Menopause & MHT

Question 1

premature ovarian insufficiency (POI), which is the more recently used term, is defined as

Answer 1

hypergonadotropic ovarian failure occurring prior to age 40. POI occurs in 5% to 10% of women who are evaluated for amenorrhea, thus the incidence varies according to the prevalence of amenorrhea in various populations. Estimates of the overall prevalence of POI in the general population range between 0.3% and 0.9% of women.

Question 2

An expansion of a trinucleotide repeat sequence in the first exon on the FMR1 gene (Xq 27.3) leads to

Answer 2

fragile X syndrome, a major cause of developmental disabilities in males. T he permutation in fragile X syndrome has been shown to be associated with POI.

Question 3

Evaluation of POI in women younger than 30 should include

Answer 3

screening for autoimmune disorders and a karyotype, vaginal ultrasound may be useful for assessing the size of the ovaries and the degree of follicular development, which, if present, may signify an immunologic defect. Cases of POI caused by immunologic defects must be screened carefully for thyroid, adrenal, and other autoimmune disorders.

Question 4

MANAGEMENT OF PREMATURE OVARIAN INSUFFICIENCY

Answer 4

estrogen replacement.

Question 5

Why estrogen replacement in these young women with POI is extremely important at least up to the natural age of menopause. and is not analogous to hormone therapy (HT) after menopause?

Answer 5

these young women are at substantial long-term risk for osteoporosis and cardiovascular disease (CVD). Coronary heart disease and death are specifically increased in approximately 70% of women with POI

Question 6

the earliest clinical sign of menopause is

Answer 6

menstrual alterations.

Question 7

The initial endocrinologic change signaling the onset of menopause is

Answer 7

decreased AMH and ovarian inhibin-B production accompanied by an increase in FSH.

Question 8

the best therapy for the hot flush

Answer 8

Estrogen, other effective therapies are progestogens, selective serotonin reuptake inhibitors (SSRIs), gabapentin, clonidine, some phytoes-trogens, acupuncture, and stellate ganglion blockade.

Question 9

Climen components

Answer 9

Estradiol valerate/cyproterone acetate first-generation” progestin and as the prototypical antiandrogen