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Flashcards in Menopause Deck (22):
1

Menopause

-one year without menses
-FSH > 30

2

Perimenopause

-age group near menopausal age, 54-55
-with symptoms - menopausal transition

3

Postmenopause

-beyond menopause or age > 55

4

End of reproductive life is?

43
-ovary continues to produce eggs sporadically, but they are abnormal
-with ovulation, estrogen is still being produced, but in lower amounts
-less estrogen produced, FSH rises
-menses becomes less frequent, lighter

5

Symptoms of Menopause

-most common: hot flashes
-probably due to gonadotropin spikes as much as estrogen deficiency
-may occur as a perimenopausal symptom
-skin changes/vasodilation have been documented

6

Menopause at Night

-wake up with sweats, then cooling effect
-may happen 5 times a night
-sleep disturbance
-if no treatment, will dissipate

7

FDA-Approved Indications for HT

-Estrogen: estradiol (pill, transdermal patch, gel)
conjugated estrogens (premarin)
-Progestin added (if has a uterus to prevent endometrial cancer)
medroxyprogesterone (side effects)
micronized progesterone
-treatment of moderate-to-severe vasomotor symptoms associated with menopause

8

Hormone Therapy in Women with Vaginal Symptoms Only

-dryness or dyspareunia
-preferred treatments are low doses of vaginal estrogen
-no need for progestins

9

Hormone Therapy in Women with a Uterus

-women who still have a uterus need to take a progestogen (progesterone or a similar product) along with the estrogen to prevent cancer of the uterus
-women with hysterectomy can take estrogen alone

10

Other Symptoms of Menopause

-vaginal atrophy: late effect, but can be treated with estrogens, vaginal or systemic

11

Symptoms not associated with menopause?

-depression
-lack of interest in sex
-going crazy

12

Medical Illnesses Associated with Menopause

1. Osteoporosis
2. Heart Disease
3. Cancer

13

Osteoporosis: High Risk Groups

-caucasian/asian
-thin
-smoker
-alcohol use
-steroid use
-family history

14

Estrogen Therapy Approved for Prevention of Osteoporosis Not Treatment

-individual risk factors
screening: bone density measurements beginning at age 65
-have another indication for hormone therapy
-affects osteoclast and osteoblast activity

15

Loss of endogenous estrogen is associated with?

CVD
-oopherectomy & premature ovarian failure
-women are protected from CVD until menopause (compared to men)

16

Endogenous estrogen does what?

-increases smooth muscle proliferation, lowers cholesterol and improves vascular tone

17

History of CVD

-women aged 35 yrs: fatty streaks & minimal atherosclerotic plaques
-45-55: active progression of lesions (menopausal transition)
-5-8 post menopause, increased in plaques & intima-media thickening
- >65: complications start to develop: Women's rate equal to mens
***statins & ASA may not have benefit in women as they do in men***

18

Perimenopausal Use of Hormone Therapy

-positive effects on vascular remodeling of age
-decreased intimal thickening
-decreases the incidence of plaques

19

Postmenopausal Use of Hormone Therapy

-women >65
-plaques already formed
-estrogen with its thrombogenic effects, clots off the artery
-effect was in the first year of use: MIs in year 1

20

Hormone Therapy & Coronary Heart Disease

-ET/EPT is not recommended as single or primary indication for coronary protection in women of any age
-data do not support EPT in secondary prevention of CHD

21

Estrogen Does What?

-increased risk of DVT in women 50-59 (no increased risk of stroke for ET or EPT)
women 60-69: increased risk of stroke for ET

-estrogen decreased risk of colon cancer

22

Estrogen & Breast Cancer

-increases with use beyond 5 years
-it may be progestin that adds risk (small risk)
-risk decreases after hormone therapy is stopped