Menopause + HRT

Question 1

Impacts age of menopause onset (earlier)

Answer 1

smoking

Question 2

one year without menses

Answer 2

Menopause

Question 3

symptoms of menopause, but periods (45-55y/o)

Answer 3

Perimenopause

Question 4

Women spend ___ of their life in menopause

Answer 4

1/3

Question 5

End of reproductive life about __ y/o

Answer 5

43

Question 6

After repro life ends, Ovary continues to produce:

Answer 6

sporadic + abnormal eggs

Question 7

After repro life ends, how do estrogen levels change (even w ovulation)?

Answer 7

decrease

Question 8

How do FSH levels change around menopause?

Answer 8

FSH rises

Question 9

Menopause defined as:

Answer 9

No menses for a year

FSH >30

Question 10

Symptoms of Menopause:

Most common, and why?

Answer 10

Hot flashes + night sweats which affect sleep

Probably due to gonadotropin spikes as much as estrogen deficiency

Question 11

Symptoms of Menopause:

Less common?

Answer 11

Skin changes/vasodilation

Question 12

T/F: White women have worse hot flashes than black women.

Answer 12

F: white women are just annoying and whiney.

Question 13

FDA-Approved Indications for HT:

Answer 13

estrogen + (if pt has uterus) progestin

Question 14

Why would you give progestin to a patient?

Answer 14

rx with estrogen if patient has a uterus to prevent endometrial CA

Question 15

Postmenopausal HT is indicated for:

Answer 15

1. trx of moderate-to-severe vasomotor symptoms
2. trx of vulvar and vaginal atrophy*
3. Prevention of postmenopausal osteoporosis

Question 16

The preferred trx for women with vaginal symptoms only:

Answer 16

low doses of vaginal estrogen

no need for progestins, non-systemic

Question 17

Can you give topical estrogen to patients with ER+ breast cancer?

Answer 17

Dr. Phillips thinks so–very little becomes systemic, so no issues

Question 18

Women who are s/p hyst need estrogen (with, without) progesterone.

Answer 18

without–no uterine cancer risk

Question 19

Estradiol is made from:

Answer 19

a plant derivative

Question 20

Associated with menopause?

Depression

Answer 20

No!

what else is going on in her life? did her kids just go to college, etc?

Question 21

Associated with menopause?

Vaginal dryness

Answer 21

Yes

Question 22

Associated with menopause?

Decreased libido

Answer 22

No

Question 23

Associated with menopause?

vaginal atrophy

Answer 23

Yes

Question 24

Medical Illnesses Associated with Menopause:

Answer 24

Osteoporosis
Heart Disease
Cancer

Question 25

High risk groups for Osteoporosis:

Answer 25

``` Caucasian/Asian Thin Smoker Alcohol Use Steroid Use Family History ```

Question 26

Estrogen therapy approved for ______ of osteoporosis.

Answer 26

prevention | **NOT trx!

Question 27

Bone Density Measurements for screening purposes begin at age __.

Answer 27

65

Question 28

How does estrogen affect osteoporosis?

Answer 28

Affects osteoclast and osteoblast activity = prevention (even low doses have some effects!)

Question 29

How does HRT affect bone fracture risk?

Answer 29

significant reduction in fractures (hip + vertebrae in study)

Question 30

Early loss of endogenous estrogen is associated with:

Answer 30

CVD

Question 31

Women appear protected from CVD until:

Answer 31

menopause (compared to men)

Question 32

Systemically, what are effects of endogenous estrogen (3)?

Answer 32

increases smooth muscle proliferation lowers cholesterol improves vascular tone

Question 33

What evidence of CVD is present in a 35 y/o F?

Answer 33

fatty streaks and minimal atherosclerotic plaques

Question 34

What evidence of CVD is present in a 45-55 y/o F?

Answer 34

active progression of athrosclerotic lesions

Question 35

What evidence of CVD is present 5-8 yrs after menopause?

Answer 35

increase in plaques and intima-media thickening

Question 36

When do CVD complications start to develop in women? WHy is this significant?

Answer 36

Aged > 65 | At this age, women’s rate is equal to men’s

Question 37

What drugs may not have the benefit in women as they do in men?

Answer 37

Statins and ASA

Question 38

What are the theorized benefits of perimenopausal use of HT, in terms of CVD?

Answer 38

1. Positive effects on vasc remodeling 2. Decreased intimal thickening 3. Decreases the incidence of plaques

Question 39

Why isn't Postmenopausal Use of HT beneficial, in terms of CVD?

Answer 39

In women > 65: Plaques already formed, so estrogen (thrombogenic) clots off the artery *MIs in year 1 of E

Question 40

Should you give a post-menp patient with hot flashes but no hx of CVD estrogen?

Answer 40

yes!

Question 41

Estrogen increases the risk of:

Answer 41

DVT stroke (women 60-69 y/o) breast cancer (if >5yrs)

Question 42

Estrogen decreases the risk of:

Answer 42

colon CA

Question 43

Risk of breast cancer with estrogen use (persists/decreases) after HT stopped

Answer 43

decreases--back to baseline **risk is small and may be due to progestin

Question 44

T/F: The option of MHT should be made on a patient by patient basis.

Answer 44

T

Question 45

Why was the study which related CVD to estrogen therapy crappy?

Answer 45

average age of women was 65, which is when the effects of low E/CVD really kicks in