Menopause and HRT

Question 1

When is perimenopause?

Answer 1

Time period preceding menopause

Question 2

What is perimenopause?

Answer 2

Fertility wanes and menstrual cycle irregularity increases, until the first year after cessation of menses

Question 3

What is the mean duration of perimenopause?

Answer 3

4 years

Question 4

What is menopause?

Answer 4

Permanent cessation of menses followed by the loss of ovarian follicular activity

Question 5

What is the median age of onset for menopause?

Answer 5

51 years

Question 6

After how many months of amenorrhea is menopause?

Answer 6

12 months (time of final menses is determined retrospectively)

Question 7

What is premature ovarian insufficiency?

Answer 7

Menopause before the age of 40

Question 8

How do we treat premature ovarian insufficiency?

Answer 8

Treatment considered more critical

Recognized to be at an increased risk for premature morbidity and mortality

Question 9

What are the causes of menopause?

Answer 9

Age (natural)
Surgery (total abdominal hysterectomy, bilateral oophrectomy)
Medications (chemo)
Pelvic radiation

Question 10

What is follicular atresia?

Answer 10

Breakdown of follicles

Question 11

How many follicles remain at the time of menopause?

Answer 11

Very few

Question 12

What is the pathophysiology for menopause?

Answer 12

Ovarian follicle numbers decrease with age
Ovaries no longer primary site of estrogen and progesterone synthesis
Increased FSH + decreased inhibin B
Remaining oocytes do not respond to gonadotropins
Uterus and vagina become atrophic

Question 13

By how much does FSH increase during menopause?

Answer 13

10-15 fold

Question 14

What does inhibin B do?

Answer 14

Inhibits FSH secretion

Question 15

Why does the uterus and vagina become atrophic?

Answer 15

Due to decreased estrogen levels

Question 16

What are signs of menopause?

Answer 16

Menstrual cycle irregularity

Urogenital atrophy

Question 17

What are the sx of menopause?

Answer 17

Vasomotor
Psychological
Genitourinary syndrome of menopause
Others

Question 18

What are the vasomotor sx of menopause?

Answer 18

Hot flashes

Night sweats

Question 19

What are the psychological sx of menopause?

Answer 19

Anxiety
Mood swings
Depression
Problems with concentration and memory

Question 20

What are the genitourinary syndrome sx of menopause?

Answer 20

Vaginal dryness, burning, irritation
Dyspareunia -> painful intercourse
Sexual dysfunction
Urinary incontinence

Question 21

What are other sx of menopause?

Answer 21

Sleep disturbance
Joint pain
HA
Metabolic (effects on body composition, lipids, vascular function, bone metabolism)

Question 22

What is the diagnosis of menopause?

Answer 22

S/sx
Age
FSH
Anti-mullerian hormone

Question 23

What is the FSH level of a woman during perimenopause?

Answer 23

10-12+ (on day 2 or 3 of the menstrual cycle)

Question 24

What is the FSH level of a woman during menopause?

Answer 24

40+

Question 25

What is the FSH level of a normal woman not during menopause?

Answer 25

4-10

Question 26

What is anti-meullerian hormone?

Answer 26

Product of growing ovarian follicles | Concentrations decline with age

Question 27

What do low concentrations of anti-mullerian hormone predict?

Answer 27

Diminishing ovarian reserve?

Question 28

When can anti-mullerian hormone be taken?

Answer 28

Any time during the cycle

Question 29

What is the pharmacological therapy for menopause?

Answer 29

HRT

Question 30

What are the HRT's for menopause?

Answer 30

Estrogen | Estrogen + progestin

Question 31

What are the benefits of HRT?

Answer 31

Vasomotor sx Prevention of bone loss Genitourinary syndrome of menopause

Question 32

What is the non-pharm treatment for hot-flashes/night sweats?

Answer 32

Lower the temp Light blankets/sheets Wearing cotton Avoiding spicy foods, hot beverages, caffeine

Question 33

What is the non-pharm treatment for vaginal dryness?

Answer 33

Lubricants | Increase fluids

Question 34

What is the non-pharm treatment for dyspareunia?

Answer 34

Lubricant

Question 35

What is the non-pharm treatment for decreased libido?

Answer 35

Discuss with partner

Question 36

What is the non-pharm treatment for urinary incontinence?

Answer 36

Kegel exercises Scheduled voiding Caffeine reduction

Question 37

What is the non-pharm treatment for mood alteration?

Answer 37

Exercise | Relaxation techniques

Question 38

What are the types of oral estrogens?

Answer 38

Conjugated equine estrogen | Micronized estradiol

Question 39

What is oral estrogen metabolized to?

Answer 39

Estrone (weaker estrogen)

Question 40

What are the dosage forms for estrogen?

Answer 40

Oral Transdermally Intravaginally

Question 41

Where is micronized estradiol absorbed?

Answer 41

Small intestines

Question 42

Does transdermal estrogen have first-pass metabolism?

Answer 42

No, it bypasses it

Question 43

What are transdermal estrogens associated with?

Answer 43

Slightly lower risk of CAD, stroke, and VTE when compared to oral

Question 44

When are transdermal estrogens more appropriate?

Answer 44

Women with DM, HTN, and other CV RFs

Question 45

What dosage form has greater estradiol concentrations than estrone?

Answer 45

Transdermal

Question 46

What dosage form has greater estrone concentrations than estradiol?

Answer 46

Oral

Question 47

Do intravaginal estrogens require opposing progesterone?

Answer 47

No

Question 48

Which intravaginal form has lower systemic absorption?

Answer 48

Vaginal tablets and rings | Creams are higher

Question 49

Do low dose vaginal estrogen preparations appear to stimulate the endometrium?

Answer 49

Minimally

Question 50

What other disorder can intravaginal estrogens help with?

Answer 50

Urinary incontinence

Question 51

How do intravaginal estrogens work on urinary incontinence?

Answer 51

Reduces the frequency and amplitude of detrusor contractions (ie detrusor muscle relaxation)

Question 52

Why do we include progestin in estrogen therapy?

Answer 52

Monotherapy has an increased risk of endometrial hyperplasia and cancer

Question 53

When is progestin included in estrogen therapy?

Answer 53

All women that have not had a hysterectomy receiving systemic estrogen therapy (not intravaginally)