Untitled Deck Flashcards
What is the clinical definition of menopause?
Permanent cessation of menses confirmed after 1 year of no menstrual bleeding due to ovarian follicular failure.
What is the average age of menopause in Western and Filipino populations?
Western: 51-52 years; Filipino: 47-48 years.
What key physiological change signals the onset of menopause?
Decreased AMH and ovarian inhibin-B, accompanied by increased FSH.
How does smoking affect the age of menopause onset?
It causes menopause 1-2 years earlier.
What impact does BMI have on the onset of menopause?
Higher BMI delays menopause onset.
What are common early symptoms of menopause (40-45 years)?
Hot flushes, sweating, insomnia, menstrual irregularity, and psychological symptoms.
What are the hallmark intermediate symptoms of menopause (50-60 years)?
Vaginal atrophy, dyspareunia, skin atrophy, and urge-stress incontinence.
Which late-stage conditions are associated with menopause (65+ years)?
Osteoporosis, atherosclerosis, cardiovascular disease, and Alzheimer’s disease.
What is the most symptomatic phase of menopause?
Perimenopause (the menopausal transition).
What is induced menopause, and what are its causes?
Menopause caused by medical interventions like bilateral oophorectomy, chemotherapy, or radiation.
What is the most common cause of premature ovarian insufficiency?
Autoimmune disorders.
What causes hot flushes in menopausal women?
Narrowing of the thermoregulatory zone due to decreased estrogen levels.
What is the role of estrogen in preventing Alzheimer’s disease?
Early estrogen exposure decreases free radical brain damage and promotes synaptic maintenance.
What is the ‘Timing Hypothesis’ in hormone therapy?
Early intervention with hormone therapy benefits cognition, but late intervention can be harmful.
How does menopause affect collagen levels?
Estrogen deficiency reduces collagen content, causing skin thinning and pelvic tissue weakening.
Which exercises can help stress incontinence in menopausal women?
Kegel exercises.
What is the new term for vulvovaginal atrophy?
Genitourinary Syndrome of Menopause (GSM).
What are the treatment options for GSM?
Regular sexual activity, lubricants, moisturizers, and local vaginal estrogen.
What defines osteoporosis based on T-scores?
Osteoporosis: T-score ≤ -2.5; Osteopenia: -1.0 to -2.5.
What is the standard diagnostic tool for osteoporosis?
Dual-Energy X-ray Absorptiometry (DEXA).
How does estrogen prevent osteoporosis?
Estrogen suppresses osteoclast activity by increasing apoptosis and maintaining bone formation balance.
Why does cardiovascular disease risk increase after menopause?
Declining estrogen leads to increased LDL, reduced HDL, and vascular changes.
Which lifestyle management steps can reduce cardiovascular risk?
Maintaining cholesterol <200 mg/dL, BP <120/80 mmHg, and BMI <25 kg/m², and regular physical activity.
What is the recommended frequency of mammograms for women aged 50-74?
Every 2 years.
Which cancers should menopausal women regularly screen for?
Breast, colorectal, endometrial, cervical, and ovarian cancers.
What lifestyle changes are recommended for menopausal women?
Smoking cessation, alcohol moderation, physical activity, and weight loss.
What common sense solutions can help vasomotor symptoms (VMS)?
Wearing comfortable clothing and staying hydrated.
When is unopposed estrogen therapy appropriate?
For women without a uterus.
What is the first-line pharmacologic treatment for menopausal symptoms?
Hormone Therapy (HT).
Why is progesterone added to estrogen therapy in women with a uterus?
To prevent endometrial hyperplasia and cancer.
What are contraindications to hormone therapy?
History of thromboembolic events, unexplained vaginal bleeding, and active liver disease.
Which medications are used for osteoporosis treatment?
Bisphosphonates, calcitonin, SERMs (e.g., raloxifene), and parathyroid hormone (e.g., teriparatide).
What adjunctive measures are recommended for osteoporosis prevention?
Calcium 1500 mg daily, vitamin D 400-800 IU, and weight-bearing exercises.
Which antidepressants are used off-label for vasomotor symptoms?
SSRIs (e.g., fluoxetine, paroxetine) and SNRIs (e.g., venlafaxine).
Which anticonvulsant is used for hot flushes?
Gabapentin.
What are examples of complementary therapies for menopause?
Soy isoflavones, black cohosh, and Traditional Chinese Medicine.
What OTC hormone is commonly used for menopause symptoms?
Topical progesterone.
What is a key diagnostic difference between menopause and other forms of menstrual cessation?
Menopause involves absent or non-functional ovaries; hysterectomy with functional ovaries is not menopause.
What genetic causes might lead to premature ovarian failure?
Genetic mutations, enzymatic defects, or gonadotropin receptor abnormalities.
How does parity affect menopause onset?
Higher parity is associated with later onset of menopause.
What psychological symptoms may occur in early menopause?
Mood swings, irritability, anxiety, and mild depression.
What causes dyspareunia in menopausal women?
Vaginal atrophy due to estrogen deficiency.
Which intermediate symptom involves thinning and drying of the skin?
Skin atrophy.
What cardiovascular condition is more likely in late menopause stages?
Coronary heart disease (CHD).
What is the primary treatment for irregular bleeding in perimenopause?
Short-term use of oral contraceptives with 20 mcg ethinyl estradiol.
What is the likelihood of spontaneous pregnancy in premature ovarian insufficiency?
Around 5%.
Which autoimmune condition is commonly screened for in premature ovarian failure?
Hashimoto’s thyroiditis.
What neurotransmitter functions does estrogen enhance in the brain?
Cholinergic and serotonergic functions.
Why is late initiation of hormone therapy potentially harmful for cognition?
It may worsen cognition and increase the risk of stroke.
What hormone replacement timing improves mood disorders in menopause?
Early initiation of estrogen therapy.
What role does estrogen play in urinary incontinence?
Estrogen reduces collagen atrophy and improves bladder control.
Which type of incontinence is commonly seen early in menopause?
Stress incontinence.
What is a non-hormonal strategy to manage incontinence?
Weight loss in overweight women.
What is the pH change in vaginal atrophy caused by estrogen deficiency?
Vaginal pH increases above 5.
What are petechiae in the context of vulvovaginal atrophy?
Small red spots on the vaginal mucosa due to thinning and fragility.
Why do vasomotor symptoms differ from vaginal atrophy in their progression?
Vasomotor symptoms abate over time, while vaginal atrophy progresses.
Which type of bone is more affected by estrogen deficiency?
Trabecular bone (e.g., spine).
What bone turnover marker reflects resorption activity?
C-terminal telopeptide of type I collagen (CTX).
What bone turnover marker reflects formation activity?
Serum procollagen type I N-terminal propeptide (P1NP).
What is the role of osteocytes in bone remodeling during estrogen deficiency?
They signal increased osteoclast recruitment.
What is the impact of menopause on HDL-C levels?
HDL-C levels trend downward slightly but inconsistently.
What direct vascular effect of estrogen helps maintain cardiovascular health?
Increased prostacyclin production and vasodilation.
What lifestyle factor significantly reduces cardiovascular risks in postmenopausal women?
Regular physical activity (≥150 minutes/week moderate or ≥75 minutes vigorous).
What is the most common cancer-related death in postmenopausal women?
Coronary artery disease (CAD).
Why is there no routine screening for ovarian cancer?
Lack of effective screening tests; evaluation is symptom-based.
What test is recommended for postmenopausal bleeding?
Pelvic ultrasound and/or endometrial biopsy.
Which dietary adjustments can reduce vasomotor symptoms?
Avoiding caffeine, alcohol, and spicy foods.
What type of clothing is recommended for managing hot flushes?
Loose, breathable layers.
What is the preferred hormone therapy for women with vaginal dryness only?
Low-dose local estrogen therapy (e.g., vaginal tablets or creams).
What progestogen is commonly combined with estrogen in hormone therapy?
Medroxyprogesterone acetate (MPA).
What systemic side effects can occur with hormone therapy?
Breast tenderness, nausea, and weight changes.
What is the contraindication for hormone therapy in active liver disease?
Estrogen is metabolized in the liver, exacerbating the condition.
What is the mechanism of bisphosphonates in osteoporosis treatment?
Inhibition of osteoclast activity, reducing bone resorption.
What rare complication can long-term bisphosphonate use cause?
Osteonecrosis of the jaw.
Which osteoporosis drug has anabolic effects on bone?
Teriparatide (parathyroid hormone analog).
Why is calcium with vitamin D insufficient alone to prevent osteoporosis?
It does not prevent bone loss in younger postmenopausal women.
Which antihypertensive is used off-label for hot flushes?
Clonidine.
What is the mechanism of gabapentin for vasomotor symptoms?
Modulation of central thermoregulation.
What are soy isoflavones, and how do they help menopause symptoms?
Plant-based phytoestrogens that mimic estrogen effects.
Which herb is commonly used for hot flushes and mood swings?
Black cohosh.
What role does melatonin play in menopause management?
Improves sleep quality.
How does yoga benefit menopausal women?
Reduces stress and alleviates mood swings.
What is a simple measure to prevent overheating at night for women with hot flushes?
Sleeping in a cool room.
Why are cold drinks recommended during hot flushes?
They help lower core body temperature rapidly.
What role does regular sexual activity play in GSM?
Helps maintain vaginal elasticity and blood flow.
What dietary modification can help prevent osteoporosis?
Increased intake of calcium-rich foods like dairy and leafy greens.
Why is mindfulness recommended during menopause?
It helps manage anxiety and emotional fluctuations effectively.
What medical intervention can lead to induced menopause?
Bilateral oophorectomy, chemotherapy, or pelvic radiation therapy.
Why is hysterectomy associated with earlier menopause?
Reduced blood supply to the ovaries accelerates follicular depletion.
What does a decrease in anti-Müllerian hormone (AMH) signify in menopause?
It marks declining ovarian reserve and the onset of menopause.
What happens to FSH levels as menopause approaches?
FSH levels increase due to reduced ovarian feedback.
What causes insomnia in menopausal women?
Sleep disruption due to hot flushes and night sweats.
Why do menopausal women experience a higher prevalence of urinary incontinence?
Collagen atrophy weakens pelvic floor support.
Which cognitive changes are common in menopause?
Memory lapses and difficulties in verbal recall.
What distinguishes premature ovarian insufficiency (POI) from natural menopause?
POI occurs before age 40 and often has an autoimmune or genetic basis.
What fertility option is available for women with POI who wish to conceive?
Oocyte donation.
What is the main goal of treatment during perimenopause?
Manage irregular bleeding and alleviate early vasomotor symptoms.
What is the hallmark vasomotor symptom of menopause?
Hot flushes.
How does estrogen deficiency affect thermoregulation?
It narrows the thermoregulatory zone, causing sweating and shivering.
What are the primary complaints of women with hot flushes at night?
Sleep disruption and night sweats.
What neurotransmitter-related benefit does estrogen provide?
Enhances cholinergic neurotransmission, potentially delaying Alzheimer’s disease.
How does estrogen deficiency affect pelvic support structures?
Causes weakening of collagen, increasing the risk of pelvic organ prolapse.
What are the urinary benefits of estrogen replacement therapy?
Reduces urgency, frequency, and recurrent UTIs.
What skin changes are caused by reduced collagen levels after menopause?
Thinner, less elastic, and drier skin.
Why do women with vaginal atrophy often experience dyspareunia?
Decreased vaginal moisture and thinning of mucosa lead to pain during intercourse.
What vaginal pH value indicates estrogen deficiency?
A pH greater than 5.
How does local estrogen therapy differ from systemic therapy?
Local estrogen targets vaginal symptoms without affecting systemic estrogen levels.
Why is trabecular bone more vulnerable to osteoporosis than cortical bone?
Trabecular bone has a higher turnover rate, making it more sensitive to estrogen deficiency.
What is the significance of the FRAX tool in osteoporosis management?
It calculates a 10-year risk of major osteoporotic and hip fractures.
What is the role of estrogen in maintaining bone remodeling balance?
It suppresses osteoclast activity and promotes osteoblast survival.
What happens to the bone formation phase during estrogen deficiency?
It shortens, leading to net bone loss.
What lipid changes are characteristic of postmenopausal women?
Increased LDL cholesterol and decreased HDL cholesterol.
How does estrogen deficiency affect vascular endothelial function?
Reduces nitric oxide production, impairing vasodilation.
What cardiovascular risk is associated with premature ovarian failure?
A 2-3 times higher risk of myocardial infarction.
What is the first-line screening tool for colorectal cancer in menopausal women?
Colonoscopy, performed every 10 years.
How is cervical cancer screening modified for women aged ≥65?
No further screening if the last three PAP tests were normal.
Why is ovarian cancer challenging to screen for in menopausal women?
There are no reliable screening tests for asymptomatic women.
What is the primary benefit of hormone therapy for vasomotor symptoms?
Reduces the frequency and severity of hot flushes.
What is the rationale for avoiding unopposed estrogen therapy in women with a uterus?
It increases the risk of endometrial hyperplasia and cancer.
Which progestogens are commonly used in combination with estrogen?
Medroxyprogesterone acetate (MPA) and norethindrone acetate.
What side effect of hormone therapy might mimic premenstrual symptoms?
Breast tenderness.
What is the benefit of low-dose vaginal estrogen for GSM?
Alleviates local symptoms like dryness and dyspareunia without systemic effects.
What is the safest hormone therapy preparation for women at high risk for thromboembolism?
Transdermal estrogen.
What precaution should be taken in diabetic women on hormone therapy?
Monitor triglyceride levels, as hormone therapy can exacerbate hypertriglyceridemia.
What is the mechanism of action of SERMs like raloxifene?
They mimic estrogen’s effects on bones while antagonizing estrogen in breast tissue.
Why is tibolone unique among osteoporosis treatments?
It has mixed estrogenic, progestogenic, and androgenic properties.
What is the role of calcitonin in osteoporosis?
Inhibits bone resorption and provides pain relief for vertebral fractures.
What is the recommended duration of teriparatide therapy?
No longer than 18 months.
Why should bisphosphonates be taken with water on an empty stomach?
To improve absorption and reduce the risk of esophageal irritation.
Which SSRI is FDA-approved for vasomotor symptom management?
Paroxetine.
What is the role of eszopiclone in menopause?
It is a hypnotic used to improve sleep quality.
Which traditional medicine practices are commonly used for menopause symptoms?
Traditional Chinese Medicine and Ayurvedic medicine.
What is valerian root commonly used for in menopause?
Managing insomnia and mild anxiety.
How does St. John’s Wort help menopausal women?
It alleviates mild depression.
What is the DASH diet, and why is it recommended for menopausal women?
The Dietary Approaches to Stop Hypertension diet promotes cardiovascular health.
What specific physical activities are recommended for menopausal women?
Weight-bearing exercises like walking or dancing to maintain bone density.
How can mindfulness meditation improve menopause symptoms?
Reduces stress and alleviates mood swings.
