Menopause and HRT Flashcards
When is perimenopause?
Time period preceding menopause
What is perimenopause?
Fertility wanes and menstrual cycle irregularity increases, until the first year after cessation of menses
What is the mean duration of perimenopause?
4 years
What is menopause?
Permanent cessation of menses followed by the loss of ovarian follicular activity
What is the median age of onset for menopause?
51 years
After how many months of amenorrhea is menopause?
12 months (time of final menses is determined retrospectively)
What is premature ovarian insufficiency?
Menopause before the age of 40
How do we treat premature ovarian insufficiency?
Treatment considered more critical
Recognized to be at an increased risk for premature morbidity and mortality
What are the causes of menopause?
Age (natural)
Surgery (total abdominal hysterectomy, bilateral oophrectomy)
Medications (chemo)
Pelvic radiation
What is follicular atresia?
Breakdown of follicles
How many follicles remain at the time of menopause?
Very few
What is the pathophysiology for menopause?
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
By how much does FSH increase during menopause?
10-15 fold
What does inhibin B do?
Inhibits FSH secretion
Why does the uterus and vagina become atrophic?
Due to decreased estrogen levels
What are signs of menopause?
Menstrual cycle irregularity
Urogenital atrophy
What are the sx of menopause?
Vasomotor
Psychological
Genitourinary syndrome of menopause
Others
What are the vasomotor sx of menopause?
Hot flashes
Night sweats
What are the psychological sx of menopause?
Anxiety
Mood swings
Depression
Problems with concentration and memory
What are the genitourinary syndrome sx of menopause?
Vaginal dryness, burning, irritation
Dyspareunia -> painful intercourse
Sexual dysfunction
Urinary incontinence
What are other sx of menopause?
Sleep disturbance
Joint pain
HA
Metabolic (effects on body composition, lipids, vascular function, bone metabolism)
What is the diagnosis of menopause?
S/sx
Age
FSH
Anti-mullerian hormone
What is the FSH level of a woman during perimenopause?
10-12+ (on day 2 or 3 of the menstrual cycle)
What is the FSH level of a woman during menopause?
40+
What is the FSH level of a normal woman not during menopause?
4-10
What is anti-meullerian hormone?
Product of growing ovarian follicles
Concentrations decline with age
What do low concentrations of anti-mullerian hormone predict?
Diminishing ovarian reserve?
When can anti-mullerian hormone be taken?
Any time during the cycle
What is the pharmacological therapy for menopause?
HRT
What are the HRT’s for menopause?
Estrogen
Estrogen + progestin
What are the benefits of HRT?
Vasomotor sx
Prevention of bone loss
Genitourinary syndrome of menopause
What is the non-pharm treatment for hot-flashes/night sweats?
Lower the temp
Light blankets/sheets
Wearing cotton
Avoiding spicy foods, hot beverages, caffeine
What is the non-pharm treatment for vaginal dryness?
Lubricants
Increase fluids
What is the non-pharm treatment for dyspareunia?
Lubricant
What is the non-pharm treatment for decreased libido?
Discuss with partner
What is the non-pharm treatment for urinary incontinence?
Kegel exercises
Scheduled voiding
Caffeine reduction
What is the non-pharm treatment for mood alteration?
Exercise
Relaxation techniques
What are the types of oral estrogens?
Conjugated equine estrogen
Micronized estradiol
What is oral estrogen metabolized to?
Estrone (weaker estrogen)
What are the dosage forms for estrogen?
Oral
Transdermally
Intravaginally
Where is micronized estradiol absorbed?
Small intestines
Does transdermal estrogen have first-pass metabolism?
No, it bypasses it
What are transdermal estrogens associated with?
Slightly lower risk of CAD, stroke, and VTE when compared to oral
When are transdermal estrogens more appropriate?
Women with DM, HTN, and other CV RFs
What dosage form has greater estradiol concentrations than estrone?
Transdermal
What dosage form has greater estrone concentrations than estradiol?
Oral
Do intravaginal estrogens require opposing progesterone?
No
Which intravaginal form has lower systemic absorption?
Vaginal tablets and rings
Creams are higher
Do low dose vaginal estrogen preparations appear to stimulate the endometrium?
Minimally
What other disorder can intravaginal estrogens help with?
Urinary incontinence
How do intravaginal estrogens work on urinary incontinence?
Reduces the frequency and amplitude of detrusor contractions (ie detrusor muscle relaxation)
Why do we include progestin in estrogen therapy?
Monotherapy has an increased risk of endometrial hyperplasia and cancer
When is progestin included in estrogen therapy?
All women that have not had a hysterectomy receiving systemic estrogen therapy (not intravaginally)
