Menopause

Question 1

the permanenet cessation of menstration is due to..

Answer 1

failure of ovarian follicular development in the presence of ADEQUATE gonadotropin stimulation

Question 2

climacteric

Answer 2

physiologic period in which there is regression of ovarian fxn

Question 3

peramture ovarian failure

Answer 3

cessation of menstruation due to depletion of ovarian follicles less than 40 yo

Question 4

average age of menopause

Answer 4

51.4 range 48-55

Question 5

average for perimenopause

Answer 5

47.5 y/o average length about 4 yrs

Question 6

premature menopause

Answer 6

genetic abnormalities on long and short arm of X chormosome

Question 7

RF for early menopause

Answer 7

Surgical causation 
FHx early 
cigarette smoking 
blindness 
chromosome defect 
precocious puberty 
left handedness

Question 8

RF for later age menopause

Answer 8

obesity, higher SES

Question 9

___ number of follicles at birth and at menopause

Answer 9

1 million follicles at birth and 1000 left by menopause

Question 10

what is most follicular loss due to ?

Answer 10

atresia not ovulation

Question 11

when does atresia rate accelerate?

Answer 11

age 37

Question 12

atresia definition

Answer 12

closure of tubal structure, death of unfertilized follicles?

Question 13

6 changes to ovaries in perimenopause

Answer 13

1. ovaries shrink in size
2. estradiol secretion amount decreases
3. number of follicles decrease substantially
4. production of inhibin lowers
5. remaining follicels respond poorly to high FSH and LH
6. erratic ovulation results in menstrual cycle irregularity

Question 14

where is inhibin produced

Answer 14

gonads, pituitary glands, placenta, corpus luteum, other organs

Question 15

FSH stimulates secretion of __ from granulosa cells of ovarian follicles

Answer 15

inhibin

Question 16

inhibin does what

Answer 16

suppresses FSH

Question 17

if inhibin secretion gets lower with each cycle…___ gets higher

Answer 17

FSH secretion

Question 18

t/f elevations of FSH at the start of a cycle are predictive of perimenopause and of the fertility of the remaining ova

Answer 18

true

Question 19

at age 45 risk of spontaneous miscarriage is__

Answer 19

up to 50%

Question 20

what is day 3 FSH testing

Answer 20

a routine way to measure ovarian reserve

if FSH high on day 3 cycle, indicates ovarian reserve is low = low egg quality / reserve

Question 21

normal day 3 FSH level is..

Answer 21

less than 9

Question 22

diminished reserve when FSH on day 3 is over

Answer 22

11

Question 23

what occurs in perimenopause?

Answer 23

1. shortening of menstrual cycle

2. shorting of follicular phase w/ lower # of follicles recruited per cycle

Question 24

w/ menopause ovary is no longer able to…

Answer 24

respond to pituitary gonadotropins low estrogen and progesterone perduction

Question 25

what 4 things decrease with menopause

Answer 25

1. circulating estrogen 2. ratio of estrogen to androgen 3. sex hormone binding globulin secretion 4. E2 to E1 ratio

Question 26

what hormone is increased in menopause

Answer 26

increased peripheral aromatization of DHEA to estrone

Question 27

what hormone level stays same in menopause

Answer 27

circulating bioavailable testosterone

Question 28

what cells make estrogen

Answer 28

theca and granulosa cells of ovaries as these atrophy.. get less estrogen secretion = high FSH and LH

Question 29

e1 estrone

Answer 29

predominant e in menopause from aromatization of androstenedione in fatty tissue less potent than E2

Question 30

E2: estradiol

Answer 30

predominant E of women after puberty but before menopause

Question 31

E3: estriol

Answer 31

placental E only seen in large amounts w/ preg least potent of all E from fetal adrenal gland in form of DHEA sulfate placenta turns that into estriol

Question 32

postmenopausal women main E

Answer 32

E1 made in periphery

Question 33

cause of hot flash

Answer 33

unknown ..related to estrogen, LH and NEpi

Question 34

what is gonadal theory of hot flashes?

Answer 34

hot flash is caused by removal of sex hormones after the body has been exposed to them for a period of time..a dynamic loss of sex hormones

Question 35

3 arguments to back up gonodal theory

Answer 35

no estrogen = hot flash orchiectomy = hot flash in many men hot flashes go away if hormone replaced yet what is exact MOA?

Question 36

pituitary theory of hot flashses

Answer 36

extreme rise in FSH and LH cause them

Question 37

2 arguments for pit theory of hot flash

Answer 37

1. seen pulse or surge of LH prior to hot flash | 2. even if surge does not happen, seem to happen near an LH peak

Question 38

evidence against pit thoery

Answer 38

ppl with chronically high FSH and LH (turners / kallmans) do not have hot flashes

Question 39

hypothalamic theory behind hot flashes

Answer 39

inhibiting hypothalamic catecholamines (NE) causes hot flashes when E levels drop so do the drop of NE receptors when E is low.. those remaining receptors may be stimulated abnormally

Question 40

CVD risks with menopause

Answer 40

6-10 yrs after CAD rates equal men and women | cholesterol increase 1-2 yr after menopause (less HDL higher TG and LDL)

Question 41

genital changes in menopause

Answer 41

1. atrophy of vaginal epithelium 2. decent of uterus due to collagen in uterosacral ligament 3. urologic .. decrease in urethral closure pressure 4. atrophic urethritis atrophic cystitis

Question 42

atrophic urethritis sx

Answer 42

urgency, frequency, dysuria, suprapubic pain without UTI

Question 43

atrophic cystitis sx

Answer 43

urge incontinence, frequency, dysuria, nocturia

Question 44

3 most common fx in postmenopausal women

Answer 44

vertebral, distal radius, neck of femur

Question 45

in what circumstance can a premenopausal women be exposed to unopposed estrogen?

Answer 45

if she doesn't have a uterus

Question 46

estrogen and progestin HRT tx risks

Answer 46

increased: MI, stroke, blood clots, breast CA lower: colorectal CA, decreased risk fx

Question 47

ex of combo hrt tx

Answer 47

Premarin with Provera

Question 48

tx vaginal atrophy

Answer 48

topical vaginal estrogen | ADR: breast pain, N = some systemic absorption