Patho of Menopause

Question 1

Define Menopause

Answer 1

Point in time that follows 1 year after cessation of menstruation

Question 2

Define Perimenopause or climacteric

Answer 2

Late reproductive years (late 40s to early 50s) immediately before menopause
“Menopausal transition”

Question 3

What happens at the beginning of menopausal transition?

Answer 3

Cycle irregulatiry and extends to 1 year after permanent cessation of menses
Span of 4-7 years
~47 years old

Question 4

Postmenopausal Levels

Answer 4

FSH is increased

No follicles leads to estrogen drop

Question 5

After age 35,

Answer 5

ovarian mass and fertility decline sharply

Question 6

Cigarette smokers experience menopause

Answer 6

2 years earlier

Question 7

Anovulatory cycles produce,

Answer 7

hyperestrogenic, hypoprogestagenic states

FSH and LH increase

Question 8

Why does FSH increase more than LH

Answer 8

Lack of inhibin and estrogen feedback regulation

Question 9

Symptoms of Perimenopausal

Answer 9

Changes in cycles
Vasomotor symptoms (hot flashes, night sweats)
Psychological and mental changes (worse PMS, mood swings)
Sexual dysfunction (vaginal dryness)
Somatic symptoms (dizzy, headache)
Thinning/itchy skin
Weight gain
Muscle weakness
CVD
Decrease bone density

Question 10

What can suppress hot flashes?

Answer 10

Estrogen therapy for 2-3 years via modulation of the thermoregulatory zone

Question 11

Hot Flash Pathophysiology

Answer 11

1-5 minutes
Skin temp rises due to peripheral vasodilation
Sweating occurs
BP, HR, MR increase
Palpitations, anxiety, irritability and panic can be seen
5-9 minutes after, core temperature decrease due to perspiration and increased peripheral vasodilation (chills)

Question 12

Estrogen + NE and serotonin

Answer 12

Estrogen feedback inhibits NE which is involved in triggering heat loss mechanisms and lower serotonin which helps with the thermoregulatory set point
All of which allows heat loss mechanisms to trigger easier

Question 13

During menopause the rate at which bone mass declines?

Answer 13

Increase 2-5% per year for the first 5-10 years and then slows to 1% per year

Question 14

Estrogen + CVD

Answer 14

Estrogen helps increase HDL and decrease LDL

So as estrogen declines, the risk for CVD increases

Question 15

Short term outcomes of hormone replacement therapy (HRT)

Answer 15

Reduce or eliminate hot flashes, vaginal dryness, urinary problems, depression and insomnia

Question 16

Long term outcomes of HRT

Answer 16

reduce CVD, osteoporosis, alzheimer’s disease

Question 17

It was thought that HRT in postmenopausal women would help but?

Answer 17

There was an increase in heart attacks among women taking estrogen and progestin

Question 18

HRT + blood clots?

Answer 18

Increased risk and even more increased if they smoke

Question 19

HRT + stroke

Answer 19

Increased risk

Question 20

HRT + Uterine/endometrial cancer

Answer 20

Estrogen alone increase risk by 6-8X

Progestin can be used to decrease the lining of the uterus

Question 21

HRT + breast cancer

Answer 21

E/P increase risk by 26%

Question 22

HRT + Ovarian cancer

Answer 22

Estrogen for 20+ years = 3X increase risk

Question 23

HRT + Osteoporosis

Answer 23

34% had few hip fractures

Once you start taking estrogen for bone density, you must keep taking it or benefits will disappear

Question 24

HRT + Menopause

Answer 24

Relief from hot flashes, sleep difficulties, vaginal dryness within few weeks
Shortterm (2-4 years) = safe (should taper off)

Question 25

Side effects of HRT

Answer 25

Mood swings
Water retention
Bloating
Nausea
Breast tenderness
Headache
Irregular bleeding