Menopause and HRT Flashcards
Menopause definition
One year without Menses, or FSH over 30
Perimenopause
Age group near menopausal age, 45-55, with symptoms.
Postmenopause
beyond menopause or over age 55
When is the end of reproductive life?
43 yo
The biology of menopause, KNOW:
With less amounts of estrogen being made, FSH rises. This causes menses to become less frequent, lighter
- Menopause is defined as: no menses for a year or FSH over 30
Number one reason women say they seek hormone replacement therapy
Menopause related symptoms
Most common symptoms of menopause
hot flases
What causes hot flashes
Probably due to gonadotropin spikes as much as estrogen deficiency.
See treatment slide
mostly includes Estrogen therapy in the form of Estroadiol (pills or transdermal patches).
Progestin is added if the pt has a uterus in order to prevent endometrial cancer
Other symptoms of menopause
Vaginal Atrophy, this comes on late and occurs because some epithelial cells in the vagina have estrogen receptors and without estrogen they basically dry up.
Symptoms that are NOT associated with menopause
- Depression
- Lack of interest in sex
- crazy
Dyspaerunia
painful intercourse
Risk factors for osteoporosis
caucasian/asian thin smoker alcohol use steroid use family history
KNOW: Estrogen therapy is approved for the prevention of osteoporosis, not the treatment though
ok
When should women begin having bone density measurements?
age 65
WHI showed that Estrogen therapy does significantly reduce the risk of fracture
ok
Number one killer of older women
cardiovascular disease
WHI Estrogen Progestin study
Asked two questions:
1 Does HT prevent CVD
2 Does HT cause breast cancer
Why were these two questions asked?
Because early loss of endogenous estrogen (oopherectomy and premature ovarian failure) is associated with CVD
Women are protected from CVD until menopause…this suggests that estrogen plays a role
Endogenous estrogen, we know, increases smooth muscle proliferation, lowers cholesterol, and improves vascular tone
What’s the major problem with observational studies?
Bias
Perimenopausal use of HT (theory)
- Positive effects on vascular remodelling
- Decreased Intimal Thickening
- Decreases the incidence of plaques
Postmenopausal use of HT (theory)
- In women over 65, plaques had most likely already formed.
- Estrogen had thrombogenic effects
- Increased rte of MI in year one
This risk increases as you get further from menopause. In reality, it looks like you have to be 20 years out of menopause before estrogen has a significant effect in regards to increasing your risk of heart disease and MI
Estrogen does increase the risk of stroke and DVT
ok
Estrogen decreases colon cancer risk
ok
Breast cancer risk increases with EPT
ok…..must use beyond 5 years
