Menopause & Hormone Therapy Flashcards
Clinical definition of menopause
Permanent cessation of menses after significant decrease in ovarian estrogen production
12 consecutive months with no menses
What is perimenopause?
Time period before menopause; transition from reproductive to non-reproductive years
How does estrogen change in perimenopause?
estrogen levels fluctuate unpredictably
What initiates the menstruation of uterus?
drop in progesterone
What are only things that influence age of menopause onset?
genetics
lifestyle (not much effect)
What hormone causes thickening of endometrium?
increased estrogen
What is premature ovarian failure?
menopause before age 40
How is premature ovarian failure dx’d?
FSH > 30
*trying to tell ovaries to make estrogen
Causes of premature ovarian failure?
genetic, autoimmune disorders, smoking, alkylating CA chemotherapy, hysterectomy
What is usually the first sign of menopause and most common sx of decreased estrogen?
hot flashes
How is sleep affected by menopause?
lengthened latent phase (time to fall asleep) with alterations in REM
How is bone density affected by menopause? Pathophysiology?
decreased bone density increasing risk of osteoporosis
progesterone and estrogen receptors on osteoblasts/clasts and affect cortical and trabecular bone
What is used to screen for osteoporosis? When is it started?
DEXA scan
Start testing for all postmenopausal women at 65yo and younger if have risk factor
How is DEXA scan scores reported?
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
Normal, osteopenia, and osteoporosis t-scores?
Normal ≥-1.0
Osteopenia -1.0 to -2.5
Osteoporosis ≤ -2.5
Osteoporosis risk factors
Medical hx of fragility fracture Weight< 127lbs Medical causes of bone loss (meds or disease) Hx of hip fracture Smoker Alcoholism RA
Osteoporosis treatment
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
Estrogen (E2 or estradiol) coverts to ________ by the liver.
E1 (estrone)
What do we do for menopause estrogen replacement?
Combo estrogen-progesterone
OTC: Soy and isoflavones, St John’s wort, Black cohosh
BHRT
Why are other routes of administration of estrogen replacement therapy better than oral pills?
When estrogen given orally converted to estrone, but remains unaltered if transdermal, transbuccal, transvaginal, IV or IM
What is BHRT?
= Bio-identical hormone replacement therapy
replace hormones in your body using “natural” chemically identical hormones; NOT synthetic
Effects of progesterone BHRT
- Neutralizes estrogen dominance
- Helps thyroid function, adrenal function, sleep, building bones, decrease weight
When _____ is low, woman has no ovulation.
estrogen
What are two ways progesterone is produced?
corpus luteum (majority) adrenal glands (small amount)
Reasons for for low progesterone
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
What are some contraindications of progesterone replacement?
Saliva testing WNL
Hx/current breast cancer
Fibroid tumor > 5cm
Hx blood clot
What are some conditions that may be treated with progesterone?
- 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
Lab for most accurate levels of progesterone? When?
saliva testing on day 16-24 if cycling (doesn’t matter when for non-cycling and men)
blood is NOT accurate
What are risks of using synthetic estrogen replacement?
stimulates breast cancer, overrides natural balance and resets system
Why does obesity increase estrogen levels?
fat cells convert cholesterol to estrogen
Xenoestrogens
synthetic estrogen in meat, dairy, and plastics
Effects of excess estrogen on body
everything grows! - weight gain, enlarged breasts, cysts, cancer, hyperplasia, hypothyroidism, disturbs sleep as excitotoxin
What are 3 forms of estrogen?
Estrone (E1)
Estradiol (E2)
Estriol (E3)
Which type of estrogen is most produced?
Estradiol (E2)
Which type of estrogen has biggest impact on vagina?
Estriol (E3)
Effects of decreased testosterone
Fatigue Depression Breast tenderness Erectile dysfunction Decreased libido Sleep disturbance Muscle loss/weakness including the heart Inflammatory diseases
Meds that decrease testosterone
Statins SSRIs Diuretics Lunesta Cimetidine Antipsychotics Antifungals (-azoles)
Positive effects of testosterone replacement therapy
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
What must also be prescribed if male started on testosterone therapy? Why?
aromatase inhibitor
body converts testosterone to estrogen
Where is testosterone made in females?
ovaries
Before giving testosterone in male, what must be checked?
prostate to rule out cancer
testosterone won’t cause cancer, but will worsen existing cancer
Symptoms of hypothyroidism
depression, dry skin, weight gain, increased BP, increased cholesterol, PMS, infertility, erectile dysfunction
