Clinicians Guide Menopause - Chapter 1 Flashcards
(133 cards)
1
Q
What is the typical age range for women to experience menopause?
A
40 to 58 years
2
Q
How many women aged 50 years and older were there worldwide in 1990?
A
471 million
3
Q
By what percentage did the number of women aged 50 years and older increase from 1990 to 2015?
A
82.6%
4
Q
What is the estimated number of US women aged at least 50 years by 2020?
A
64 million
5
Q
What is the projected number of US women aged at least 50 years by 2060?
A
Close to 90 million
6
Q
What is the overall life expectancy for US females as of 2012?
A
81.2 years
7
Q
What percentage of US women who survive to age 50 are expected to live an average of 33.3 more years?
A
67.2%
8
Q
What percentage of Canadian women were aged at least 50 years in 2016?
A
39%
9
Q
What is the projected percentage of Canadian women aged at least 50 years by 2038?
A
43%
10
Q
What is the term used for the period of changes during menopause?
A
Climacteric
11
Q
What is the definition of early menopause?
A
Menopause occurring before age 45
12
Q
What is the definition of late menopause?
A
Menopause occurring after age 54
13
Q
What is classified as early postmenopause according to STRAW+10?
A
Within 8 years of the final menstrual period
14
Q
What is induced menopause?
A
Cessation of menses after surgical removal of ovaries or iatrogenic ablation
15
Q
What characterizes the menopause transition according to STRAW+10?
A
Time before the final menstrual period with menstrual cycle variability
16
Q
What defines natural menopause?
A
Permanent cessation of menses due to loss of ovarian follicular activity
17
Q
What does the term perimenopause mean?
A
Around menopause
18
Q
What is the definition of postmenopause?
A
Stage of life after menopause
19
Q
What is primary ovarian insufficiency (POI)?
A
Menopause occurring before age 40
20
Q
What percentage of US women experience POI?
A
Approximately 1%
21
Q
What is the definition of premenopause?
A
Stage of life that precedes menopause
22
Q
What is the significance of the STRAW+10 staging system?
A
It characterizes reproductive aging from reproductive years through menopause
23
Q
How many stages are in the STRAW+10 staging system?
A
Seven stages
24
Q
What are the stages that comprise the reproductive interval in STRAW+10?
A
Stages −5, −4, −3b, and −3a
25
What marks the late reproductive stage (STRAW+10 stage −3)?
Decline in fecundability and menstrual cycle changes
26
What hormone is commonly used to test ovarian reserve on cycle day 3?
FSH (follicle-stimulating hormone)
27
What happens to the number of oocytes from fetal development to puberty?
Declines from 6 to 7 million to about 400,000
28
What does the term 'menopause' ultimately define?
Ovarian follicular exhaustion
29
True or False: Menstrual-cycle criteria can be applied to women who do not have regular menstrual cycles.
False
30
What is the typical age range for natural menopause to occur?
40 to 58 years
31
Fill in the blank: The _____ is defined as the time before the final menstrual period when menstrual cycle variability occurs.
menopause transition
32
What factors can influence reproductive aging besides menopause?
Obesity, diabetes mellitus, dyslipidemia, thyroid disease, hypertension
33
What are the characteristics of the late reproductive stage (stage -3a)?
Subtle menstrual-cycle changes in flow and length, increased frequency of shorter cycles, variable FSH levels, and other markers of ovarian aging being low
## Footnote
Stage -3a indicates advanced ovarian aging with specific hormonal changes.
34
What is the most commonly used test of ovarian reserve?
Cycle day 3 FSH
## Footnote
FSH stands for Follicle-Stimulating Hormone.
35
How does elevated estradiol affect FSH levels?
Elevated estradiol can suppress FSH, giving 'falsely' normal FSH levels
## Footnote
This interaction complicates the interpretation of ovarian reserve tests.
36
What does Antimüllerian hormone (AMH) levels indicate?
AMH levels capture quantitative but not qualitative data on ovarian reserve
## Footnote
AMH is a marker of small, partially unmeasured follicles and nonatretic follicles.
37
What is the peak AMH concentration age?
24.5 years
## Footnote
This peak is correlated with the number of follicles until menopause.
38
What factors may influence AMH levels?
Exogenous hormone use, pregnancy, BMI, and smoking
## Footnote
AMH levels can be lower in hormone contraception users and during pregnancy.
39
What defines the early menopause transition (stage -2)?
Persistent difference of 7 days or more in the length of consecutive cycles
## Footnote
This must recur within 10 cycles of the first variable-length cycle.
40
What is the late menopause transition (stage -1) characterized by?
60 or more consecutive days of amenorrhea and increased variability in cycle length
## Footnote
This stage includes fluctuations in hormone levels and increased prevalence of anovulation.
41
What is a Luteal Out-of-Phase (LOOP) event?
A phenomenon where elevated FSH levels recruit a second follicle during the luteal phase
## Footnote
This can lead to abnormal cycle lengths and increased estradiol secretion.
42
What hormonal changes occur during early postmenopause (stages +1a, +1b, and +1c)?
FSH continues to rise and estradiol continues to decrease
## Footnote
Vasomotor symptoms are most likely to occur during these stages.
43
What is the hallmark for initiation of postmenopause?
The final menstrual period (FMP)
## Footnote
There is no specific endocrine marker for postmenopause.
44
What happens to SHBG levels during the menopause transition?
SHBG levels decrease by approximately 40%
## Footnote
The greatest change occurs 2 years before menopause.
45
What characterizes late postmenopause (stage +2)?
Limited further changes in reproductive endocrine function and increased genitourinary symptoms
## Footnote
This stage begins 5 to 8 years after the FMP.
46
True or False: Anovulatory cycles are characterized by low progesterone levels.
True
## Footnote
Progesterone levels show a linear decline during the menopause transition.
47
What do elevated FSH levels indicate during the menopause transition?
They indicate the transition towards menopause and potential anovulation
## Footnote
FSH levels greater than 25 IU/L are significant for classification.
48
What is the relationship between ethnicity and AMH levels?
White women have higher AMH levels than black and Hispanic women
## Footnote
Ethnic variations have been observed in hormone levels during menopause.
49
What happens to testosterone levels during the menopause transition?
Testosterone levels may not change significantly during the transition
## Footnote
Some studies show transient reductions followed by normalization.
50
What hormones do the postmenopausal ovary continue to produce?
Androstenedione and testosterone
## Footnote
Higher levels of androgens in some postmenopausal women might reflect ovarian stromal hyperplasia and luteinization.
51
In the Rancho Bernardo Study, what trend was observed regarding total testosterone levels in women aged 50 to 89 years?
Total testosterone levels increased with age, reaching premenopause levels by age 70
## Footnote
Levels were relatively stable thereafter.
52
What factors are associated with lower testosterone levels in women aged older than 65 years?
* White ethnicity
* Lower BMI
* Oral estrogen
* Corticosteroid use
53
How does surgical menopause affect testosterone levels?
Results in lower testosterone levels
## Footnote
Women who underwent bilateral oophorectomy with hysterectomy had testosterone levels that were 40% to 50% lower than those with intact uterus and ovaries.
54
What is the primary driver of change in the HPO axis during menopause?
Ovarian follicular depletion
## Footnote
This process begins even before birth and results in a progressive loss of follicles over a woman’s lifetime.
55
What characterizes an idealized menstrual cycle?
28 days long with a 14-day follicular phase and a 14-day luteal phase
56
What initiates a wave of folliculogenesis during the menstrual cycle?
A slight rise in early follicular-phase FSH levels
57
What happens to estradiol levels during the midcycle peak?
Estradiol rises exponentially, reaching a peak on day 13
58
What is the early menopause transition often conceptualized as?
A state of 'compensated failure' of the HPO axis
59
What happens to inhibin B and AMH levels in early reproductive life?
They are higher, helping to protect the follicle pool and limit the number of follicles in the 'growing pool' each month
60
What is a key feature of the early menopause transition?
Increase in cycle irregularity by 7 or more days or occasional 'skipped' menstrual periods
61
What characterizes the late menopause transition?
Follicular depletion drops below a critical threshold, leading to intermittent folliculogenesis
62
What symptoms become more prevalent during the late transition?
Estrogen deficiency symptoms
## Footnote
These symptoms become more common as women go longer without sufficient estradiol production.
63
What is the relationship between FSH levels and menopause stage?
FSH levels are variable and a very high FSH level can predict menopause, but a normal or low FSH is not informative
64
What is the role of AMH in predicting menopause?
AMH may be a superior marker of time to menopause
## Footnote
However, it requires validation in further clinical studies.
65
What percentage of women are affected by polycystic ovary syndrome (PCOS)?
5% to 20%
## Footnote
The exact percentage depends on the definition used.
66
What is the adrenal gland composed of?
Adrenal cortex and adrenal medulla
67
What hormones are produced in the adrenal cortex?
* Glucocorticoids (cortisol and corticosterone)
* Mineralocorticoids (aldosterone)
* Sex steroids (primarily androgens)
68
What regulates aldosterone secretion from the zona glomerulosa?
* Angiotensin II
* Potassium concentration
* Adrenocorticotropic hormone
69
What is the primary regulator of glucocorticoid secretion?
Adrenocorticotropic hormone
70
How does oral estrogen affect cortisol-binding globulin?
Increases cortisol-binding globulin, leading to increased total cortisol concentration
71
What happens to DHEAS levels with age?
Circulating levels of DHEAS decrease with age
## Footnote
This decline begins in the early to mid-twenties.
72
What transient change occurs in DHEAS levels during the late menopause transition?
Transient increase in circulating DHEAS levels
73
Is exogenous DHEA supplementation recommended for the general population?
No, due to lack of evidence for efficacy and safety concerns
74
What association has been observed between LH levels and adrenal steroid production?
Higher LH levels correlate with higher urinary cortisol and lower urinary aldosterone in postmenopausal women
75
What are the levels of Dehydroepiandrosterone sulfate (DHEAS) in women with adrenal insufficiency?
Lower than normal levels
## Footnote
The adrenal glands are the predominant source of DHEA and DHEAS production.
76
What has studies shown about the efficacy of exogenous DHEA treatment in women with adrenal insufficiency?
Conflicting results
77
What are some potential risks associated with DHEA treatment?
* Androgenic adverse effects
* Lack of strict regulation of quality and content of DHEA supplements
* Unknown long-term safety profile
78
What did a systematic review and meta-analysis conclude about DHEA treatment in women with adrenal insufficiency?
Led to small improvements in quality of life and depression but no significant benefits in anxiety and sexual well-being
79
Is routine DHEA use recommended for postmenopausal women with normal adrenal function?
No, it is not recommended
80
What condition is described by the term 'adrenal fatigue'?
A purported scenario of chronic exposure to physical, emotional, or psychological stress leading to adrenal gland fatigue
81
Is there a diagnostic test for adrenal fatigue?
No, there is no diagnostic test
82
What are common symptoms attributed to adrenal fatigue?
* Fatigue
* Difficulty sleeping
* Mood disturbances
83
How does adrenal fatigue differ from true adrenal insufficiency?
True adrenal insufficiency is characterized by low serum cortisol levels and requires glucocorticoid replacement therapy
84
What did a 2016 systematic review conclude about adrenal fatigue?
Most studies lacked evidence of adrenal function assessment and concluded that adrenal fatigue does not exist
85
What is primary ovarian insufficiency (POI)?
A condition characterized by hypergonadotropic hypogonadism in women under 40 years
86
What is the estimated prevalence of POI in US women by age 40?
Approximately 1%
87
What is early menopause defined as?
Menopause occurring between the ages of 40 and 45 years
88
What is the risk associated with early menopause?
Increased risk for long-term effects of early estrogen deficiency
89
What are some known etiologies of primary ovarian insufficiency?
* Genetic
* Autoimmune
* Toxic
* Infectious
* Metabolic
* Iatrogenic
90
What is Turner syndrome?
A genetic disorder characterized by the complete or partial loss of one X chromosome
91
What is the incidence of Turner syndrome in births?
1 in 2,500 to 3,000 births
92
What are some phenotypic expressions of Turner syndrome?
* POI
* Short stature
* Lymphedema
* Cardiac anomalies
* Renal anomalies
93
What is the recommended treatment for girls with Turner syndrome?
Estrogen replacement therapy beginning at age 12
94
What are some genetic disorders associated with primary ovarian insufficiency?
* X chromosome disorders
* Autosomal genes affecting ovarian development
* Mutations in reproductive hormone receptors
95
What is fragile X syndrome?
An X-linked inherited cause of POI in premutation carriers due to a mutation of the FMR1 gene
96
What is the chance of developing POI for women with fragile X premutation?
Approximately 20%
97
What are the potential long-term risks for women with fragile X premutation?
16% risk of developing ataxia as they age
98
What is the range of CGG trinucleotide repeats associated with fragile X syndrome?
5 to 45 copies in normal individuals; more than 200 repeats lead to fragile X syndrome
## Footnote
Fragile X syndrome is more common in men and is associated with mental disability and autism.
99
What is the risk of developing POI with 55 to 200 CGG repeats?
Approximately 20% chance
## Footnote
This is referred to as a “premutation allele.”
100
What condition has a 16% risk of developing in women with the fragile X premutation?
Ataxia as the woman ages
101
What is autoimmune oophoritis and its prevalence in spontaneous POI?
A rare cause of POI, occurring in 4% of women with spontaneous POI and adrenal antibodies
102
What should be done if steroidal antibodies are present in a woman with autoimmune oophoritis?
Referral for careful follow-up by an endocrinologist
103
Which infectious disease is classically associated with oophoritis?
Mumps
104
What environmental factors are identified as potential contributors to POI development?
Polycyclic aromatic hydrocarbons from fossil fuel combustion or tobacco smoke
105
What is the relationship between PCOS and POI incidence?
The incidence of POI is found to be higher in women with PCOS
106
What is iatrogenic menopause?
Menopause induced by medical or surgical means, such as bilateral oophorectomies or chemotherapy
107
What are the potential long-term risks of elective bilateral oophorectomy in premenopausal women under 45?
* Increased risk of all-cause mortality (HR, 1.41)
* Increased risk of coronary heart disease (HR, 1.26)
* Increased risk of cardiovascular disease (HR, 1.84)
* Worse bone health, menopause symptoms, and mood symptoms
108
What is the standard diagnostic criterion for menopause in women aged 40 and older?
12 months with no menses
109
What are the diagnostic criteria for POI according to the European Society of Human Reproduction and Embryology?
* Menstrual disturbance (oligomenorrhea or amenorrhea for at least 4 months)
* Elevated FSH level more than 25 IU/L on two occasions at least 4 weeks apart
110
What symptoms are often experienced by women undergoing induced menopause?
* Hot flashes
* Mood changes
* Depression
* Insomnia
* Lack of energy
111
What initial laboratory evaluations should be performed for a woman under 40 who misses three or more consecutive menstrual cycles?
* Serum prolactin
* FSH
* Estradiol
* Thyroid-stimulating hormone
112
What imaging technique is useful for providing information regarding ovarian volume and AFC?
Transvaginal ultrasound imaging
113
What is the recommended follow-up for patients with positive adrenal antibodies?
Follow-up with an endocrinologist
114
What is the recommended hormone therapy for women with POI?
Physiologic estrogen and progestogen therapy
115
What are the effects of early estrogen deficiency on health?
* Negative effect on bone density
* Possible negative effect on cognitive function and sexual function
116
What should be considered when performing elective bilateral oophorectomy?
The benefits and risks must be carefully reviewed and discussed with the woman
117
What is the average age for natural menopause?
Around 51 years
118
What are some psychological consequences of early menopause or POI?
* Grief
* Sadness
* Diminished self-esteem
119
What is the relationship between hormone therapy and breast cancer risk in women under 45?
There is no evidence that HT increases the risk of breast cancer in this age group
120
What should be monitored in younger patients receiving hormone therapy?
Z-score for age and ethnic group rather than T-score
121
What is the impact of POI on life expectancy?
Earlier mortality, primarily because of cardiovascular disease
122
What are the recommended follow-up intervals for bone mineral density testing in women undergoing hormone therapy?
Every 5 years
123
What alternative therapies are available for managing secondary amenorrhea and oligomenorrhea?
* Continuous or extended cycle oral contraceptive pills
* Intrauterine progestin system combined with transdermal estrogen
124
What is spontaneous POI associated with?
Increased lifetime risk for major depression and poorer psychosocial adjustment
## Footnote
Spontaneous POI refers to premature ovarian insufficiency that occurs without medical intervention.
125
What is the impact of earlier menopause caused by BSO on mental health?
Increased risk of depression and anxiety
## Footnote
BSO stands for bilateral salpingo-oophorectomy.
126
What is the suggested approach for women experiencing early loss of fertility?
Offer psychological support and be sensitive to mood changes
## Footnote
It is important to address concerns about fertility, self-image, and sexual function.
127
What type of therapy is suggested to reduce menopause symptoms and possibly improve mood?
Adequate hormone therapy (HT)
## Footnote
Hormone therapy can help alleviate symptoms associated with menopause.
128
What should clinicians provide before treatments that may induce menopause?
Counseling regarding childbearing options
## Footnote
This is crucial for women facing chemotherapy, radiation, or surgery.
129
What are some options for preserving fertility?
* Ovarian hyperstimulation with oocyte retrieval
* Oocyte or embryo cryopreservation
* Ovarian tissue cryopreservation
* Ovarian suppression with hormones
* Ovarian transposition
* Conservative gynecologic surgery (e.g., trachelectomy for cervical cancer)
## Footnote
These methods may vary in availability and effectiveness based on individual circumstances.
130
What is a key consideration for women with POI regarding pregnancy?
Counseling early about their desire to conceive
## Footnote
This is important due to the possibility of spontaneous and unexpected pregnancy.
131
What contraceptive methods are suggested for women who do not desire pregnancy?
* Oral contraceptives
* Barrier methods
* Intrauterine device (IUD)
## Footnote
These methods help prevent unintentional pregnancies.
132
What additional benefits do oral contraceptives provide?
* Relief of vasomotor symptoms (VMS)
* Alleviation of vaginal dryness
* Maintenance of bone mineral density (BMD)
## Footnote
These benefits are particularly relevant for women undergoing treatment affecting fertility.
133
Why is contraception discussion especially important for women carrying the FMR1 gene?
Higher risk for a child with mental retardation
## Footnote
The FMR1 gene is associated with Fragile X syndrome, which can lead to cognitive impairments.
