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Repro > Menopause + HRT > Flashcards

Menopause + HRT Flashcards

1
Q

Impacts age of menopause onset (earlier)

A

smoking

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2
Q

one year without menses

A

Menopause

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3
Q

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

A

Perimenopause

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4
Q

Women spend ___ of their life in menopause

A

1/3

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5
Q

End of reproductive life about __ y/o

A

43

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6
Q

After repro life ends, Ovary continues to produce:

A

sporadic + abnormal eggs

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7
Q

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

A

decrease

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8
Q

How do FSH levels change around menopause?

A

FSH rises

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9
Q

Menopause defined as:

A

No menses for a year

FSH >30

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10
Q

Symptoms of Menopause:

Most common, and why?

A

Hot flashes + night sweats which affect sleep

Probably due to gonadotropin spikes as much as estrogen deficiency

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11
Q

Symptoms of Menopause:

Less common?

A

Skin changes/vasodilation

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12
Q

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

A

F: white women are just annoying and whiney.

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13
Q

FDA-Approved Indications for HT:

A

estrogen + (if pt has uterus) progestin

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14
Q

Why would you give progestin to a patient?

A

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

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15
Q

Postmenopausal HT is indicated for:

A
  1. trx of moderate-to-severe vasomotor symptoms
  2. trx of vulvar and vaginal atrophy*
  3. Prevention of postmenopausal osteoporosis
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16
Q

The preferred trx for women with vaginal symptoms only:

A

low doses of vaginal estrogen

no need for progestins, non-systemic

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17
Q

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

A

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

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18
Q

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

A

without–no uterine cancer risk

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19
Q

Estradiol is made from:

A

a plant derivative

20
Q

Associated with menopause?

Depression

A

No!

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

21
Q

Associated with menopause?

Vaginal dryness

A

Yes

22
Q

Associated with menopause?

Decreased libido

A

No

23
Q

Associated with menopause?

vaginal atrophy

A

Yes

24
Q

Medical Illnesses Associated with Menopause:

A

Osteoporosis
Heart Disease
Cancer

25
Q

High risk groups for Osteoporosis:

A 
Caucasian/Asian
Thin
Smoker
Alcohol Use
Steroid Use
Family History
26
Q

Estrogen therapy approved for ______ of osteoporosis.

A

prevention

**NOT trx!

27
Q

Bone Density Measurements for screening purposes begin at age __.

A

65

28
Q

How does estrogen affect osteoporosis?

A

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

29
Q

How does HRT affect bone fracture risk?

A

significant reduction in fractures (hip + vertebrae in study)

30
Q

Early loss of endogenous estrogen is associated with:

A

CVD

31
Q

Women appear protected from CVD until:

A

menopause (compared to men)

32
Q

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

A

increases smooth muscle proliferation
lowers cholesterol
improves vascular tone

33
Q

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

A

fatty streaks and minimal atherosclerotic plaques

34
Q

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

A

active progression of athrosclerotic lesions

35
Q

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

A

increase in plaques and intima-media thickening

36
Q

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

A

Aged > 65

At this age, women’s rate is equal to men’s

37
Q

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

A

Statins and ASA

38
Q

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

A
  1. Positive effects on vasc remodeling
  2. Decreased intimal thickening
  3. Decreases the incidence of plaques
39
Q

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

A

In women > 65:
Plaques already formed, so estrogen (thrombogenic) clots off the artery

*MIs in year 1 of E

40
Q

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

A

yes!

41
Q

Estrogen increases the risk of:

A

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

42
Q

Estrogen decreases the risk of:

A

colon CA

43
Q

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

A

decreases–back to baseline

**risk is small and may be due to progestin

44
Q

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

A

T

45
Q

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

A

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

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