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Menopause Definition and Stages Flashcards

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1
Q

What is natural menopause?

A

Permanent cessation of menses for 12 months from loss of ovarian follicular activity.

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2
Q

What is induced menopause?

A

Surgical or iatrogenic loss of ovarian function (e.g., bilateral oophorectomy, chemotherapy, pelvic radiation, other forms of ovarian toxicity).

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3
Q

What is primary ovarian insufficiency?

A

Loss of normal ovarian function before age 40 years, resulting in irregular menstrual cycles and reduced fertility.

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4
Q

What is premature menopause?

A

First menstrual period (FMP) before age 40 years.

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5
Q

What is early menopause?

A

Final menstrual period (FMP) before age 45 years.

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6
Q

What is late menopause?

A

Final menstrual period (FMP) after the age of 55 years.

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7
Q

What is perimenopause?

A

The time frame ‘around menopause’ marked by intermenstrual cycle irregularities or other menopause-related symptoms (hot flashes, sleep problems, vaginal dryness); ends after 1 year of amenorrhea.

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8
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A
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9
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10
Q

What is the term characterized by hypergonadotropic hypogonadism that can be transient?

A

Primary ovarian insufficiency (POI)

POI affects 1% of women aged younger than 40 years.

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11
Q

What percentage of the population experiences early menopause, occurring between the ages of 40 and 45 years?

A

Approximately 3%

Early menopause is distinct from premature menopause.

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12
Q

What is defined as permanent ovarian failure before the age of 40?

A

Premature menopause

Premature menopause is different from early menopause.

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13
Q

What is the most common etiology of primary ovarian insufficiency (POI), premature menopause, and early menopause?

A

Idiopathic

Other etiologies can include genetic, autoimmune, iatrogenic, infectious, and metabolic causes.

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14
Q

Fill in the blank: Primary ovarian insufficiency affects _____ of women aged younger than 40 years.

A

1%

This condition may be transient.

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15
Q

True or False: Early menopause occurs after the age of 45.

A

False

Early menopause occurs between the ages of 40 and 45.

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16
Q

List the potential etiologies of primary ovarian insufficiency (POI).

A
  • Genetic
  • Autoimmune
  • Iatrogenic
  • Infectious
  • Metabolic

Most cases of POI are idiopathic.

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17
Q

What is the most common method for measuring ovarian reserve?

A

Follicle-stimulating hormone (FSH) in conjunction with estradiol during days 2-5 of the menstrual cycle (not taking hormones).

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18
Q

What are the FSH and estradiol levels indicating low ovarian reserve?

A

FSH >10 IU/L + estradiol < 60 pg/mL or
FSH <10 IU/L + estradiol >100 pg/mL.
*Elevated E2 will give falsely low FSH

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19
Q

What is the Antral Follicle Count (AFC)?

A

The number of ultrasound-detected follicles 2 mm to 10 mm in both ovaries.

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20
Q

What AFC value indicates low ovarian reserve?

A

AFC <7 follicles.

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21
Q

What are AFC and AMH useful for?

A

They are useful markers of ovarian response to controlled ovarian stimulation. They both decline in a linear fashion in MT and post menopause.

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22
Q

What is Antimüllerian hormone (AMH)?

A

AMH is produced by the granulosa cells of preantral and small antral follicles.

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23
Q

When can AMH be measured?

A

AMH can be measured any day of the cycle or while taking hormones.

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24
Q

Is AMH recommended as a screening tool in general?

A

No, AMH is not recommended as a screening tool in general.

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25
What is the Stages of Reproductive Aging Workshop (STRAW)?
Established in 2001, STRAW created a nomenclature for reproductive aging based on menstrual cycle.
26
What was the purpose of STRAW+10?
STRAW+10 updated and modified the model in 2011, becoming the gold standard for categorizing reproductive aging.
27
How does STRAW categorize the reproductive lifespan?
It divides the reproductive lifespan into three broad phases: Reproductive Phase, Menopause Transition (MT), and Postmenopause Phase.
28
What are the stages in the Reproductive Phase?
The Reproductive Phase includes Early (Stage −5), Peak (Stage −4), and Late (Stage –3).
29
What are the stages in the Menopause Transition (MT)?
The Menopause Transition includes Early (Stage –2) and Late (Stage –1)
30
What are the stages in the Postmenopause Phase?
The Postmenopause Phase includes Early (Stage +1) and Late (Stage +2).
31
Who does the STRAW model apply to?
It applies to menstruating women regardless of demographics, age, body mass index (BMI), and lifestyle.
32
What characterizes the early menopause transition?
Persistent cycle irregularity by ≥7 days.
33
What happens to inhibin B and AMH during early menopause transition?
They decline due to a reduction in follicles (low AFC).
34
What is diminished ovarian reserve associated with?
Lower AMH and inhibin B promote growth of the remaining follicular pool, accelerating follicular atresia.
35
How often to luteal out-of-phase (LOOP) events occur in MT?
They occur in about one in four cycles.
36
What are typical symptoms of early menopause transition?
May or may not have mild vasomotor symptoms (VMS) and may have pronounced premenstrual syndrome.
37
What cycle length characterizes the late menopause transition?
Amenorrhea > 60 days.
38
How do menstrual cycles behave during late menopause transition?
They have variable cycle length.
39
What happens to estradiol levels during late menopause transition?
They are variable with increased prevalence of anovulation.
40
What are FSH levels during late menopause transition?
FSH levels are ≥25 IU/L because of few remaining oocytes.
41
What is the status of AMH and AFC during late menopause transition?
Negligible AMH and AFC.
42
How common are LOOP cycles in late menopause transition?
They occur in a third of women; VMS and other signs of menopause are likely.
43
What are symptoms from elevated estradiol?
Mastalgia, migraine, menorrhagia, growth of fibroids, endometrial hyperplasia.
44
What is the increased risk associated with elevated estradiol?
Increased risk of reproductive cancers, especially with longer menstrual cycles.
45
Can pregnancy occur during luteal out-of-phase events?
Yes, with an increased incidence of twins.
46
What is the relationship between obesity and estradiol concentrations?
Obesity is associated with elevated estradiol concentrations due to aromatization of androgen to estrogen.
47
What are the two main components of the adrenal gland?
The adrenal gland is composed of the adrenal cortex and adrenal medulla.
48
What hormones are produced by the adrenal cortex?
The adrenal cortex produces cortisol, aldosterone, and androgens.
49
What are the androgens produced by the adrenal cortex?
The androgens include dehydroepiandrosterone (DHEA), dehydroepiandrosterone sulfate (DHEAS), androstenedione, and testosterone.
50
What does the adrenal medulla produce and secrete?
The adrenal medulla produces and secretes catecholamines: epinephrine, norepinephrine, and some dopamine.
51
What is the significane of the increase in adrenal androgens related as they relate to estrogens in MT?
Adrenal androgens are enzymatically converted to estrogens in the peripheral tissues. | This is a response to the increased FSH and decrease in circulating E2
52
What happens to cortisol and androgen levels with age?
Cortisol levels increase with age, while androgen levels decrease.
53
Is the drop in androgens correlated with menopause symptoms?
The significance of the drop in androgens with natural menopause is not correlated with menopause symptoms.
54
What percentage of individuals experience changes during late perimenopause and early menopause?
85% of those in the late perimenopause and early menopause experience hormonal changes.
55
What hormones see a marked rise during late perimenopause and early menopause?
There is a marked rise in DHEA and androstenediol.
56
Which hormones see a moderate rise during late perimenopause and early menopause?
DHEAS, testosterone, and androstenedione
57
What happens to adrenal androgen levels after the final menstrual period (FMP)?
Adrenal androgen levels return to premenopause level within 1 to 2 years after FMP.
58
What adrenal hormone associated with the rise in FSH during late perimenopause?
A marked rise in cortisol is associated with the rise in FSH in late perimenopause.
59
What cortisol patterns are associated with during menopause?
Increased cortisol is associated with mood, sleep, and vasomotor symptoms.
60
What at classic signs of early menopause transition STRAW -2?
1. A persitent difference of 7 days or more in cycle length of consecutive cycles 2. Elevated but variable FSH, low AMH and AFC
61
What symptoms characterize late MT transition -1?
*60 or more consecutive days of amenorrhea for age 45 or older *Or recurrent episodes of 60 days or longer for age 40-44 *Cycles are variable in length *extreme fluctuations in hormone levels *FSH > 25 in random blood draw *This stage est lasts 1-3 yrs
62
Why do women with longer MT experience increased risk of reproductive cancers?
Overproduction of estradiol during LOOP cycles lead to: *increased exposure of unopposed estrogen leading to *migraine *menorrhagia *uterine fibroids *endometrial hyperplasia *increased risk of reproductive cancers.
63
Why does a menstrual cycle irregularity occur in the early MT?
The follicular phase of the cycle becomes compressed and the luteal phase is lengthened because FSH and E2 are intermittently elevated. This leads to a second E2 surge in the luteal phase.

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