Perimenopause

Question 0

Hormone changes in perimenopause?

Answer 0

Estrogen and androgen levels drop

Because ovarian inhibin levels decrease, FSH and LH levels rise even before estradiol falls

Question 1

Perimenopause? a.k.a.?

Answer 1

Transitional 2-4 years between pre-menopause in post menopause;

Climacteric

Question 2

Symptoms of decreased estradiol?

Answer 2

Vaginal atrophy, bone loss, vasomotor symptoms (hot flashes)

Question 3

Adverse effects of continuous estrogen-progestin treatment? Duration before increased risk?

Answer 3

Increased risk of breast cancer, heart disease, PE, stroke

No evidence of adverse effects with <6 months therapy

Question 4

HRT indications? if patient cannot take estrogen, can use?

Answer 4

Vasomotor symptoms; clonidine

Question 5

Use of Raloxifene in Perimenopause?

Answer 5

SERM useful in preventing bone loss, but does not alter hot flashes

Question 6

Advice for perimenopausal women to maintain bone mass? Can FSH be used to titrate estrogen replacement dose?

Answer 6

Weight-bearing exercise, calcium/vitamin D, estrogen replacement

No, because of decreased inhibition, FSH will be elevated even with appropriate estrogen

Question 7

Prolactinoma dysfunction of?

Answer 7

Hypothalamus

Question 8

Relationship between prolactin and thyroid hormone?

Answer 8

Hypothyroidism can lead to hyperprolactinemia

However, Prolactin does not affect thyroid

Question 9

Raloxifene – effect on endometrial cancer? Breast-cancer? Thromboembolism?

Answer 9

No change (Does not increase risk like tamoxifen);

decreases risk

; increases risk