Module 7 menopause

Question 1

average age of menopause

Answer 1

51

can range from 40-58

Question 2

definition of menopause

Answer 2

12 consecutive months without menses

• with age there is a decline in ovarian follicles and a decline in estrogen production
• also a decline in progesterone

Question 3

premature menopause

Answer 3

chemotherapy
s/p surgery (oophorectomy)
medication side effect
radiation
impaired ovarian function

Question 4

Perimonopause

Answer 4

varying length of cycles
inc. levels of FSH
Anovulatory cycles 
unpredictable bleeding
mood changes
dec. libido 
night sweats

Question 5

age related health concerns

Answer 5

Bone health: inc. fx risk 
CV risk 
Wt changes: gain, middle
cancer risk 
sexual dysfunction

Question 6

vasomotor symptoms

Answer 6

dec. estrogen
- hot flashes
75% of women experience this
may last form 30 seconds to 5 minutes
25% of women have them for more than 5 years

Question 7

Genitourinary syndrome of menopause symptoms

Answer 7

dec. lubrication
pain with sexual intercourse
bleeding after sex 
dec. arousal, orgasm, desire
irritation/burning/itching of vulva or vagina 
painful urination 
urinary frequency or urgency

Question 8

Genitourinary syndrome of menopause objective

Answer 8

dec. moisture
dec. elasticity
pallor/redness
loss of vaginal rugae
tissue fragility, fissures, petechiae
urethral eversion or prolapse, prominence of meatus
introital retraction
recurrent UTI

Question 9

mood changes of menopause

Answer 9

assess for hx of depression and anxiety
use screening tools
brain fog

Question 10

sleep disturbance

Answer 10

40-60% of women report sleep impairment
multifactorial
HT shown to alleviate symptoms if caused by VMS

Question 11

Womens health initiative 2030

Answer 11

HT increases risk of 
- coronary heart disease
- stroke
- VTE 
- breast cancer 
Data favorable for use in women <60
dec in colorectal cancer
inc. in bone density 
Short-term and low dose therapy

Question 12

sexual functioning

Answer 12

decline in sexual activity probably influenced by culture and attitudes than by nature and physiology

• psychological, sociocultural, interpersonal, biologic factors
• low estrogen levels

Question 13

Chronic disease most common

Answer 13

CVD: VTE, stroke, CHD 
osteoporosis 
atrophic vaginitis
cognitive decline 
certain cancers

Question 14

HT recommendations

Answer 14

appropriate for healthy, younger menopausal women with VMS or genitourinary s/s
NOT recommended for:
- women with pre-existing CHD, 
- thromboembolic disease 
- some types of cancer
- prevention of CVD
- prevention of dementia

Question 15

osteoporosis risk factors

Answer 15

gender
age
dietary calcium intake
hormone status
genetics
meds 
disease states
low vitamin D levels
excess ETOH
sedentary lifestyle
low lean body mass
smoking 
early onset of menopause

Question 16

Estrogens and osteoporosis

Answer 16

not approved for primary tx of osteoporosis
are approved for prevention
- oral, transdermal, and oral conjugated equine estrogen
If HT is Rx it should be for at least 5 years

Question 17

Cognitive decline and HT

Answer 17

HT initiated early in menopausal transition has been shown to be neuroprotective
BUT HT begun in late menopause (after 65) associated with inc. risk for cognitive decline and dementia

Question 18

Life style changes for VMS

Answer 18

keep core body temp cool 
- cooling pillow, bed fan 
maintain healthy body weight
avoiding triggers
using relaxation techniques 
engage in regular exercise
SUPPLEMENTS:
yoga
tai chi
acupuncture
soy
isoflavone supplements
black cohosh
red clover 
Vit. E
omega-3 fatty acids

Question 19

Lifestyle management for menopause

Answer 19

stop smoking
wt-bearing exercise: improves bone density 
eating a healthy diet
maintaining normal body weight 
reducing stress levels