Menopause and HRT

Question 1

Menopause definition

Answer 1

One year without Menses, or FSH over 30

Question 2

Perimenopause

Answer 2

Age group near menopausal age, 45-55, with symptoms.

Question 3

Postmenopause

Answer 3

beyond menopause or over age 55

Question 4

When is the end of reproductive life?

Answer 4

43 yo

Question 5

The biology of menopause, KNOW:

Answer 5

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

Question 6

Number one reason women say they seek hormone replacement therapy

Answer 6

Menopause related symptoms

Question 7

Most common symptoms of menopause

Answer 7

hot flases

Question 8

What causes hot flashes

Answer 8

Probably due to gonadotropin spikes as much as estrogen deficiency.

Question 9

See treatment slide

Answer 9

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

Question 10

Other symptoms of menopause

Answer 10

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.

Question 11

Symptoms that are NOT associated with menopause

Answer 11

• Depression
• Lack of interest in sex
• crazy

Question 12

Dyspaerunia

Answer 12

painful intercourse

Question 13

Risk factors for osteoporosis

Answer 13

caucasian/asian
thin
smoker
alcohol use
steroid use
family history

Question 14

KNOW: Estrogen therapy is approved for the prevention of osteoporosis, not the treatment though

Answer 14

ok

Question 15

When should women begin having bone density measurements?

Answer 15

age 65

Question 16

WHI showed that Estrogen therapy does significantly reduce the risk of fracture

Answer 16

ok

Question 17

Number one killer of older women

Answer 17

cardiovascular disease

Question 18

WHI Estrogen Progestin study

Answer 18

Asked two questions:
1 Does HT prevent CVD
2 Does HT cause breast cancer

Question 19

Why were these two questions asked?

Answer 19

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

Question 20

What’s the major problem with observational studies?

Answer 20

Bias

Question 21

Perimenopausal use of HT (theory)

Answer 21

• Positive effects on vascular remodelling
• Decreased Intimal Thickening
• Decreases the incidence of plaques

Question 22

Postmenopausal use of HT (theory)

Answer 22

• 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

Question 23

Estrogen does increase the risk of stroke and DVT

Answer 23

ok

Question 24

Estrogen decreases colon cancer risk

Answer 24

ok

Question 25

Breast cancer risk increases with EPT

Answer 25

ok…..must use beyond 5 years