Menopause and HRT Flashcards Preview

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Flashcards in Menopause and HRT Deck (53):
1

When is perimenopause?

Time period preceding menopause

2

What is perimenopause?

Fertility wanes and menstrual cycle irregularity increases, until the first year after cessation of menses

3

What is the mean duration of perimenopause?

4 years

4

What is menopause?

Permanent cessation of menses followed by the loss of ovarian follicular activity

5

What is the median age of onset for menopause?

51 years

6

After how many months of amenorrhea is menopause?

12 months (time of final menses is determined retrospectively)

7

What is premature ovarian insufficiency?

Menopause before the age of 40

8

How do we treat premature ovarian insufficiency?

Treatment considered more critical
Recognized to be at an increased risk for premature morbidity and mortality

9

What are the causes of menopause?

Age (natural)
Surgery (total abdominal hysterectomy, bilateral oophrectomy)
Medications (chemo)
Pelvic radiation

10

What is follicular atresia?

Breakdown of follicles

11

How many follicles remain at the time of menopause?

Very few

12

What is the pathophysiology for menopause?

Ovarian follicle numbers decrease with age
Ovaries no longer primary site of estrogen and progesterone synthesis
Increased FSH + decreased inhibin B
Remaining oocytes do not respond to gonadotropins
Uterus and vagina become atrophic

13

By how much does FSH increase during menopause?

10-15 fold

14

What does inhibin B do?

Inhibits FSH secretion

15

Why does the uterus and vagina become atrophic?

Due to decreased estrogen levels

16

What are signs of menopause?

Menstrual cycle irregularity
Urogenital atrophy

17

What are the sx of menopause?

Vasomotor
Psychological
Genitourinary syndrome of menopause
Others

18

What are the vasomotor sx of menopause?

Hot flashes
Night sweats

19

What are the psychological sx of menopause?

Anxiety
Mood swings
Depression
Problems with concentration and memory

20

What are the genitourinary syndrome sx of menopause?

Vaginal dryness, burning, irritation
Dyspareunia -> painful intercourse
Sexual dysfunction
Urinary incontinence

21

What are other sx of menopause?

Sleep disturbance
Joint pain
HA
Metabolic (effects on body composition, lipids, vascular function, bone metabolism)

22

What is the diagnosis of menopause?

S/sx
Age
FSH
Anti-mullerian hormone

23

What is the FSH level of a woman during perimenopause?

10-12+ (on day 2 or 3 of the menstrual cycle)

24

What is the FSH level of a woman during menopause?

40+

25

What is the FSH level of a normal woman not during menopause?

4-10

26

What is anti-meullerian hormone?

Product of growing ovarian follicles
Concentrations decline with age

27

What do low concentrations of anti-mullerian hormone predict?

Diminishing ovarian reserve?

28

When can anti-mullerian hormone be taken?

Any time during the cycle

29

What is the pharmacological therapy for menopause?

HRT

30

What are the HRT's for menopause?

Estrogen
Estrogen + progestin

31

What are the benefits of HRT?

Vasomotor sx
Prevention of bone loss
Genitourinary syndrome of menopause

32

What is the non-pharm treatment for hot-flashes/night sweats?

Lower the temp
Light blankets/sheets
Wearing cotton
Avoiding spicy foods, hot beverages, caffeine

33

What is the non-pharm treatment for vaginal dryness?

Lubricants
Increase fluids

34

What is the non-pharm treatment for dyspareunia?

Lubricant

35

What is the non-pharm treatment for decreased libido?

Discuss with partner

36

What is the non-pharm treatment for urinary incontinence?

Kegel exercises
Scheduled voiding
Caffeine reduction

37

What is the non-pharm treatment for mood alteration?

Exercise
Relaxation techniques

38

What are the types of oral estrogens?

Conjugated equine estrogen
Micronized estradiol

39

What is oral estrogen metabolized to?

Estrone (weaker estrogen)

40

What are the dosage forms for estrogen?

Oral
Transdermally
Intravaginally

41

Where is micronized estradiol absorbed?

Small intestines

42

Does transdermal estrogen have first-pass metabolism?

No, it bypasses it

43

What are transdermal estrogens associated with?

Slightly lower risk of CAD, stroke, and VTE when compared to oral

44

When are transdermal estrogens more appropriate?

Women with DM, HTN, and other CV RFs

45

What dosage form has greater estradiol concentrations than estrone?

Transdermal

46

What dosage form has greater estrone concentrations than estradiol?

Oral

47

Do intravaginal estrogens require opposing progesterone?

No

48

Which intravaginal form has lower systemic absorption?

Vaginal tablets and rings
Creams are higher

49

Do low dose vaginal estrogen preparations appear to stimulate the endometrium?

Minimally

50

What other disorder can intravaginal estrogens help with?

Urinary incontinence

51

How do intravaginal estrogens work on urinary incontinence?

Reduces the frequency and amplitude of detrusor contractions (ie detrusor muscle relaxation)

52

Why do we include progestin in estrogen therapy?

Monotherapy has an increased risk of endometrial hyperplasia and cancer

53

When is progestin included in estrogen therapy?

All women that have not had a hysterectomy receiving systemic estrogen therapy (not intravaginally)