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Men's and Women's Health > Menopause > Flashcards

Menopause Flashcards

1
Q

Define perimenopause

A

The time period before menopause characterized by irregular menses and decreased fertility

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2
Q

Average length of perimenopause?

A

4 years

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3
Q

Define menopause

A

permanent cessation of menses

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4
Q

How is menopause determined and what is the criteria?

A

retrospectively when there is a full year of amenorrhea

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5
Q

What is premature ovarian insufficiency and how is it treated?

A

menopause before the age of 40. Treated with HRT until about age 51

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6
Q

What is the etiology of menopause?

A
  1. aging
  2. surgery
  3. medications (chemo)
  4. pelvic irradiation
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7
Q

What is the pathophysiology of menopause?

A

Ovarian follicles decrease with age due to follicular atresia. Ovaries no longer the primary site of estrogen and progesterone synthesis. FSH increases and inhibin B decreases. Oocytes don’t respond to gonadotropins

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8
Q

Signs and symptoms of menopause

A
  1. cycle irregularity
  2. hot flashes
  3. night sweats
  4. depression
    5 . anxiety
  5. mood swings
  6. concentration problems
  7. vaginal itching, burning
  8. dyspareunia
  9. sexual dysfunction
  10. urinary incontinence
  11. sleep disturbance
  12. joint pain
  13. headache
  14. metabolic
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9
Q

How do you diagnose menopause?

A
  1. age
  2. signs and symptoms
  3. FSH
  4. Anti-Mullerian hormone
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10
Q

Normal level of FSH

A

4-10

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11
Q

Perimenopause level of FSH

A

10-12

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12
Q

Menopause level of FSH

A

> 40

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13
Q

Menopause level of AMH

A

< 1

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14
Q

What was the result of WHI 1991 study?

A

Black box warning for MI, stroke, breast cancer, and VTE on all estrogen products

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15
Q

brand name: conjugated equine estrogen

A

Premarin

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16
Q

brand name: micronized estradiol

A

Estrace

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17
Q

brand name: estradiol acetate

A

Femtrace

18
Q

brand name: synthetic conjugated estrogen

A

Cenestin and Enjuvia

19
Q

brand name: esterified estrogens

A

Menest

20
Q

brand name: estropipate

A

Ogen

21
Q

What are the oral estrogen products metabolized into

A

estrone

22
Q

Which concentration of estrogen is higher in the transdermal patches?

A

estradiol

23
Q

What is a key difference in pharmacokinetics between the patches and the topical gels, sprays, and emulsions?

A

the patches release estradiol at a continuous rate unlike the gels, emulsions, and sprays

24
Q

What are the once weekly patches?

A

Climara, Climara Pro, and Menostar

25
Q

What are the twice weekly patches?

A

Alora, Minivelle, Vivelle, Vivelle Dot, and CombiPatch

26
Q

Site of application for Estrasorb topical emulsion

A

both thighs and calves

27
Q

Site of application for Estrogel topical gel

A

one arm from wrist to shoulder

28
Q

Site of application for Elestrin topical gel

A

one upper arm and shoulder area

29
Q

Site of application for Divigel topical gel

A

one upper thigh

30
Q

Site of application of Evamist topical spray

A

inner surface of the forearm starting near the elbow

31
Q

Why do we combine estrogen therapy with progestin?

A

to decrease the risk of endometrial hyperplasia and cancer

32
Q

Who should get progestin therapy?

A

all females who have not had a hysterectomy and are taking estrogen products

33
Q

What is the minimum day length required each month for progestin protection

A

12-14 days

34
Q

What is the benefit of micronized progesterone over synthetic?

A

better CV, BP, VTE, stroke, and breast cancer outcomes

35
Q

What is continuous cyclic (sequential) dosing?

A

estrogen daily with progestin coadministered for 12-14 days of cycle

36
Q

What is continuous combined dosing?

A

combined estrogen and progesin administration

37
Q

What is continuous long-cycle (cyclic withdrawal)?

A

estrogen given daily and progestin given 6 times per year (every other month) for 12-14 days

38
Q

What is intermittent combined?

A

3 days of estrogen therapy alone and then 3 days of combined estrogen and progestin

39
Q

What are the adverse effects of HRT?

A
  1. cardiovascular
  2. breast cancer
  3. endometrial cancer
  4. VTE
  5. Nausea
  6. Headache
  7. Breast tenderness
40
Q

Contraindications for HRT?

A
  1. unexplained vaginal bleeding
  2. Hx of breast/endometrial cancer
  3. Hx of VTE
  4. CHD, stroke, dementia
  5. severe liver disease
41
Q

Prescribing considerations

A
  1. < 60 yo
  2. within 10 years of menopause
  3. PMH
  4. FH
  5. BP, lipid panel, liver function
  6. mammogram, pap smear
  7. smoking status

Men's and Women's Health (2 decks)

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