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Men's and Women's Health > Menopause and HRT > Flashcards

Menopause and HRT Flashcards

1
Q

When is perimenopause?

A

Time period preceding menopause

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2
Q

What is perimenopause?

A

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

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3
Q

What is the mean duration of perimenopause?

A

4 years

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4
Q

What is menopause?

A

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

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5
Q

What is the median age of onset for menopause?

A

51 years

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6
Q

After how many months of amenorrhea is menopause?

A

12 months (time of final menses is determined retrospectively)

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7
Q

What is premature ovarian insufficiency?

A

Menopause before the age of 40

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8
Q

How do we treat premature ovarian insufficiency?

A

Treatment considered more critical

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

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9
Q

What are the causes of menopause?

A

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

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10
Q

What is follicular atresia?

A

Breakdown of follicles

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11
Q

How many follicles remain at the time of menopause?

A

Very few

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12
Q

What is the pathophysiology for menopause?

A

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

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13
Q

By how much does FSH increase during menopause?

A

10-15 fold

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14
Q

What does inhibin B do?

A

Inhibits FSH secretion

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15
Q

Why does the uterus and vagina become atrophic?

A

Due to decreased estrogen levels

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16
Q

What are signs of menopause?

A

Menstrual cycle irregularity

Urogenital atrophy

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17
Q

What are the sx of menopause?

A

Vasomotor
Psychological
Genitourinary syndrome of menopause
Others

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18
Q

What are the vasomotor sx of menopause?

A

Hot flashes

Night sweats

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19
Q

What are the psychological sx of menopause?

A

Anxiety
Mood swings
Depression
Problems with concentration and memory

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20
Q

What are the genitourinary syndrome sx of menopause?

A

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

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21
Q

What are other sx of menopause?

A

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

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22
Q

What is the diagnosis of menopause?

A

S/sx
Age
FSH
Anti-mullerian hormone

23
Q

What is the FSH level of a woman during perimenopause?

A

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

24
Q

What is the FSH level of a woman during menopause?

A

40+

25
Q

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

A

4-10

26
Q

What is anti-meullerian hormone?

A

Product of growing ovarian follicles

Concentrations decline with age

27
Q

What do low concentrations of anti-mullerian hormone predict?

A

Diminishing ovarian reserve?

28
Q

When can anti-mullerian hormone be taken?

A

Any time during the cycle

29
Q

What is the pharmacological therapy for menopause?

A

HRT

30
Q

What are the HRT’s for menopause?

A

Estrogen

Estrogen + progestin

31
Q

What are the benefits of HRT?

A

Vasomotor sx
Prevention of bone loss
Genitourinary syndrome of menopause

32
Q

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

A

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

33
Q

What is the non-pharm treatment for vaginal dryness?

A

Lubricants

Increase fluids

34
Q

What is the non-pharm treatment for dyspareunia?

A

Lubricant

35
Q

What is the non-pharm treatment for decreased libido?

A

Discuss with partner

36
Q

What is the non-pharm treatment for urinary incontinence?

A

Kegel exercises
Scheduled voiding
Caffeine reduction

37
Q

What is the non-pharm treatment for mood alteration?

A

Exercise

Relaxation techniques

38
Q

What are the types of oral estrogens?

A

Conjugated equine estrogen

Micronized estradiol

39
Q

What is oral estrogen metabolized to?

A

Estrone (weaker estrogen)

40
Q

What are the dosage forms for estrogen?

A

Oral
Transdermally
Intravaginally

41
Q

Where is micronized estradiol absorbed?

A

Small intestines

42
Q

Does transdermal estrogen have first-pass metabolism?

A

No, it bypasses it

43
Q

What are transdermal estrogens associated with?

A

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

44
Q

When are transdermal estrogens more appropriate?

A

Women with DM, HTN, and other CV RFs

45
Q

What dosage form has greater estradiol concentrations than estrone?

A

Transdermal

46
Q

What dosage form has greater estrone concentrations than estradiol?

A

Oral

47
Q

Do intravaginal estrogens require opposing progesterone?

A

No

48
Q

Which intravaginal form has lower systemic absorption?

A

Vaginal tablets and rings

Creams are higher

49
Q

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

A

Minimally

50
Q

What other disorder can intravaginal estrogens help with?

A

Urinary incontinence

51
Q

How do intravaginal estrogens work on urinary incontinence?

A

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

52
Q

Why do we include progestin in estrogen therapy?

A

Monotherapy has an increased risk of endometrial hyperplasia and cancer

53
Q

When is progestin included in estrogen therapy?

A

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

Men's and Women's Health (3 decks)

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