Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

NAMS > Physiology/Pathophysiology of the Menopause Transition > Flashcards

Physiology/Pathophysiology of the Menopause Transition Flashcards

1
Q

menopause

A

ovarian follicular exhaustion; changes in bleeding patterns hormone levels, body composition, and psychosocial well-being; climacteric - period of endocrinologic, somatic, and transitory psychological changes (perimenopause)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

menopause transition

A

time before FMP, menses cycle becomes variable or menopause-related sxs begin; early (7+day change) or late (60+day wo); stages -2,-1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

postmenopause

A

time after menopause; marked by 1 yr after FMP; stage +1a, +1b, +1c, b (late)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

mean age of menopause

A

52.54 years; between age 40-58 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

prevalence for menopause

A

life expectancy in women 81.2yrs; by 2020, 64 million women will be +50yo
-women worldwide living longer
>many will spend >40% of life in postmeno
>more than 60% survive at least until 80yo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

STRAW +10 stages

A

-5 early reproductive
-4 peak reproductive
-3b late reproductive
-3a late reproductive
-2 early menopause transition (perimeno)
-1 late menopause transition (perimeno)
(0 FMP)
+1a early postmenopause (perimeno)
+1b early postmenopause
+1c early postmenopause
+2 late postmenopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

-5 stage sxs

A

-part of reproductive interval
-early; starts at menarche; cycle starts to regulate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

-4 stage sxs

A

-part of reproductive interval
-regular menses
-cycle is regulating; peak years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

-3b stage sxs

A

-part of reproductive interval
-regular menses, some changes
-fecundability declines
-menses & FSH normal
-getting into late reproductive yrs; AMH, AFC, Inhibin getting low

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

-3a stage sxs

A

-part of reproductive interval; some regular menses
-subtle menstrual changes in flow, length, frequency; shorter cycles; variable FSH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

-2 stage sxs

A

persistent difference of +7 days in length; variable FSH, low AMH; early meno transition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

-1 stage sxs

A

+60 days consecutive days of amenorrhea; late meno transition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

+1a stage sxs

A

-the 12mo after FMP, end of perimeno; start VMS
-postmeno

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

+1b stage sxs

A

second postmeno year; start VMS; stabilizing FSH/estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

+1c stage sxs

A

3-6 years postmeno; high FSH, low estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

+2 stage sxs

A

5-8 years postmeno through remaining lifespan; more GSM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Endocrine markers used to assess reproductive aging

A

-FSH
-AFC
-AMH
-Inhibin B
-Estradiol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

LOOP - Luteal out-of-phase events

A

-can be seen in early/late meno transition
-luteal phase FSH high enough to recruit follicles for subsequent cycle before current cycle is over; causes incr estrogen
-causes very short follicular phase
-can cause perimeno sxs of mastalgia, migraine, menorrhagia, fibroids, endometrial hyperplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Clinical implications for high Estradiol

A

-obesity —> more likely anovulatory cycles a/w lower levels in premeno but higher levels in postmeno
-pregnancy —> ovulatory cycles are noted up to FMP; increased risk for twins
-ethnicity —> hormone concentrations differ among ethnic groups; Chinese & Japanese women have lower estradiol levels compared w black, white, Hispanic; FSH concentrations are higher in black women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Estro & Andro alterations

A

-androgens become estrogen via aromatization, in peripheral tissues
-adrenal - androgens (DHEA, DHEA-S, androstenedione)–>estrogen in peripheral tissues ***
-precursor hormones produced by adrenal gland
-DHEA local vag therapy is helpful

21
Q

Adrenal physiology & Meno

A

-DHEAS levels decrease during & after menopause transition:
>SWAN study shows fall in circulating DHEAS levels
>longitudinal analyses of women undergoing meno transition also showed a transient increase in circulating DHEAS levels in the menopause transition
-despite decr in DHEAS in meno, no benefit in DHEA supplementation
-systematic review & meta-analysis of DHEA use in postmeno women w normal adrenal function found no evidence of improvement in sexual sxs, serum lipids, serum glucose, weight, or BMD
-DHEA supplementation of postmeno is not routinely recommended

22
Q

Fertility change / Ovarian reserves

A

-testing as a screening tool is not recommended
-cycle day 3 FSH commonly used test
-AMH capture quantitative but not qualitative data;
-peak at 24.5yo
-can be influenced by exogenous hormones

23
Q

Early Menopause Transition

A

-decreasing ovarian reserve & reduced cohort of follicles; Inhibin B & AMH drop
-loss of Inhibin restraint of FSH leads to:
>monotropic rise in FSH
>faster growth of remaining follicles (short follicular phase)
>incr atresia
>occasional LOOP cycles
-common sxs
>cycle irregularity by >days
>skipped menstrual cycles (bc of ovulatory failure)
>pronounced premenstrual syndrome sxs (bc of longer luteal phase)

24
Q

Late Menopause Transition

A

-number of remaining oocytes drops below critical level, w sporadic follicular development
-ovulation is more sporadic
-rare follicular development results in poor rate of ovulation w low progesterone levels
-eventually follicular development stops, resulting in estradiol deficiency
-common sxs:
>amenorrhea >60 days
>estrogen deficiency sxs such as hot flashes & vaginal dryness

25
POI - Primary Ovarian Insufficiency a.k.a. premature ovarian failure
-cessation of menstrual periods bc of failure of the ovaries before age 40 -hypergonadotrophic hypogonadism in women <40yo; not always complete or permanent -age-specific incidence of POI: 1% <40yo, 0.1% <30yo, 0.01% <20yo; may rise as childhood ca survival increases -most common in white 1%, black 1.4%, Hispanic 1.4%, Chinese 0.5%, Japanese 0.1%b -genetic (X chromosome disorders, gene or reproductive mutations), autoimmune (DM type 1, thyroid, adrenal, etc.), toxic, infectious, metabolic, iatrogenic (chemo, radiation, surgical); most cases are idiopathic
26
Clinical Features & Dx of POI
-change in menses function (irregular menses or amenorrhea) -estrogen deficiency sxs -sxs masked if woman is on combined OC -dx: menstrual change such as oligomenorrhea or amenorrhea for >4mo; FSH concentrations in postmeno range >25IU/L on 2 separate occasions w low estradiol
27
Diagnostic work-up POI
-H&P, detailed fam hx -Estradiol, FSH, LH; if elevated FSH, repeat FSH & estradiol at least 4 wks later -karyotype -anti-21hydroxylase abs -fragile x screen -TSH, free T4, anti-thyroid-peroxidase abs -glucose, metabolic profile, CBC
28
Management of POI
-standard of care is physiologic EPT: >estrogen 100 mcg transdermal patch, 1.25mg CEE, or 2mg estradiol daily >if uterus is present, cyclical progestins should be added >12d/mo >combo hormone contraception or transdermal estradiol-progestin sxs are alternatives >recommended duration of therapy is at least until natural age of menopause -if pregnancy is desired -> can still carry a pregnancy but will likely require an egg donor to become pregnant
29
surgical menopause
abrupt nonreversible drop in hormones (estro, prog, andro); elective or consequential can cause bone, cards, cognitive issues, Parkinson's
30
chemo/rad-induced menopause
cause variable gonadotoxic effects
31
consequence of early estrogen loss
risk for CVD, psychological consequence - grief, low self-esteem, fertility loss
32
HT for POI and surg meno
transdermal patch, conjugated equine estro, or estradiol PO; if uterus is still there, add progestogen (or may cause hyperplasia)
33
Menopause demographics
-meno trans natural event -postmeno defined by FMP & confirmed after 1yr no menses -represents permanent cessation of menses resulting from loss of ovarian follicular function, usually bc of aging
34
Early menopause
FMP before age 45yo
35
Late menopause
FMP after age 54yo
36
Natural menopause
Permanent cessation of menses bc of loss of follicular activity
37
Induced menopause
Surgical or iatrogenic loss of ovarian function
38
Perimenopause
Stage in menopause transition characterized by irregular menstrual cycles (early perimenopause) or 2-12 months of amenorrhea (late perimenopause)
39
Postmenopause
Defined as 12mo of amenorrhea
40
Premature menopause
FMP before age 40
41
Premenopause
Reproductive stage between menarche & onset of perimenopause
42
Primary ovarian insufficiency
Menopause occurring at age <40yo
43
Menopause S/Sxs
-Classic sxs: >change in menses cycle pattern (during perimenopause) >VMS (hot flashes, night sweats, etc) >vulvovaginal sxs, dyspareunia >sleep disturbances >psychological sxs (depression, anxiety, moodiness) -Other sxs sometimes a/w meno: >cognitive (memory, concentration, intake of new info, etc) >joint pain >dry eyes >change in wt distribution -there is no one universal menopause syndrome
44
Stages of Reproductive Aging
-Aging: >natural, time-related, genetically determined, & environmentally modified process of deterioration of physiological function -Reproductive aging: >loss of locates by ovulation & atresia >women are born w a finite number of oocytes: @20 wks GA 6-7N, @Birth 1-2M, @Puberty 300-500K, @Menopause 300-400 remaining; lifespan = 400-500 ovulated (most lost through apoptosis)
45
AMH, AFC, FSH, & Estradiol
-taken together, predict response to ovarian stimulation in fertility treatment but less predictive of pregnancy
46
AMH
-produced by granulosa cells of activated follicles, most reflective of true ovarian reserve -provides the best single prediction of time of menopause
47
Day 3 FSH
-useful for predicting ovarian response (<10 IU/L is normal) -menopause only if very high -cycle-to-cycle fluctuates limit usefulness in predicting time to menopause
48
Estradiol
-tends to be elevated on days 3 in perimeno; <80pg/ml is normal
49
AFC
->12 ultrasound detected follicles 2-10 mm in size predicts ovarian response; normal -not predictive of time to menopause

NAMS (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions