Menopause and HRT Flashcards Preview

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Flashcards in Menopause and HRT Deck (25):
1

Menopause definition

One year without Menses, or FSH over 30

2

Perimenopause

Age group near menopausal age, 45-55, with symptoms.

3

Postmenopause

beyond menopause or over age 55

4

When is the end of reproductive life?

43 yo

5

The biology of menopause, KNOW:

With less amounts of estrogen being made, FSH rises. This causes menses to become less frequent, lighter
- Menopause is defined as: no menses for a year or FSH over 30

6

Number one reason women say they seek hormone replacement therapy

Menopause related symptoms

7

Most common symptoms of menopause

hot flases

8

What causes hot flashes

Probably due to gonadotropin spikes as much as estrogen deficiency.

9

See treatment slide

mostly includes Estrogen therapy in the form of Estroadiol (pills or transdermal patches).
Progestin is added if the pt has a uterus in order to prevent endometrial cancer

10

Other symptoms of menopause

Vaginal Atrophy, this comes on late and occurs because some epithelial cells in the vagina have estrogen receptors and without estrogen they basically dry up.

11

Symptoms that are NOT associated with menopause

- Depression
- Lack of interest in sex
- crazy

12

Dyspaerunia

painful intercourse

13

Risk factors for osteoporosis

caucasian/asian
thin
smoker
alcohol use
steroid use
family history

14

KNOW: Estrogen therapy is approved for the prevention of osteoporosis, not the treatment though

ok

15

When should women begin having bone density measurements?

age 65

16

WHI showed that Estrogen therapy does significantly reduce the risk of fracture

ok

17

Number one killer of older women

cardiovascular disease

18

WHI Estrogen Progestin study

Asked two questions:
1 Does HT prevent CVD
2 Does HT cause breast cancer

19

Why were these two questions asked?

Because early loss of endogenous estrogen (oopherectomy and premature ovarian failure) is associated with CVD

Women are protected from CVD until menopause...this suggests that estrogen plays a role

Endogenous estrogen, we know, increases smooth muscle proliferation, lowers cholesterol, and improves vascular tone

20

What's the major problem with observational studies?

Bias

21

Perimenopausal use of HT (theory)

- Positive effects on vascular remodelling
- Decreased Intimal Thickening
- Decreases the incidence of plaques

22

Postmenopausal use of HT (theory)

- In women over 65, plaques had most likely already formed.
- Estrogen had thrombogenic effects
- Increased rte of MI in year one

This risk increases as you get further from menopause. In reality, it looks like you have to be 20 years out of menopause before estrogen has a significant effect in regards to increasing your risk of heart disease and MI

23

Estrogen does increase the risk of stroke and DVT

ok

24

Estrogen decreases colon cancer risk

ok

25

Breast cancer risk increases with EPT

ok.....must use beyond 5 years