Menopause

Question 1

what is perimenopause/menopausal transition

Answer 1

the period leading up to and immediately following menopause

Question 2

what is menopause

Answer 2

final menstrual period

Question 3

what is post menopause

Answer 3

the phase of life that comes after menopause

Question 4

premature menopause

Answer 4

final menstrual period before age 40

Question 5

how long does perimenopause last?

Answer 5

variable 1-3 years, but may begin 6years before menopause and continue for a variable number of years after menopause
extends to 12 months after menopause

Question 6

what is the patho of menopausal transition

Answer 6

decline in quantity and quality of follicles.
ovaries lose sensitivity to gonadotropin stimulation and serum inhibin B levels and estrogen levels decrease
Anovulatory cycles
Irregular Pattern of gonadotropin and steroid production
Estrogen insensitivity

Question 7

what happens with permanent amenorrhea

Answer 7

once all follicles are depleted FSH remains elevated for life

Question 8

signs of perimenopause

Answer 8

hot flashes
irregular menses (metrorrhagia, oligomenorrhe, polymenorrhea)
Insomnia
vaginal dryness
depression symptoms
increased hirsuitism

Question 9

what is the MC symptom of perimenopause/MT

Answer 9

hot flashes

observed in 75% of women

Question 10

hot flashes are described as

Answer 10

feeling heat/burning in the face, neck and chest followed by immediately by sweating outbreak over the whole body

Question 11

what is the Tx for perimenopause

Answer 11

estrogen
Oral contraceptives- low dose estrogen
SSRI and SNRI-1st alternative to hormones
soy products
black cohosh
Gabapentin

Question 12

what is the DDx for vaginal dryness

Answer 12

stress
meds- anti-histamines
vulvar lesions
menopause

Question 13

what is the Tx for vaginal dryness

Answer 13

Lubricants prior to intercourse
Moistureizers
Vitamin E oil

Question 14

what is menopause

Answer 14

last menses/cessation of menses

Question 15

how is menopause diagnoses

Answer 15

after 12months of amenorrhea

Question 16

what is the average age of menopause

Answer 16

50-51

Question 17

what is the only risk factor associated with early menopause

Answer 17

smoking

Question 18

what are the hormonal changes that are taking place during menopause

Answer 18

d/t decline in the function of the ovaries- decreased production of estradiol and progesterone
d/t decline in progesterone and estradiol there is an increase in LH/FSH (FSH>LH)

Question 19

what are physical changes of the reproductive tract in menopause

Answer 19

atrophy of labia majora
atrophic changed of vaginal epithelium
vaginal wall become smooth
cervix decreases in size and become stenotic 
uterus shrinks
fibroids 
ovaries decrease in size
loss of pelvic muscle tone

Question 20

what is atrophic vaginitis

Answer 20

atrophy of epithelium w/ decreased blood supply
this results in smooth, thin, shiny, pale surface
more susceptible to trauma

Question 21

what is the symptoms of atrophic vaginitis

Answer 21

dryness, spotting, vaginal pain/burning, dyspareunia

urinary symptoms

Question 22

what is the Tx for atrophic vaginitis

Answer 22

mositurizers, lubricants, vit E oil

estrogen vaginal creams or rings

Question 23

what are other physical signs of menopause

Answer 23

decreased breast size
thinning hair/skin
depression
memory loss
decreased libido
osteoporosis
CAD

Question 24

what are the 3 most important effects of menopause to paitents

Answer 24

symptoms
osteoporosis
cardiovascular disease

Question 25

how do treat their symptoms control

Answer 25

``` Hot flashes: dress in layers Supplements (soy, black cohosh) Estrogen replacment therapy SSRI, SNRI, gabapentin Vaginal dryness: lubricants, moisturizers, Vit E oil Topical estrogen Decreased Libido: estrogen replacement therapy androgen therapy ```

Question 26

when do women lose up to 20% of their bone mass with osteoporosis?

Answer 26

first 5-7 years

Question 27

how is osteoporosis treated?

Answer 27

``` weight bearing exercise Calcium/Vit D supp. Bisphosphanates calcitonin Estrogen PTH SERM (selective estrogen receptor modulators)-Raloxfine ```

Question 28

what happens to CV risk with women after what age?

Answer 28

>60 CAV women=men risk of cardiovascular dx increases 2-3 times that of a women the same age before menopause they thinks its d/t estrogen

Question 29

multiple studies and trial have shown what with HRT

Answer 29

posed more health risks than benefits particularly when given to older postmenopausal woman only useful in certain women depending of RF

Question 30

what did the HERS study (Heart and estrogen replacement study) show

Answer 30

there was no reduction in risk of MI or coronary event | showed increase of MI during 1st year of HRT

Question 31

WHI results with estrogen plus progesterone

Answer 31

Increased risk of MI, Stroke, Blood Clots, Breast Cancer Reduced risk of Colon cancer fewer fractures no protection with cognitive impairment

Question 32

WHI results with Estrogen ALONE?

Answer 32

no difference in MI risk Increased risk of stroke/ blood clots not sure about breast cancer or colon cancer reduced risk of fracture

Question 33

what are the FDA approved indications for HRT?

Answer 33

``` prevention of osteoporosis Tx vasomotor symptoms Tx vulvovaginal atrophy use lowest does for shortest time women with a uterus need to take estrogen and progesteron to prevent uterine cancer ```

Question 34

what are the benefits of estrogen plus progesterone

Answer 34

lower colorectal cancer lower risk of Fx improves vasomotor and GU symptoms

Question 35

what are the benfits of estrogen alone in women w/o uterus

Answer 35

lower risk of Fx | improves vasomotor and GU

Question 36

what are the risk of estrogen/progesterone in menopause

Answer 36

Increased risk of MI, stroke, blood clots, breast cancer, gall bladder dz

Question 37

what are the risks of estrogen alone in menopause

Answer 37

increase risk of stokes, blood clots and gallbladder dz

Question 38

what are the benefits of local topical HRT?

Answer 38

little systemic absorption estradiol level remain in the postmenopausal range endometrial safety is maintained

Question 39

what are CI for HRT

Answer 39

``` undiagnosed vaginal bleeding Hx of breast cancer estrogen dependent neoplasia Active or HX of DVT/PE Thrombolic dz (stroke,MI) endometrial cancer ```

Question 40

what needs to be used with women who have an intact uterus?

Answer 40

estrogen/progesterone