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2nd Repro > Metabolic and Menopause > Flashcards

Metabolic and Menopause Flashcards

1
Q

What stimulates releaase of FSH and LH from the pituitary?

A

GnRH from hypothalamus

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2
Q

effect of FSH/LH on uterus and ovary

A

release estrogen and progesterone

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3
Q

Progesterone has ____ effect on GnRH release

A

negative

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4
Q

is a syndrome of ovarian dysfunction affecting 6-8% of reproductive age women worldwide. The most common endocrine abnormality of women of reproductive age.

• Its clinical manifestations include: chronic anovulation (oligo/amenorrhea, infertility) and hyperandrogenism (hirsutism, acne, alopecia).

A

PCOS

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5
Q

Define PCOS

what risks are associated with it?

A

The syndrome is defined by a clustering of signs and features, where no single test is diagnostic.

• PCOS is associated with an increased risk of diabetes and other metabolic abnormalities which may potentially increase the risk of coronary artery disease

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6
Q

Clinical Manifestations of PCOS Hyperandrogenism

A

Hirsutism, acne, alopecia, deepening voice, more muscle, clitoromegaly often peripubetal onset

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7
Q

Pathophysciology of PCOS?

A

 Complex disorder and partially understood

 Gonadotropin secretion disturbance
 Steroidogenesis disorder
 Insulin resistance

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8
Q

Explain pathphys of PCOS in relationship to high androgens effect on:

skin:

insulin:

adipose tissue:

A

Skin: hirsutism, acne, acnothosis nigrans

INuslin: insuiln resistance

Adipose: increase estrone production causing endometiral hyperplasia as well as follicular atresian = anovulation/amneorrhea

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9
Q

We get tons of androgen production in PCOS becse the ____ is stimulated by a high LH:FSH ratio from abnormal androgen and estrone feedback

A

ovary or theca

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10
Q

LH stimulstes the ____ cell to make testosterone and androstendione from cholesterol

A

Theca cell

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11
Q

FSH stimulates the ___ cell to make estradiol and DHT from androstendione and testosterone it gets from the Thecal cell

A

Granulosa cell

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12
Q

High levels of ___ and ___ INCREASE thecal cell production of more androstendion and testesterone

A

IFG and INhibin

also insulin increases prodcution!!!

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13
Q

we see ____ in lean and obese women with PCOS compared to otehr women

A

insulin resistance (thus encourages Thecal cell to make androgens)

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14
Q

Dx criteria for PCOS

A

at least 2 of the 3:

  • Oligo- or anovulation
  • Clinical and/or biochemical signs of hyperandrogenism

• Polycystic ovaries on imaging
And

• Absence of secondary causes (CAH, androgen-secreting tumors, Cushing’s syndrome)

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15
Q

Similarities of PCOS and Metabolic Syndrome Related to Insulin Resistance

A
  • Central obesity
  • Hyperinsulinemia
  • Low SHBG
  • Abnormal lipids (elevated TG, low HDL)
  • Higher prevalence of IGT and diabetes.
  • Increased risk of non alcoholic steatohepatitis (fatty liver).
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16
Q

Dx of PCOS

A
  • Diagnosis of PCOS made based on history, clinical suspicion
  • Biochemical evaluation is for excluding less common causes of hirsutism and menstrual irregularities (androgen secreting tumors, CAH, thyroid disease)
  • Biochemical testing will often result in “normal” results
  • Tests for insulin resistance are not required to make a diagnosis of PCOS
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17
Q

Mangement of PCOS; tx complaint and think about long term issues:

• Treatment of symptoms of anovulation :

A
  • regulate menses
  • induce ovulation
  • endometrial cancer risk reduction
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18
Q

• Treatment of obesity and metabolic disorders in women with PCOS includes:

A
  • Obesity management
  • Sleep apnea screening
  • Diabetes prevention

-Lipid management and cardiovascular disease risk reduction

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19
Q

Treat symptoms of hyperandrogenism and screen for anxiety and depresssion

A

in women with PCOS

20
Q

HOw do OCPS help tx PCOS?

A

Suppress ovarian androgen secretion by suppression of gonadotropins

Increases SHBG

Decreases free testosterone and free androgen index

Improves hirsutism

Regulates menses and provides adequate progestin to protect endometrial lining (lowers risk for endometrial hyperplasia)

21
Q

• Competitive inhibitor of androgen receptor

  • Improves hirsutism, acne and alopecia
  • Does not inhibit androgen secretion
  • Requires reliable contraception

used to tx PCOS

A

spironolactone

22
Q

the final menstrual period and is usually confirmed when a woman has missed her period for 12 consecutive months (in the absence of other obvious causes).

• It reflects complete or near complete depletion of ovarian follicles and absence of ovarian estrogen secretion. It marks the permanent end of fertility.

A

• Menopause

23
Q

Age of menopause and what is it influenced by?

A
  • Average age is 51, but age ranges from 40 to early 60s. (occurs after 55 in 5% and between 40-45 in 5%.
  • Age of menopause influenced by genetics, ethnicity, smoking, and reproductive history.
24
Q

It can last 6 years or more and ends 1 year after the final menstrual

period.

A

Perimenopause/Menopause Transition

25
Q

Interval of amenorrhea >60 days with elevated FSH during cycle, and start to see VMS

A

late transition to menopause

26
Q

Pt has amenorrhea, highly variable FSH with VMS

A

EArly post menopause

27
Q

pt has amnenhorrea, stable FHS, increaseing UG atrophy

A

Late post menopause

28
Q

Vasomotor symptoms, sleep disturbance and depression are ___ signs of meonopause

A

GOOD evidence

29
Q

FAir evidence of menopause

A

cognitive dysnfx, urinary incontinence,sexual dysfunx

30
Q

Consequences of Estrogen Deficiency in the Postmenopausal Years

A
  • Increased risk of osteoporosis
  • Increased risk of diabetes
  • Increased risk of CHD and CVD
  • Changes in body composition-_increased fat mass_

• Skin changes

31
Q

early tests where they gave women E+P for postmenopause discontinued bc?

What about Estrogen only?

A

average follow up 5.2 years due to increased breast cancer, CHD, stroke, VTE

Estrogen only: increased risk of stroke

32
Q

Observational studies had different results then the WHI:

VMS

Age at HT initiaion

time since menopause

BMI:

A

Yes had VMS

initiated at 52 yrs

2 yrs since menopause

BMI 24-25

33
Q
  • relieves VMS and relieves vaginal atrophy
  • blocks bone resorption (approved for prevention of osteoporosis)

• provides endometrial protection and an alternative to progestogen therapy for women with a uterus who are averse to vaginal bleeding, breast tenderness, or altered mood.

A

The combination of CEE with the SERM bazedoxifene (BZA)

34
Q

provides endometrial protection and an alternative to progestogen therapy for women with a uterus who are averse to vaginal bleeding, breast tenderness, or altered mood.

A

Bazedoxifene

35
Q

Current Indications for
Menopausal Hormone Therapy (MHT)

A

Younger symptomatic postmenopausal women less than a decade from final menstrual period and without increased risk for CHD and breast cancer with LOWEST possible dose

36
Q

must be prescribed with systemic ET for uterine protection in women who have a uterus

A

Progestin or the SERM bazedoxifene

37
Q

MHT is not indicated for

A

prevention of chronic disease (CHD, breast cancer, dementia, etc)

38
Q

For isolated vaginal symptoms, both systemic and vaginal estrogens are effective

A

VAGINAL ESTROGEN

39
Q

V is preferred for isolated vaginal symptoms– vaginal dryness, dyspareunia—given its potent local effect and minimal degree of systemic absorption.

A

vaginal estrogen

***dont need progestin even if they have uterus if given at LOW does

40
Q

SERM taken orally for atrophic vaginitis and dyspareunia

A

OSPEMIFENE

41
Q

NOn hormone alternatives for vasomotor symptoms

A

SSRI/SNRI- paroxetine, venlafaxine, etc Gabapentin
Clonidine

42
Q

• has important systemic effects affecting the risk of cardiovascular disease, osteoporosis, and endometrial and breast cancer

A

Estrogen

43
Q

• is the most effective treatment for vasomotor symptoms

A

Estrogen

44
Q

is safe for the majority of symptomatic, younger, healthy postmenopausal women for short term use for treatment of vasomotor symptoms and osteoporosis prevention and treatment

A

Estrogen therapy

45
Q

Unopposed estrogen is contraindicated in women

A

with a uterus

2nd Repro (16 decks)

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