Menopause and HRT 3

Question 1

What is the clinical significance of menopause?

Answer 1

• Cessation of preproduction, still need birth control until one year after FMP
  
  • possible to get pregnant
• Women will wpend 1/3 of their lives in postmenopausal years
• Increased prevalence of or development of new diseases in the postmenopausal years
• Landmark event, good time to identify health risks
  
  • focus on disease prevention
  • institude needed lifestyle changes
  • quality of life can deteriorate significantly otherwise
• Physician should engage in self-assessment to become role models for good health

Question 2

What are the major diseases that are associated with menopause transition or postmenopausal years?

Answer 2

• Depression
• Coronary Heart Disease (CHD)
• Osteoporosis

Question 3

How does menopause affect the risk of depression?

Answer 3

• Menopause transition
  
  • 2x greater risk for clinical depression
  • risk factors
    
    • prior history
    • postpartum depression
    • PMS/PMDD
• Stressful life events
  
  • empty nest
  • illness in spouse
  • elder care
  • job changes
  • does not normalize depression risk even if corrected
• Benefits of screening
  
  • ​interferes with health-seeking behaviors
  • life threatening
  • treatable
  • risk factor for development of coronary heart disease

Question 4

How does menopause affect the risk of coronary heart disease?

Answer 4

• Notable increase in cardiovascular disease after menopause
• At age 50, lifetime risk is ~1/2.5
• Role of estrogen deficiency
  
  • women with premature menopause have earlier onset
  • increase in total cholesterol, LDL-C, and triglycerides
    
    • also increases insulin resistance, vasoconstriction, and procoagulant factors
    • decrease in HDL-C, endothelin, and prostacyclin
  • estrogen-only therapy seems to decrease coronary artery calcification
  • however, once CHD is already established, estrogen can actuall accelerate problems

Question 5

How does menopause affect the risk of osteoporosis?

Answer 5

• Marked bone loss one year before and two years after FMP
• Can be prevented with estrogen, but will rapidly decline if therapy is discontinued
• Osteoporosis and hip fracture are serious concerns for all women >/= 70 years
• One of two Caucasian women over 50 will suffer osteoporotic fracture
• Prevention strategies
  
  • ​calcium and vitamin D
  • weight bearing and muscle-strengthening exercise
  • decrease risk factors for falls
• Diagnose with DXA scan or FRAX
• Treat with drugs such as bisphosphonates, denosumab, raloxifene, calcitonin, etc.