Menopause Dr. Pond

Question 1

When does Menopause start?

Answer 1

-at about 51 years

-ovary stops to secrete estrogen

-happens gradually

Question 2

Symptoms of Menopause

Answer 2

Vasomotor symptoms: constriction or dilation of blood vessels (the brain perceives an increase in body temperature)

-hot flashes, night sweats, heart palpitations, changes in blood pressure

Question 3

Physiology of vasomotor symptoms

Answer 3

KNDy neurons regulate the cooling mechanism in the hypothalamus (thermoregulatory center)

Neurokinin B (NKB) activates KNDy neurons
estrogen inhibits KNDy neurons
-> This balance provides normal thermoregulation

when estrogens stops during menopause -> heat dissipation throughout the body is activated -> the brain thinks it is too hot -> hot flashes, sweat

Question 4

Drug that indicated for the relief of Vasomotor symptoms

Answer 4

-fezolinetant

-oral NK3-receptor antagonist
-reduces NKB signaling and KNDy neuron activity
-help to restore thermoregulatory balance

ADE: GI pain, diarrhea, insomnia
Endometrial hyperplasia
Endometrial cancer risk
elevated liver enzymes (mild and transient)

Question 5

Other menopausal symptoms

Answer 5

-mood swings
-vaginal dryness
-urinary symptoms (due estrogens role in urogenital tone
-bone loss! (estrogen has antiresorptive effect, opposing osteoclasts)
-increase in CV! (leading cause of death in menopausal women)

Question 6

hormonal replacement therapy risks

Answer 6

-estrogen alone therapy only in patients without a uterus (due to cancer risk), otherwise use estrogen + progesterone

-risks: hypertension (estrogen increases angiotensin (vasoconstrictor) release)
clots, stroke (may be due to increased risk for clots)

info: BUT estrogen also increases nitric oxide - vasodilation)