Menopause

Question 1

What is perimenopause?

Answer 1

the time before, during and after menopause

Question 2

What percent will have irregular menses for about 4 yeas?

Answer 2

90%

10% will just have an abrupt cessation of menses

Question 3

WHen is menopause?

Answer 3

When they haven’t had menses for at least 1 year, with signs of hypoestrogenemia and FSH over 40

Question 4

What is the median age?

Answer 4

51

Question 5

When is it considered premature?

Answer 5

before age 40 (only 1%)

Question 6

What are the concerns in the postmenopausal period?

Answer 6

hormone replacement
osteoporosis
CVD
sexual fuction
uterovaginal prolapse
skin issues
mood
hot flashes
vaginal atrophy
incontinence

Question 7

Ovaries stop producing follicles, so what hormones decrease?

Answer 7

inhibin, leads to FSH rise

eventually estradiol level decreases

Question 8

What happens in response to the estradiol level decline?

Answer 8

endometrial development fails, so they ahve absence of menses

Question 9

After menopause, where does the estrogen come from?

Answer 9

aromatization of androgens in the periphery - muscle and adipose

Question 10

Progesterone production ceases, which increases risk for what?

Answer 10

endometrial cancer

Question 11

Androgen production decreases from both the ovaries and adrenals. What is the effect of this?

Answer 11

maybe decrease libido

Question 12

Why do we prefer to leave the ovaries in?

Answer 12

estrogen is heart protective

Question 13

What happens to body mass?

Answer 13

weight and total body fat increase

increase in waist;hip ratio

Question 14

Does hormone replacement therapy cause weight gain in and of itself?

Answer 14

no

Question 15

What happens to the skin?

Answer 15

cdecreased collagen - thinning sin, tooth loss, atrophic vaginitis with poor uterovaginal support

Question 16

What are the issues with poor uterovaginal support?

Answer 16

cystocele (bladder into vagina)
rectocele (rectum into vagina)
enterocele (cervix removed)
uterine prolapse

Question 17

What are the urinary issues

Answer 17

incontinence, dysuria, frequency

Question 18

What hormone are hot flashes related to?

Answer 18

directly related to estrogen levels (and indirectly to GnRH pulses from the hypohtalamus)

Question 19

How long do hot flashes typically last?

Answer 19

30/day for 1-5 minutes
(5-10 per day is the average)

usually for 2-3 years, uncommon more than 5 years

Question 20

WHat are some other general symptoms of menopause?

Answer 20

depression, anxiety, irritability, fatigue, insomnia, loss of libido, headaches, amenorrhea

Question 21

What do you need to rule out with the menstrual irregularity here?

Answer 21

rule out pregnancy if they’re under 50

endometrial cancer

endometrial hyperplasia
polyps
cervical cancer
fibroids
adenomyosis

Question 22

What are the general treatments for abnormal uterine bleeding?

Answer 22

medical with cyclic hormone replacement or OCPs

hysteroscopy/EM ablation/D&C

Hysterectomy

or none if the woman is fine with abnormal bleeding after ruliing scary stuff out

Question 23

post-menopause bone density decreases by about hat percent per year?

Answer 23

1-2% per year (esp in whites and asians)

Question 24

At age 60, what percent will have spinal compression fractures?

Answer 24

25%

Question 25

At age 80, what percent will ahve a hip fx?

Answer 25

20%

Question 26

After a hip fx, 15% die in how long?

Answer 26

6 months

Question 27

What's treatment fo rosteoporosis?

Answer 27

``` HRT bisphosphonates calcitonin SERMs calcium vitamin D ```

Question 28

What are the indications for HRT?

Answer 28

hot flashes vaginal atrophy osteoporosis osteopenia

Question 29

What are the contraindications for HRT?

Answer 29

pregnancy undiagnosedvaginal bleeding active VTE current gallbladder disease liver disease unopposed estrogen replacement if they still have a uterus CVD - will increase risk for subsequent event

Question 30

What are the relative contraindications for HRT?

Answer 30

history of breast cancer | history of VTE

Question 31

What are the side effects of HRT?

Answer 31

vaginal bleeding breast tenderness mood changes

Question 32

HOw can we give HRT?

Answer 32

orally, transdermally, parenteral, vaginal

Question 33

What are the options for the hormone?

Answer 33

estrogen with progesterone (need both if they still have a uterus) estrogen with metyltestosterone (more common in younger women who had their ovaries out and estrogen alone didn't work) estrogen alone progesterone

Question 34

What did the women's health initiative part 1 find?

Answer 34

women with a uterus needing combined HRT (prempro) after 4 years, saw an increase risk of breast cancer, CV disease, stroke, and VTE. 1/1000 women. but still NO increased mortality from all cause. but it actually decreased colon cancer and hip fracture

Question 35

What did the WHI Part 2 find?

Answer 35

women WITHOUT a uterus using ERT - premarin went for 7 years increased risk for embolic stroke 1/1000 VTE risk 1/500 (which is lower than BC and pregnancy) still no increased mortality from all cause no new heart disease didn't help colon cancer or hip fracture actually decreased breast cancer but not statistically significant