Widstrom: Menopause

Question 1

What is perimenopause?

Answer 1

Time before, during and after menopause

Question 2

What is menopause?

Answer 2

permanent cessation of menses after the cessation of ovarian function- 1 year w/ no period

Question 3

What are signs of menopause?

Answer 3

Amenorrhea in presence of signs of hypoestrogenemia and FSH> 40
Age 51

Question 4

What are concerns during the postmenopausal period?

Answer 4

HRT
osteoporosis
CVD
sexual fxn
uterovaginal prolapse
mood
hot flashes
vaginal atrophy
incontinence

Question 5

What hormonal changes occur during menopause?

Answer 5

Ovaries stop producing follicles> inhibin falls>
Increase in FSH>
less follicle development>
decline in estradiol>
decrease in endometrial development>
absence of menses

Question 6

After menopause, what happens to estrogen that is aromatized from androgens (in muscle and adipose)?

Answer 6

obesity> endometrial cancer

thin> osteoporosis, hot flashes, (lack of androgens)

Question 7

What leads to higher estrogen levels and increased risk of endometrial cancer in menopause?

Answer 7

Progesterone production stops

Question 8

What affects libido during menopause?

Answer 8

decrease in androgen production

Question 9

What physical changes are seen during menopause?

Answer 9

Increase weight and body fat
increase waist: hip ratio
Decreased collagen
hot flashes

Question 10

What are hte pathognomonic sxs of menopause?

Answer 10

Hot flashes (directly correlate to estrogen levels)

Question 11

What should you consider in a menopausal women w/ abnormal uterine bleeding?

Answer 11

1. rule out pregnancy
2. endometrial cancer (10%)
3. EM hyperplasia, polpys, cervical cancer, fibroids, adenomyosis
4. ADenocarcinoma in situ

Question 12

How do you tx abnormal uterine bleeding?

Answer 12

Medical: cyclic HRT, CCHRT, OCP
hysteroscopy/EM ablation/D and C
Hysterectomy

Question 13

What happens to bone density in post menopause?

Answer 13

decreases by 1-2% per year in whites and asians

Question 14

When should you start screening for osteoporosis in a woman w/out risk factors?

Answer 14

at age 65

Question 15

What can be used to treat hot flashes, vaginal atrophy, osteoporosis, and osteopenia?

Answer 15

HRT

Question 16

When is HRT contraindicated?

Answer 16

pregnancy
undx vaginal bleeding
active VTE
current GB dz
liver dz

Question 17

What type of HRT do you give a menopausal woman who still has her uterus?

Answer 17

Estrogen and progesterone

Question 18

What type of HRT should be given to younger woman who ahve had their ovaries taken out?

Answer 18

estrogen and methyltestosterone (blocking sex hormone binding globuling allows estrogen to be more available)