Menopause/Journal Club (Week 7--Pregler)

Question 1

Menopause

Answer 1

Technically defined as amenorrhea for one year

Associated with end of ovarian function

E, P levels drop because you rapidly lose ovarian follicles

FSH, LH levels increase in response

Question 2

Why do you get hot flashes (flushes) during menopause?

Answer 2

Decreased amounts of E and inhibin cause less negative feedback so get more GnRH and stimulation of thermoregulatory center in hypothalamus

Ultimately, FSH/LH levels rise and peripheral dilitation results in hot flash

Question 3

Symptoms of menopause

Answer 3

Vasomotor symptoms attributed to hypothalamic “instability” (hot flashes, sleep disturbance, muscle aches, irritability, mental “fuzziness”)–these resolve with time

Urogenital atrophy because estradiol is what maintains vaginal lining (pain with intercourse, UTIs)–doesn’t improve with time

Question 4

Andropause

Answer 4

Normal men have slow decrease in testosterone over their lives but no abrupt drop

“True” andropause occurs in men who experience abrupt end to testicular function (GnRH agonist given for prostate cancer) and then men experience same vasomotor symptoms as menopausal women

Question 5

Hormone replacement therapy

Answer 5

Estrogen given to replace lack of estrogen from ovaries

Progesterone must be given in women with uterus too because just giving estrogen alone causes hyperplasia of uterine lining that can progress to endometrial cancer

Question 6

What was shown in cohort studies regarding HRT?

Answer 6

PROTECTIVE effect of estrogen on heart disease

Estrogen replacement increases HDL, lowers LDL, lowers total cholesterol

Question 7

The number RR (relative risk)

Answer 7

Experimental/Control (kinda)

If under 1, then happened less than control

If over 1, then happened more than control

Ex: RR of CAD in women who took estrogen was 0.5 compared to women who did not (from cohort study, turned out to be wrong according to WHI study)

Question 8

Why were the cohort studies biased?

Answer 8

Women who chose to take hormones were healthier!

Richer, thinner, exercised more, less likely to smoke, no high BP, no diabetes, etc

Question 9

Is HRT suggested today?

Answer 9

Only if symptoms are very bad and only for a short amount of time and low dose

And only if don’t have contraindications