calcium balance, postmenopausal women require a total of 1200mg of elemental calcium per day(total of diet plus supplements)
What are some major risk factors for osteoporosis?
history of fracture as an adult, low body weight and being a current smoker
What should be done before starting bisphosphonates as treatment for osteoporosis?
bone mineral density should be documented; bone mineral density should be documented at 2 year intervals
what are general recommendations for prevention of osteoporosis?
eating a balanced diet that includes adequate intake of calcium and vitamin D, regular physical activity, avoidance of heavy alcohol consumption and smoking cessation
What is the definition of menopause?
amenorrhea for greater than 12 months
What treatment options may improve hot flash symptoms?
estrogen is most effective and current recommendation is for lowest dose for shortest time
Why can estrogen levels in postmenopausal women be significant and why can removal of postmenopausal ovaries result in resurgence of menopausal symptoms?
estrogen production by the ovaries does not continue beyond menopause, however levels in postmenopausal women can be significant due to the extraglandular conversion of androstenedione and testosterone to estrogen that occurs in peripheral fat cells and thus body weight is directly correlated; menopausal ovaries are known to continue production of androgens, removal can result in resurgence of menopausal symptoms
What are risks and guidelines for prescribing HRT?
increase in breast cancer and reduction in colon cancer with combination HRT; initiation of combined HRT is considered safe option for healthy, symptomatic women who are within 10 years of menopause or younger than age 60
What is the effect of hormone therapy on serum lipid profiles?
HDL levels increase and LDL levels decrease with combination HRT; estrogen increases triglycerides and increases LDL catabolism, as well as lipoprotein receptor numbers and activity, therefore causing decreased LDL; hormones inhibit hepatic lipase activity, which prevents conversion of HDL2 to HDL3 thus increasing HDL levels
What defines osteopenia by T score?
T scores of -1 to -2.5
What are some risk factors for fracture?
prior fracture, family history of osteoporosis, white or asian race, dementia, history of falls, poor nutrition, smoking, low BMI, estrogen deficiency, alcoholism, and insufficient physical activity
