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Women's Health - GYN > Menopause & Hormone Therapy > Flashcards

Menopause & Hormone Therapy Flashcards

1
Q

Clinical definition of menopause

A

Permanent cessation of menses after significant decrease in ovarian estrogen production

12 consecutive months with no menses

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2
Q

What is perimenopause?

A

Time period before menopause; transition from reproductive to non-reproductive years

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3
Q

How does estrogen change in perimenopause?

A

estrogen levels fluctuate unpredictably

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4
Q

What initiates the menstruation of uterus?

A

drop in progesterone

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5
Q

What are only things that influence age of menopause onset?

A

genetics

lifestyle (not much effect)

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6
Q

What hormone causes thickening of endometrium?

A

increased estrogen

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7
Q

What is premature ovarian failure?

A

menopause before age 40

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8
Q

How is premature ovarian failure dx’d?

A

FSH > 30

*trying to tell ovaries to make estrogen

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9
Q

Causes of premature ovarian failure?

A

genetic, autoimmune disorders, smoking, alkylating CA chemotherapy, hysterectomy

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10
Q

What is usually the first sign of menopause and most common sx of decreased estrogen?

A

hot flashes

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11
Q

How is sleep affected by menopause?

A

lengthened latent phase (time to fall asleep) with alterations in REM

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12
Q

How is bone density affected by menopause? Pathophysiology?

A

decreased bone density increasing risk of osteoporosis

progesterone and estrogen receptors on osteoblasts/clasts and affect cortical and trabecular bone

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13
Q

What is used to screen for osteoporosis? When is it started?

A

DEXA scan

Start testing for all postmenopausal women at 65yo and younger if have risk factor

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14
Q

How is DEXA scan scores reported?

A

T-score = std dev from mean peak BMD of nl, young adult population

Z-score = std dev from mean peak BMD of same age/sex/race of the pt

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15
Q

Normal, osteopenia, and osteoporosis t-scores?

A

Normal ≥-1.0
Osteopenia -1.0 to -2.5
Osteoporosis ≤ -2.5

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16
Q

Osteoporosis risk factors

A 
Medical hx of fragility fracture
Weight< 127lbs
Medical causes of bone loss (meds or disease)
Hx of hip fracture
Smoker
Alcoholism
RA
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17
Q

Osteoporosis treatment

A

Calcium (Ca++) 1200mg RDA

Vitamin D3

Hormone therapy (not primary indication)

Bisphosphonates - inhibit osteoclasts to reduce bone resorption

SERMs (selective estrogen receptor modulators) like tamoxifen

18
Q

Estrogen (E2 or estradiol) coverts to ________ by the liver.

A

E1 (estrone)

19
Q

What do we do for menopause estrogen replacement?

A

Combo estrogen-progesterone

OTC: Soy and isoflavones, St John’s wort, Black cohosh

BHRT

20
Q

Why are other routes of administration of estrogen replacement therapy better than oral pills?

A

When estrogen given orally converted to estrone, but remains unaltered if transdermal, transbuccal, transvaginal, IV or IM

21
Q

What is BHRT?

A

= Bio-identical hormone replacement therapy

replace hormones in your body using “natural” chemically identical hormones; NOT synthetic

22
Q

Effects of progesterone BHRT

A
  • Neutralizes estrogen dominance

- Helps thyroid function, adrenal function, sleep, building bones, decrease weight

23
Q

When _____ is low, woman has no ovulation.

A

estrogen

24
Q

What are two ways progesterone is produced?

A 
corpus luteum (majority)
adrenal glands (small amount)
25
Q

Reasons for for low progesterone

A

Anovulation
PCOS (cysts form instead of corpus luteum)
Luteal phase deficiency (ovaries produce less)
Oral contraceptives (don’t allow ovulation)
Emotional or physical stressors
Surgical/chemical dysfunctional ovaries
Perimenopause/menopause

26
Q

What are some contraindications of progesterone replacement?

A

Saliva testing WNL
Hx/current breast cancer
Fibroid tumor > 5cm
Hx blood clot

27
Q

What are some conditions that may be treated with progesterone?

A
  • Uterine fibroids < 5cm
  • May prevent BRCA by cell maturation induction
  • May prevent/treat osteoporosis by stimulating osteoblasts
  • Post-partem depression secondary to losing the placenta
28
Q

Lab for most accurate levels of progesterone? When?

A

saliva testing on day 16-24 if cycling (doesn’t matter when for non-cycling and men)

blood is NOT accurate

29
Q

What are risks of using synthetic estrogen replacement?

A

stimulates breast cancer, overrides natural balance and resets system

30
Q

Why does obesity increase estrogen levels?

A

fat cells convert cholesterol to estrogen

31
Q

Xenoestrogens

A

synthetic estrogen in meat, dairy, and plastics

32
Q

Effects of excess estrogen on body

A

everything grows! - weight gain, enlarged breasts, cysts, cancer, hyperplasia, hypothyroidism, disturbs sleep as excitotoxin

33
Q

What are 3 forms of estrogen?

A

Estrone (E1)
Estradiol (E2)
Estriol (E3)

34
Q

Which type of estrogen is most produced?

A

Estradiol (E2)

35
Q

Which type of estrogen has biggest impact on vagina?

A

Estriol (E3)

36
Q

Effects of decreased testosterone

A 
Fatigue
Depression
Breast tenderness
Erectile dysfunction
Decreased libido
Sleep disturbance
Muscle loss/weakness including the heart
Inflammatory diseases
37
Q

Meds that decrease testosterone

A 
Statins
SSRIs
Diuretics 
Lunesta
Cimetidine
Antipsychotics
Antifungals (-azoles)
38
Q

Positive effects of testosterone replacement therapy

A

Improves brain function, increases sex drive, improves HDL/LDL, increases energy, improves glucose metabolism, increases muscle and bone strength, improves cardio health, increases bone density

39
Q

What must also be prescribed if male started on testosterone therapy? Why?

A

aromatase inhibitor

body converts testosterone to estrogen

40
Q

Where is testosterone made in females?

A

ovaries

41
Q

Before giving testosterone in male, what must be checked?

A

prostate to rule out cancer

testosterone won’t cause cancer, but will worsen existing cancer

42
Q

Symptoms of hypothyroidism

A

depression, dry skin, weight gain, increased BP, increased cholesterol, PMS, infertility, erectile dysfunction

Women's Health - GYN (12 decks)

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