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0 - OB2 > Untitled Deck > Flashcards

Untitled Deck Flashcards

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
Q

What are common management strategies for menopause symptoms?

A

Management includes lifestyle changes, hormone replacement therapy (HRT), and medical interventions to alleviate discomfort and reduce long-term health risks.

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26
Q

What is the definition of perimenopause?

A

Perimenopause is the transitional period around menopause, also called ‘the menopausal transition.’

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27
Q

What are common symptoms of perimenopause?

A

Symptoms include irregular bleeding, hot flushes, mood changes, and reduced fertility.

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28
Q

How is perimenopause managed?

A

Short-term oral contraceptives (20 mcg ethinyl estradiol) may be used to manage symptoms and regulate cycles.

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29
Q

What is induced menopause?

A

Induced menopause is menopause resulting from medical interventions, also known as iatrogenic menopause.

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30
Q

What are the causes of induced menopause?

A

Causes include bilateral oophorectomy (with or without hysterectomy), chemotherapy, or pelvic radiation therapy.

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31
Q

What is Premature Ovarian Failure (POF) or Premature Ovarian Insufficiency (POI)?

A

POF or POI is ovarian failure before age 40, accompanied by high levels of gonadotropins (hypergonadotropic ovarian failure).

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32
Q

What are possible causes of POI?

A

Causes include genetic factors, enzymatic defects, autoimmune reactions, gonadotropin defects, ovarian insults (surgery or infections), or idiopathic cases.

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33
Q

How is POI managed?

A

Management includes screening for autoimmune disorders, karyotyping for genetic abnormalities, transvaginal ultrasound, and specific tests for thyroid and adrenal issues.

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34
Q

What is the primary treatment for POI?

A

Estrogen Replacement Therapy (ERT) is used for symptom relief and prevention of long-term health issues.

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35
Q

What is the most effective fertility option for women with POI?

A

Oocyte (egg) donation is the most effective option, with a spontaneous pregnancy rate of around 5%.

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36
Q

Why is perimenopause considered challenging?

A

Perimenopause involves irregular cycles, hot flushes, mood changes, and reduced fertility, often requiring symptom management and hormone regulation.

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37
Q

How does induced menopause differ from natural menopause?

A

Induced menopause occurs abruptly due to medical interventions, unlike the gradual transition typical of natural menopause.

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38
Q

What are common autoimmune conditions screened for in POI?

A

Common conditions include Hashimoto’s Thyroiditis, adrenal disorders, and other autoimmune diseases.

39
Q

What is the role of estrogen in the brain during menopause?

A

Estrogen affects mood, thermoregulation, and cognition, with its decline during menopause leading to symptoms like hot flushes and sleep disturbances.

40
Q

What are the two main estrogen receptors in the brain?

A

Estrogen Receptors (ER) α and β mediate estrogen’s effects in the brain.

41
Q

What is the hallmark symptom of menopause?

A

The hallmark symptom of menopause is the hot flush (vasomotor episode).

42
Q

What is the difference between a hot flash and a hot flush?

A

A hot flash is an intense sensation of heat, while a hot flush involves heat sensation with skin changes, such as sweating (diaphoresis).

43
Q

How long do hot flushes typically last after menopause onset?

A

Hot flushes typically last 2 years but can persist for over 10 years.

44
Q

What causes hot flushes during menopause?

A

Declining estrogen levels disrupt thermoregulation, narrowing the thermoneutral zone, making women sensitive to minor temperature changes.

45
Q

What is the thermoneutral zone, and how does it differ in symptomatic women?

A

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
Q

What are the physiological changes during a hot flush?

A

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
Q

How do hot flushes impact sleep?

A

Hot flushes disrupt sleep by causing frequent awakenings and excessive sweating, leading to fatigue and irritability.

48
Q

How does estrogen therapy help manage hot flushes?

A

Estrogen therapy reduces the frequency of hot flushes and improves sleep quality.

49
Q

What is the impact of disrupted sleep due to hot flushes?

A

Disrupted sleep causes daytime fatigue, irritability, and decreased quality of life.

50
Q

Why are hot flushes more distressing in symptomatic women?

A

Symptomatic women have a narrower thermoneutral zone, making them highly sensitive to minor temperature changes.

51
Q

What is the thermoneutral zone?

A

The thermoneutral zone is the range of core body temperature in which neither sweating nor shivering is triggered.

52
Q

How does the thermoneutral zone differ in asymptomatic women?

A

In asymptomatic women, the thermoneutral zone is wide, allowing stable temperature regulation without frequent hot flushes or chills.

53
Q

What happens to the thermoneutral zone in symptomatic menopausal women?

A

In symptomatic menopausal women, the thermoneutral zone becomes narrowed, making them more sensitive to minor temperature changes.

54
Q

What triggers a hot flush in menopausal women?

A

A hot flush is triggered when core body temperature rises slightly above the narrowed sweating threshold.

55
Q

What triggers chills in menopausal women?

A

Chills are triggered when core body temperature drops slightly below the narrowed shivering threshold.

56
Q

Why does the thermoneutral zone narrow in menopause?

A

Reduced estrogen levels disrupt thermoregulation, leading to a narrowed thermoneutral zone.

57
Q

What neurotransmitters are involved in thermoregulation during menopause?

A

Norepinephrine (NE), serotonin (5-HT), and related pathways are involved in thermoregulation.

58
Q

How can treatments help manage hot flushes?

A

Treatments like Yohimbine, Clonidine, SSRIs, or agents targeting norepinephrine and serotonin may widen the thermoneutral zone, reducing hot flush frequency.

59
Q

How do SSRIs affect the thermoneutral zone?

A

SSRIs stabilize thermoregulation by increasing serotonin levels, which can help widen the thermoneutral zone.

60
Q

Why are symptomatic women more prone to hot flushes and chills?

A

Symptomatic women have a narrowed thermoneutral zone, making them more sensitive to small temperature fluctuations.

61
Q

What is MPHG, and how does it relate to hot flushes?

A

MPHG (3-Methoxy-4-hydroxyphenylglycol) is a norepinephrine metabolite that may influence thermoregulation and help reduce hot flush frequency.

62
Q

What is the role of Clonidine in managing hot flushes?

A

Clonidine reduces norepinephrine activity, helping to stabilize thermoregulation and alleviate hot flushes.

63
Q

Why is management of hot flushes important?

A

Hot flushes disrupt daily life and sleep, so treatments targeting thermoregulation can significantly improve quality of life for menopausal women.

64
Q

How does estrogen deficiency affect cognitive decline in postmenopausal women?

A

Estrogen deficiency contributes to cognitive decline by reducing support for neuronal and synaptic activity, alongside aging.

65
Q

How does estrogen impact verbal memory?

A

Estrogen improves verbal memory, suggesting its supportive role in certain cognitive functions.

66
Q

What is the relationship between estrogen and Alzheimer’s Disease (AD)?

A

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
Q

Can estrogen therapy reverse Alzheimer’s Disease?

A

No, estrogen therapy does not reverse AD once the disease has developed.

68
Q

What is the effect of early initiation of estrogen therapy on cognitive decline?

A

Early initiation near menopause reduces brain damage from free radicals and supports neuronal activity, protecting against cognitive decline.

69
Q

Why is late initiation of estrogen therapy not recommended for cognition?

A

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
Q

What are common mood changes during menopause?

A

Mood changes include feelings of upset, loss of control, irritability, fatigue, and dysphoria (blue moods).

71
Q

What causes mood disturbances during menopause?

A

Fluctuating hormone levels temporarily disrupt neural systems, causing mood disturbances.

72
Q

Who is more vulnerable to depressive symptoms during menopause?

A

Women with a history of PMS, significant stress, sexual dysfunction, physical inactivity, or hot flashes are more vulnerable.

73
Q

What is the strongest predictor of depression at midlife?

A

A prior history of clinical depression is the strongest predictor of midlife depression.

74
Q

What are some strategies to manage mood changes during menopause?

A

Management includes relaxation techniques, stress reduction, antidepressants, and psychotherapy for severe symptoms.

75
Q

How does early estrogen treatment benefit mood?

A

Early estrogen treatment at menopause onset may improve mood and cognition by stabilizing hormone levels.

76
Q

Why is late estrogen treatment not effective for mood disorders?

A

Late treatment (after 65 or 10+ years post-menopause) offers no mood benefit and may increase health risks.

77
Q

What is the Timing Hypothesis in hormone replacement therapy (HRT)?

A

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
Q

What are the benefits of early HRT initiation?

A

Early HRT initiation protects against cardiovascular disease, supports cognitive function, improves blood vessel health, and reduces oxidative stress.

79
Q

When is HRT considered ‘early intervention’?

A

Early intervention occurs when HRT is started close to menopause onset in younger, early postmenopausal women.

80
Q

What are the risks of late HRT initiation?

A

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
Q

When is HRT considered ‘late intervention’?

A

Late intervention occurs when HRT is started years after menopause, typically after age 65 or more than 10 years post-menopause.

82
Q

Why does late HRT pose cardiovascular risks?

A

Late HRT can lead to plaque destabilization in blood vessels and increase the risk of thrombosis, especially in women with existing coronary disease.

83
Q

How does early HRT benefit the cardiovascular system?

A

Early HRT helps maintain blood vessel integrity, improves vascular health, and prevents oxidative damage, reducing cardiovascular risks.

84
Q

What is the main clinical implication of the Timing Hypothesis?

A

HRT should be initiated close to menopause onset for maximum benefit and avoided.

85
Q

What does the Timing Hypothesis suggest about hormone replacement therapy (HRT)?

A

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
Q

What are the benefits of early HRT initiation?

A

Early HRT protects against cardiovascular disease, supports cognitive function, improves blood vessel health, and reduces oxidative stress.

87
Q

When is HRT considered ‘early intervention’?

A

HRT is considered early intervention when initiated close to menopause onset in younger, early postmenopausal women.

88
Q

What are the risks associated with late HRT initiation?

A

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
Q

When is HRT considered ‘late intervention’?

A

HRT is considered late intervention when started years after menopause, typically after age 65 or more than 10 years post-menopause.

90
Q

Why does late HRT pose cardiovascular risks?

A

Late HRT can lead to plaque destabilization in blood vessels, increasing the likelihood of rupture and thrombosis.

91
Q

How does early HRT support cardiovascular health?

A

Early HRT maintains blood vessel integrity, improves vascular health, and prevents oxidative damage.

92
Q

What is the main clinical implication of the Timing Hypothesis for HRT use?

A

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
Q

How does late HRT affect asymptomatic women with coronary disease?

A

Late HRT can destabilize plaques, leading to plaque rupture and thrombosis, resulting in serious cardiovascular events.

94
Q

Why is timing critical in HRT for cardiovascular health?

A

Timing is critical because early HRT supports vascular health, while late HRT increases risks due to plaque destabilization and clot formation.

0 - OB2 (13 decks)

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