Menopause Flashcards
What is the definition of menopause?
12 consecutive months without a period
What is the average age of menopause?
52
What is the definition of premature menopause?
Cessation of ovulation/menses <40 years old, either spontaneous or induced
What laboratory findings are associated with menopause?
FSH >40
LH 20-100
E2- <20pg/mL
What happens to bone integrity post-menopause and why?
Increased bone loss associated with decreased estrogen
What happens to vaginal pH after menopause?
Due to decrease in estrogen and change in vaginal microbes, pH becomes alkaline >5.0
At what age is it appropriate to stop paps if the most recent test was within 5 years and all have been negative in the last 10 years?
65 years old
If there is a history of CIN-2 or higher, how long should you continue screening?
20 years after spontaneous regression or appropriate management
When are vasomotor symptoms most frequent and severe?
the first two years after the final menstrual period
How long do vasomotor symptoms usually last?
Typically 5-7 years but may continue longer than 10-15 years
What are some proven non-pharmacologic ways to manage mild/moderate vasomotor symptoms?
Cognitive behavioral therapy and clinical hypnosis
Is estrogen therapy (ET) only for a woman with or without a uterus?
Unopposed estrogen is for an individual without a uterus
What is the main point of progesterone in estrogen progesterone therapy (EPT)?
To reduce the risk of endometrial cancer in women with a uterus associated with unopposed estrogen
What is the only FDA approved human estrogen available?
17B-estradiol
What does SERM or ERAA stand for and what is it?
SERM- Selective estrogen receptor modulators
ERAA- Estrogen receptor agonists/antagonists
It is an estrogen like compound that acts as an estrogen agonist or antagonist depending on the SERM and target tissue
What is CEE?
Conjugated equine estrogen.
Mixture of estrogens isolated from urine of pregnant mares
What is BZA and what is it used for?
Bazedoxifene is a SERM with estrogen antagonist effects on endometrial and breast tissue and estrogen agonist on bone.
Often used with CEE as an alternative to adding a progestogen to prevent endometrial hyperplasia
CEE combined with medroxyprogesterone acetate (MPA) does what compared to BZA/CEE use?
Less unscheduled uterine bleeding and less breast tenderness and similar prevention of bone loss, vasomotor symptoms and vulvovaginal atrophy
Bio-identical hormones are chemically identical to hormones produced during what phase of a woman’s life?
Reproductive
How does oral estrogen therapy alone affect CV markers such as HDL-C and LDL-C?
positively, by increasing HDL-C and decreasing LDL-C
How does oral estrogen therapy alone affect CV markers such as triglycerides and c-reactive protein levels?
negatively, by increasing triglycerides and CRP levels
What is continuous cyclic EPT and is there a withdrawal bleed?
Estrogen everyday with progestogen added 12-14 days monthly.
Withdrawal bleed when progestogen withdrawn each month
What is continuous combined EPT and how does it affect bleeding?
Estrogen and low dose progestogen everyday.
Unpredictable bleeding at first, then usually the women has amenorrhea
What are some side effects of HT related to estrogen?
breast tenderness (subsides after a few weeks), nausea, fluid retention and bloating
What are some side effects of HT related to progestogen?
breast tenderness (subsides after a few weeks), fluid retention and bloating, alterations in mood
What is the only non hormonal pharmacologic method approved by the FDA for vasomotor symptoms?
Paxil 7.5mg daily at bedtime
What symptoms are associated with GSM?
Genital dryness/burning/irritation
Sexual symptoms- lack of lubrication/discomfort/impaired function
Urinary symptoms- nocturia, urgency, dysuria and recurrent UTIs
Which two drugs aid with dyspareunia associated with GSM?
Ospemifine and Prasterone
What do the studies show about HT and dementia?
Relationship is inconclusive.
But, there is a small increase if EPT is initiated in individuals older >65
