Menopause and HRT 2

Question 1

List the cardinal signs/symptoms of perimenopause.

Answer 1

• Menstrual change
• Vasomotor symptoms (hot flashes or night sweats)
• Sleep disturbances
• Vulvovaginal atrophy
  
  • dyspareunia
  • dryness
  • burning
• Mood disturbance
  
  • depressed mood
  • anxiety
  • irritability
  • clinical depression

Question 2

What is the physiology of menopause transition?

Answer 2

• Continual depletion of eggs in female life cycle
  
  • 1,000 by menopause transition
  • 0 after menopause
• Follicular depletion
  
  • decreased inhibin B
  • increased and erratic FSH
    
    • leads to erratic ovulation
    • menstrual cycle irregularity
    • INCREASED estradiol, heavier menses
  • eventual fall in estradiol due to inadequate production
• Bleeding is abnormal in postmenopausal years

Question 3

What is the pathophysiology behind hot flashes?

Answer 3

• Most common symptom in perimenopause, not well understood
• Characterized by sudden onset of heat that beings at the head and neck and spreads throughout the body, lasting from 1-5 minutes
  
  • sweating and flushing
  • anxiety and palpitations
  • shivering may follow
  • disrupts sleep
• Associated with:
  
  • genetic predisposition
  • noradrenergic and serotonergic systems
  • change in thermoneutral zone of the hypothalamus
    
    • narrower
    • small changes promps heat response
• Treat with estroegen, widen threshold
  
  • clonidine also helps with lowering brain NE and increasing sweating threshold