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1

physiological consequences of ovarian failure

1. vasomotor symptoms
2. menstraul changes
3. Sleep distrubances
4. mood changes
5. genital atrophy
6. cardiovascular disease
7. osteoporosis

2

cessation of menses for 6 months

menopause

3

average age of menopause

51.4
*2 yrs earlier if a smoker and earlier if undernourished

4

late menopause-age _____
premature ovarian failure- age ____

late- age 50
premature- 40

5

amenorrhea, symptoms of estrogen deficiency, gonadotrophin (FSH/LH) in the menopause range

premature ovarian failure

*failure does not imply total cessation --> 5-10% have been able to conceive and deliver normal pregnancies because they may intermittently produce estrogen.

6

symptoms:
hot flashes
vaginal dryness
dyspareunia

premature ovarian failure

*normal puberty, and regulr menses prior

7

what labs do u check for premature ovarian failure

HCG (pregnancy)
prolactin
FSH
E2
additional labs: TSH, DEXA-scan, karyotype, auto-antibodies
*pelvic u/s and biopsy have no proven benefit

8

implications of premature ovarian failure

1. osteoporosis
2. CHD
3. hot flashes
4. vaginal dryness

9

treatment of premature ovarian failure

estrogen therapy/OCPs
*used to prevent complications of low estrogen state

10

what menopause stage?
cycle irregularity --> increased FSH, normal/high estradiol secretion (increased aromatase activity), low luteal progesterone secretion

early menopause

11

what menopause stage?
increased cycle variability, FSH and estradiol levels fluctuate

late menopause

12

what menopause stage?
no estrogen secretion by ovary; LH continues to be released which causes the ovary to continue to produce and secrete androgens

postmenopause

13

what is typically the 1st symptom in perimenopause/menopause

hot flashes/power surge
*75% of women affected

14

symptoms:
sleep disturbance
anovulatory bleeding irregular bleeding
UTI, incontinence
sexual dysfucntion
forgetfulness, irritability
joint pain, dry skin, breast pain, migraines

perimenopause/menopause
*sometimes heavy bleeding during perimenopause

15

How do you diagnose menopause?

-based on symptoms and mesnstrual cycle history
*6 months of amenorrhea in a woman >45 yrs. w/ no biologic or physiologic cause (labs not routinely indicated: FSH/LH)

16

DDX of menopause

DDX: hyperthyroidism, pregnancy, hyperprolactinemia, medications (IUDs, chemo, radiation)

17

Increased FSH, variable cycle lengths, cessation of menstruation

menopausal transition

18

describe what causes menopause

Declining ovarian response to FSH results in decreased estrogen--> no feedback to cause an LH surge-->therefore no ovulation, no progesterone from corpus luteum, no progesterone drop off and no bleeding

19

why is there GU symptoms for menopause

due to less estrogen –> vaginal and urethral atrophy --> stress and urge incontinence from atrophic urethral changes and disrupted urethral seal, vaginal dryness, increased pH leading to increased vaginitis

20

why is there sexual dysfunction with menopause

decrease estrogen --> decreased blood flow to vagina and vulva

21

why are there skin/nails symptoms with menopause

increased testosterone leads to facial hair, skin is less elastic, nails become thin

22

what is the most common age group of abortions

45-50y/o and 14-18 y/o

23

risks associated with HRT

1. thromboembolism (mostly in women with risk, E+P only)
2. increased risk of Breast CA ( E +P only)
3. increased risk of CHD (E+P only)
4. increased risk of stroke (greater with E)

24

HRT has shown to be beneficial for what?

menopause/perimenopause
osteoporosis

25

how do you treat menopause

HRT
-low dose OCP (sadfe in non-smokes

26

alternative treatment options for menopause

1. vaginal lubricants (replens)
2. SSRIs/SNRIs
3. gabapentin

27

recommendations for HRT in menopausal women

1. short term therapy (2-3 yr but not more than 5 yrs)
2. use lowest dose possible
3. tailor to paitent's needs
4. women wit ha uterus need combination estrogen and progetin therapy

28

HRT for menopause is contraindicated in who?

1. Hx of breast CA/ovarian CA (R)
2. CAD (absolute)
3. Previous venous thromboembolism or stroke (absolute)
4. undiagnosed vaginal bleeding (absolute)
5. pregnancy (absolute)
6. severe liver disease (absolute)
7. acitve gallbaldder disease (R)
8. migraine HA (R)
9. atypical ductal hyperplasia of the breast (R)
10. MUST use a progestin with estrogen in women with a uterus (Estrogen-only if previous hysterectomy)****

29

___% of women have incontinence
---% of women in US have prolapse

20-40% of women in mid-life and beyond have some incontinence
16% have prolapse

30

why is prolapse more common in older women?

more childbirths
#1 risk factor for UI is childbirth