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1
Q

What is the definition of menopause?

A

Menopause is the final menstrual period confirmed after 1 year without menstrual bleeding, marking the permanent cessation of menses due to loss of ovarian follicular function.

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2
Q

What is the primary cause of menopause?

A

Menopause primarily occurs due to aging and the loss of ovarian follicular function.

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3
Q

What is the average age of natural menopause onset in Western countries?

A

The average age of natural menopause onset in Western countries is 51-52 years.

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4
Q

What is the average age of natural menopause onset in Filipino women?

A

The average age of natural menopause onset in Filipino women is 47-48 years.

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5
Q

What are the causes of premature menopause?

A

Premature menopause can occur due to medical interventions like hysterectomy with bilateral oophorectomy, chemotherapy, radiotherapy, or genetic factors affecting ovarian function.

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6
Q

Does hysterectomy without bilateral oophorectomy cause menopause?

A

No, hysterectomy alone does not cause menopause if the ovaries remain functional.

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7
Q

What marks menopause hormonally?

A

Menopause is marked by reduced estrogen production due to absent or non-functional ovaries.

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8
Q

How does ethnicity affect menopause onset?

A

Ethnicity influences menopause onset; for example, Filipinos generally experience menopause earlier than Western women.

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9
Q

How does general health affect menopause onset?

A

Health issues can influence the timing of menopause.

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10
Q

How does parity (number of pregnancies) affect menopause onset?

A

Higher parity is associated with a later onset of menopause.

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11
Q

How does smoking affect menopause onset?

A

Smoking typically leads to menopause 1-2 years earlier than non-smokers.

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12
Q

How does hysterectomy affect menopause onset?

A

Hysterectomy can lead to earlier menopause due to reduced blood supply to the ovaries, which affects their function.

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13
Q

How does BMI affect menopause onset?

A

Higher BMI, especially obesity, is associated with a later onset of menopause.

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14
Q

What are the initial endocrine changes signaling menopause onset?

A

Menopause onset is signaled by decreased Anti-Müllerian Hormone (AMH) and ovarian inhibin-B production, along with increased Follicle-Stimulating Hormone (FSH) levels due to reduced ovarian function.

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15
Q

What are common early-stage menopausal symptoms (ages 40-50)?

A

Early-stage symptoms include hot flushes, night sweats, insomnia, menstrual irregularity, mood swings, anxiety, depression, and irritability.

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16
Q

What are common intermediate-stage menopausal symptoms (ages 50-60)?

A

Intermediate-stage symptoms include vaginal atrophy, dyspareunia, skin atrophy, and urge-stress incontinence.

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17
Q

What health risks are associated with late-stage menopause (ages 65-75+)?

A

Late-stage health risks include osteoporosis, atherosclerosis, coronary heart disease, cardiovascular disease, and Alzheimer’s disease.

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18
Q

What is a hallmark early symptom of menopause related to thermoregulation?

A

Hot flushes, sudden feelings of heat often accompanied by sweating, are hallmark early symptoms.

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19
Q

What causes dyspareunia during menopause?

A

Dyspareunia is caused by vaginal dryness due to thinning and drying of vaginal tissues (vaginal atrophy).

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20
Q

Why does menopause increase the risk of osteoporosis?

A

Estrogen deficiency during menopause leads to decreased bone density, increasing the risk of fractures.

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21
Q

How does menopause contribute to cardiovascular disease?

A

Estrogen deficiency promotes atherosclerosis, coronary heart disease, and other cardiovascular risks.

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22
Q

What cognitive risk is potentially heightened in late-stage menopause?

A

Late-stage menopause is associated with a potentially increased risk of Alzheimer’s disease and cognitive decline.

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23
Q

How does menopause impact quality of life?

A

Symptoms across all stages can significantly impact physical, emotional, and social well-being, necessitating comprehensive management strategies.

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24
Q

What are the progression patterns of menopausal symptoms?

A

Early symptoms are related to hormonal fluctuations affecting mood, sleep, and thermoregulation, while intermediate symptoms reflect changes in reproductive and urinary tract tissues, and late-stage risks involve bone, cardiovascular, and cognitive health.

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25
What are common management strategies for menopause symptoms?
Management includes lifestyle changes, hormone replacement therapy (HRT), and medical interventions to alleviate discomfort and reduce long-term health risks.
26
What is the definition of perimenopause?
Perimenopause is the transitional period around menopause, also called 'the menopausal transition.'
27
What are common symptoms of perimenopause?
Symptoms include irregular bleeding, hot flushes, mood changes, and reduced fertility.
28
How is perimenopause managed?
Short-term oral contraceptives (20 mcg ethinyl estradiol) may be used to manage symptoms and regulate cycles.
29
What is induced menopause?
Induced menopause is menopause resulting from medical interventions, also known as iatrogenic menopause.
30
What are the causes of induced menopause?
Causes include bilateral oophorectomy (with or without hysterectomy), chemotherapy, or pelvic radiation therapy.
31
What is Premature Ovarian Failure (POF) or Premature Ovarian Insufficiency (POI)?
POF or POI is ovarian failure before age 40, accompanied by high levels of gonadotropins (hypergonadotropic ovarian failure).
32
What are possible causes of POI?
Causes include genetic factors, enzymatic defects, autoimmune reactions, gonadotropin defects, ovarian insults (surgery or infections), or idiopathic cases.
33
How is POI managed?
Management includes screening for autoimmune disorders, karyotyping for genetic abnormalities, transvaginal ultrasound, and specific tests for thyroid and adrenal issues.
34
What is the primary treatment for POI?
Estrogen Replacement Therapy (ERT) is used for symptom relief and prevention of long-term health issues.
35
What is the most effective fertility option for women with POI?
Oocyte (egg) donation is the most effective option, with a spontaneous pregnancy rate of around 5%.
36
Why is perimenopause considered challenging?
Perimenopause involves irregular cycles, hot flushes, mood changes, and reduced fertility, often requiring symptom management and hormone regulation.
37
How does induced menopause differ from natural menopause?
Induced menopause occurs abruptly due to medical interventions, unlike the gradual transition typical of natural menopause.
38
What are common autoimmune conditions screened for in POI?
Common conditions include Hashimoto's Thyroiditis, adrenal disorders, and other autoimmune diseases.
39
What is the role of estrogen in the brain during menopause?
Estrogen affects mood, thermoregulation, and cognition, with its decline during menopause leading to symptoms like hot flushes and sleep disturbances.
40
What are the two main estrogen receptors in the brain?
Estrogen Receptors (ER) α and β mediate estrogen's effects in the brain.
41
What is the hallmark symptom of menopause?
The hallmark symptom of menopause is the hot flush (vasomotor episode).
42
What is the difference between a hot flash and a hot flush?
A hot flash is an intense sensation of heat, while a hot flush involves heat sensation with skin changes, such as sweating (diaphoresis).
43
How long do hot flushes typically last after menopause onset?
Hot flushes typically last 2 years but can persist for over 10 years.
44
What causes hot flushes during menopause?
Declining estrogen levels disrupt thermoregulation, narrowing the thermoneutral zone, making women sensitive to minor temperature changes.
45
What is the thermoneutral zone, and how does it differ in symptomatic women?
The thermoneutral zone is the temperature range between sweating and shivering. In symptomatic women, it is narrower, leading to abrupt sweating or shivering with minor temperature fluctuations.
46
What are the physiological changes during a hot flush?
A hot flush involves an increase in core temperature, skin blood flow, and heart rate, followed by intense heat sensation, sweating, and later chills or shivering.
47
How do hot flushes impact sleep?
Hot flushes disrupt sleep by causing frequent awakenings and excessive sweating, leading to fatigue and irritability.
48
How does estrogen therapy help manage hot flushes?
Estrogen therapy reduces the frequency of hot flushes and improves sleep quality.
49
What is the impact of disrupted sleep due to hot flushes?
Disrupted sleep causes daytime fatigue, irritability, and decreased quality of life.
50
Why are hot flushes more distressing in symptomatic women?
Symptomatic women have a narrower thermoneutral zone, making them highly sensitive to minor temperature changes.
51
What is the thermoneutral zone?
The thermoneutral zone is the range of core body temperature in which neither sweating nor shivering is triggered.
52
How does the thermoneutral zone differ in asymptomatic women?
In asymptomatic women, the thermoneutral zone is wide, allowing stable temperature regulation without frequent hot flushes or chills.
53
What happens to the thermoneutral zone in symptomatic menopausal women?
In symptomatic menopausal women, the thermoneutral zone becomes narrowed, making them more sensitive to minor temperature changes.
54
What triggers a hot flush in menopausal women?
A hot flush is triggered when core body temperature rises slightly above the narrowed sweating threshold.
55
What triggers chills in menopausal women?
Chills are triggered when core body temperature drops slightly below the narrowed shivering threshold.
56
Why does the thermoneutral zone narrow in menopause?
Reduced estrogen levels disrupt thermoregulation, leading to a narrowed thermoneutral zone.
57
What neurotransmitters are involved in thermoregulation during menopause?
Norepinephrine (NE), serotonin (5-HT), and related pathways are involved in thermoregulation.
58
How can treatments help manage hot flushes?
Treatments like Yohimbine, Clonidine, SSRIs, or agents targeting norepinephrine and serotonin may widen the thermoneutral zone, reducing hot flush frequency.
59
How do SSRIs affect the thermoneutral zone?
SSRIs stabilize thermoregulation by increasing serotonin levels, which can help widen the thermoneutral zone.
60
Why are symptomatic women more prone to hot flushes and chills?
Symptomatic women have a narrowed thermoneutral zone, making them more sensitive to small temperature fluctuations.
61
What is MPHG, and how does it relate to hot flushes?
MPHG (3-Methoxy-4-hydroxyphenylglycol) is a norepinephrine metabolite that may influence thermoregulation and help reduce hot flush frequency.
62
What is the role of Clonidine in managing hot flushes?
Clonidine reduces norepinephrine activity, helping to stabilize thermoregulation and alleviate hot flushes.
63
Why is management of hot flushes important?
Hot flushes disrupt daily life and sleep, so treatments targeting thermoregulation can significantly improve quality of life for menopausal women.
64
How does estrogen deficiency affect cognitive decline in postmenopausal women?
Estrogen deficiency contributes to cognitive decline by reducing support for neuronal and synaptic activity, alongside aging.
65
How does estrogen impact verbal memory?
Estrogen improves verbal memory, suggesting its supportive role in certain cognitive functions.
66
What is the relationship between estrogen and Alzheimer’s Disease (AD)?
Estrogen enhances neurotransmitter function, which is deficient in women with AD, and may reduce the risk or delay its onset when initiated early after menopause.
67
Can estrogen therapy reverse Alzheimer’s Disease?
No, estrogen therapy does not reverse AD once the disease has developed.
68
What is the effect of early initiation of estrogen therapy on cognitive decline?
Early initiation near menopause reduces brain damage from free radicals and supports neuronal activity, protecting against cognitive decline.
69
Why is late initiation of estrogen therapy not recommended for cognition?
Late initiation (after age 65 or 10+ years post-menopause) has no cognitive benefit and may worsen cognition due to increased thrombosis and stroke risks.
70
What are common mood changes during menopause?
Mood changes include feelings of upset, loss of control, irritability, fatigue, and dysphoria (blue moods).
71
What causes mood disturbances during menopause?
Fluctuating hormone levels temporarily disrupt neural systems, causing mood disturbances.
72
Who is more vulnerable to depressive symptoms during menopause?
Women with a history of PMS, significant stress, sexual dysfunction, physical inactivity, or hot flashes are more vulnerable.
73
What is the strongest predictor of depression at midlife?
A prior history of clinical depression is the strongest predictor of midlife depression.
74
What are some strategies to manage mood changes during menopause?
Management includes relaxation techniques, stress reduction, antidepressants, and psychotherapy for severe symptoms.
75
How does early estrogen treatment benefit mood?
Early estrogen treatment at menopause onset may improve mood and cognition by stabilizing hormone levels.
76
Why is late estrogen treatment not effective for mood disorders?
Late treatment (after 65 or 10+ years post-menopause) offers no mood benefit and may increase health risks.
77
What is the Timing Hypothesis in hormone replacement therapy (HRT)?
The Timing Hypothesis suggests that the timing of HRT initiation relative to menopause onset influences its benefits and risks, particularly for the cardiovascular system.
78
What are the benefits of early HRT initiation?
Early HRT initiation protects against cardiovascular disease, supports cognitive function, improves blood vessel health, and reduces oxidative stress.
79
When is HRT considered 'early intervention'?
Early intervention occurs when HRT is started close to menopause onset in younger, early postmenopausal women.
80
What are the risks of late HRT initiation?
Late HRT initiation can destabilize atherosclerotic plaques, increase the risk of thrombosis, and lead to heart attacks or strokes, particularly in older women or those with established cardiovascular disease.
81
When is HRT considered 'late intervention'?
Late intervention occurs when HRT is started years after menopause, typically after age 65 or more than 10 years post-menopause.
82
Why does late HRT pose cardiovascular risks?
Late HRT can lead to plaque destabilization in blood vessels and increase the risk of thrombosis, especially in women with existing coronary disease.
83
How does early HRT benefit the cardiovascular system?
Early HRT helps maintain blood vessel integrity, improves vascular health, and prevents oxidative damage, reducing cardiovascular risks.
84
What is the main clinical implication of the Timing Hypothesis?
HRT should be initiated close to menopause onset for maximum benefit and avoided.
85
What does the Timing Hypothesis suggest about hormone replacement therapy (HRT)?
The Timing Hypothesis suggests that the timing of HRT initiation relative to menopause onset determines its benefits and risks, particularly for the cardiovascular system.
86
What are the benefits of early HRT initiation?
Early HRT protects against cardiovascular disease, supports cognitive function, improves blood vessel health, and reduces oxidative stress.
87
When is HRT considered 'early intervention'?
HRT is considered early intervention when initiated close to menopause onset in younger, early postmenopausal women.
88
What are the risks associated with late HRT initiation?
Late HRT can destabilize atherosclerotic plaques, increase thrombosis risk, and lead to heart attacks or strokes, especially in older women or those with existing cardiovascular disease.
89
When is HRT considered 'late intervention'?
HRT is considered late intervention when started years after menopause, typically after age 65 or more than 10 years post-menopause.
90
Why does late HRT pose cardiovascular risks?
Late HRT can lead to plaque destabilization in blood vessels, increasing the likelihood of rupture and thrombosis.
91
How does early HRT support cardiovascular health?
Early HRT maintains blood vessel integrity, improves vascular health, and prevents oxidative damage.
92
What is the main clinical implication of the Timing Hypothesis for HRT use?
For safe HRT use, initiate therapy close to menopause onset and avoid or cautiously approach it in older women or those with underlying coronary disease.
93
How does late HRT affect asymptomatic women with coronary disease?
Late HRT can destabilize plaques, leading to plaque rupture and thrombosis, resulting in serious cardiovascular events.
94
Why is timing critical in HRT for cardiovascular health?
Timing is critical because early HRT supports vascular health, while late HRT increases risks due to plaque destabilization and clot formation.

0- OB gyne (32 decks)

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