Menopause Flashcards
Clinical definition of menopause
>12 months of amenorrhea due to depletion of ovarian follicles
Median age for natural menopause
51 years
___ is the first and principal hormone to be lost in perimenopause
Inhibin is the first and principal hormone to be lost in perimenopause
Consequentially, FSH increases, and estrogen increases in turn.
As women progress towards menopause, the ___ shortens
As women progress towards menopause, the follicular phase shortens
Why are perimenopausal women at high risk for endometrial hyperplasia and endometrial cancer?
- The downstream effect of low inhibin raises estrogen levels
- There are frequently anovulatory cycles, meaning that endometrium is exposed to unopposed estrogen signaling for longer periods
Hormone profile of perimenopause vs menopause
- Perimenopause: Low inhibin, high estradiol, high FSH, normal LH
- Menopause: Low inhibin, low estradiol, high FSH, high LH
Etiology of hot flashes in perimenopause and menopause
It is hypothesized that subacute estrogen withdrawal increases neurotransmitter concentrations (serotonin and norepinephrine) in the hypothalamus thermoregulatory center, which has the effect of narrowing the “thermoregulatory zone” and decreasing the barrier for vasomotor thermoregulatory responses.
Mechanism of osteoporosis in menopausal patients
Estrogen is a major positive regulator of osteoprotegrin.
When estrogen levels drop, osteoprotegrin levels drop, and thus there is more free RANKL to stimulate osteoclast development and activation.
Effects of hypoestrogenemia on cardiovascular health
Low estrogen increases levels of circulating LDL, increasing risk of atherosclerotic disease.
Menopausal vulvovaginal atrophy
Lack of estrogen stimulation leads to thinning of vaginal epithelium and loss of vaginal collagen, adipose tissue, and sebaceous glands.
The result is dryness, itchiness, and dyspareunia
Hypoestrogenemia and the lower urinary tract
Hypoestrogenemia decreases urinary epithelium thickness, aka atrophic urethritis, increasing risk for incontinence and UTIs.
Also increases risk of stress incontinence from pelvic organ prolapse, since those structures may also become atrophic in the absence of estrogen.
Menopausal hormone therapy
- Goal is to use the minimal dose for the shortest amount of time possible to overcome menopausal symptoms
- Defends bone integrity and decreases symptoms of menopause
- Risks of estrogen + progesterone therapy in women with a uterus:
- Breast cancer, stroke, VTE, coronary heart disease
- However, it is protective against colon cancer as well
- Risks of estrogen only therapy in women without a uterus:
- Stroke, VTE
Alternatives to menopausal hormone therapy
- Gabapentin (mechanism unknown)
- Clonidine (central alpha 2 agonist, acts directly in thermoregulatory center)
- SSRIs / SNRIs (act directly in thermoregulatory center)
Commonly touted herbal menopause remedies
Black cohosh
Phytoestrogens
Both have questionable evidence and are not recommended for treatment.
Vaginal estrogen for menopausal symptoms
May be used for vulvovaginal or urinary symptoms of menopause
Effective for these symptoms and is not absorbed systemically in any significant amount.
