Menopause & Hormone Therapy

Question 1

Clinical definition of menopause

Answer 1

Permanent cessation of menses after significant decrease in ovarian estrogen production

12 consecutive months with no menses

Question 2

What is perimenopause?

Answer 2

Time period before menopause; transition from reproductive to non-reproductive years

Question 3

How does estrogen change in perimenopause?

Answer 3

estrogen levels fluctuate unpredictably

Question 4

What initiates the menstruation of uterus?

Answer 4

drop in progesterone

Question 5

What are only things that influence age of menopause onset?

Answer 5

genetics

lifestyle (not much effect)

Question 6

What hormone causes thickening of endometrium?

Answer 6

increased estrogen

Question 7

What is premature ovarian failure?

Answer 7

menopause before age 40

Question 8

How is premature ovarian failure dx’d?

Answer 8

FSH > 30

*trying to tell ovaries to make estrogen

Question 9

Causes of premature ovarian failure?

Answer 9

genetic, autoimmune disorders, smoking, alkylating CA chemotherapy, hysterectomy

Question 10

What is usually the first sign of menopause and most common sx of decreased estrogen?

Answer 10

hot flashes

Question 11

How is sleep affected by menopause?

Answer 11

lengthened latent phase (time to fall asleep) with alterations in REM

Question 12

How is bone density affected by menopause? Pathophysiology?

Answer 12

decreased bone density increasing risk of osteoporosis

progesterone and estrogen receptors on osteoblasts/clasts and affect cortical and trabecular bone

Question 13

What is used to screen for osteoporosis? When is it started?

Answer 13

DEXA scan

Start testing for all postmenopausal women at 65yo and younger if have risk factor

Question 14

How is DEXA scan scores reported?

Answer 14

T-score = std dev from mean peak BMD of nl, young adult population

Z-score = std dev from mean peak BMD of same age/sex/race of the pt

Question 15

Normal, osteopenia, and osteoporosis t-scores?

Answer 15

Normal ≥-1.0
Osteopenia -1.0 to -2.5
Osteoporosis ≤ -2.5

Question 16

Osteoporosis risk factors

Answer 16

Medical hx of fragility fracture
Weight< 127lbs
Medical causes of bone loss (meds or disease)
Hx of hip fracture
Smoker
Alcoholism
RA

Question 17

Osteoporosis treatment

Answer 17

Calcium (Ca++) 1200mg RDA

Vitamin D3

Hormone therapy (not primary indication)

Bisphosphonates - inhibit osteoclasts to reduce bone resorption

SERMs (selective estrogen receptor modulators) like tamoxifen

Question 18

Estrogen (E2 or estradiol) coverts to ________ by the liver.

Answer 18

E1 (estrone)

Question 19

What do we do for menopause estrogen replacement?

Answer 19

Combo estrogen-progesterone

OTC: Soy and isoflavones, St John’s wort, Black cohosh

BHRT

Question 20

Why are other routes of administration of estrogen replacement therapy better than oral pills?

Answer 20

When estrogen given orally converted to estrone, but remains unaltered if transdermal, transbuccal, transvaginal, IV or IM

Question 21

What is BHRT?

Answer 21

= Bio-identical hormone replacement therapy

replace hormones in your body using “natural” chemically identical hormones; NOT synthetic

Question 22

Effects of progesterone BHRT

Answer 22

• Neutralizes estrogen dominance

- Helps thyroid function, adrenal function, sleep, building bones, decrease weight

Question 23

When _____ is low, woman has no ovulation.

Answer 23

estrogen

Question 24

What are two ways progesterone is produced?

Answer 24

corpus luteum (majority)
adrenal glands (small amount)

Question 25

Reasons for for low progesterone

Answer 25

Anovulation PCOS (cysts form instead of corpus luteum) Luteal phase deficiency (ovaries produce less) Oral contraceptives (don’t allow ovulation) Emotional or physical stressors Surgical/chemical dysfunctional ovaries Perimenopause/menopause

Question 26

What are some contraindications of progesterone replacement?

Answer 26

Saliva testing WNL Hx/current breast cancer Fibroid tumor > 5cm Hx blood clot

Question 27

What are some conditions that may be treated with progesterone?

Answer 27

- Uterine fibroids < 5cm - May prevent BRCA by cell maturation induction - May prevent/treat osteoporosis by stimulating osteoblasts - Post-partem depression secondary to losing the placenta

Question 28

Lab for most accurate levels of progesterone? When?

Answer 28

saliva testing on day 16-24 if cycling (doesn't matter when for non-cycling and men) blood is NOT accurate

Question 29

What are risks of using synthetic estrogen replacement?

Answer 29

stimulates breast cancer, overrides natural balance and resets system

Question 30

Why does obesity increase estrogen levels?

Answer 30

fat cells convert cholesterol to estrogen

Question 31

Xenoestrogens

Answer 31

synthetic estrogen in meat, dairy, and plastics

Question 32

Effects of excess estrogen on body

Answer 32

everything grows! - weight gain, enlarged breasts, cysts, cancer, hyperplasia, hypothyroidism, disturbs sleep as excitotoxin

Question 33

What are 3 forms of estrogen?

Answer 33

Estrone (E1) Estradiol (E2) Estriol (E3)

Question 34

Which type of estrogen is most produced?

Answer 34

Estradiol (E2)

Question 35

Which type of estrogen has biggest impact on vagina?

Answer 35

Estriol (E3)

Question 36

Effects of decreased testosterone

Answer 36

``` Fatigue Depression Breast tenderness Erectile dysfunction Decreased libido Sleep disturbance Muscle loss/weakness including the heart Inflammatory diseases ```

Question 37

Meds that decrease testosterone

Answer 37

``` Statins SSRIs Diuretics Lunesta Cimetidine Antipsychotics Antifungals (-azoles) ```

Question 38

Positive effects of testosterone replacement therapy

Answer 38

Improves brain function, increases sex drive, improves HDL/LDL, increases energy, improves glucose metabolism, increases muscle and bone strength, improves cardio health, increases bone density

Question 39

What must also be prescribed if male started on testosterone therapy? Why?

Answer 39

aromatase inhibitor body converts testosterone to estrogen

Question 40

Where is testosterone made in females?

Answer 40

ovaries

Question 41

Before giving testosterone in male, what must be checked?

Answer 41

prostate to rule out cancer | testosterone won't cause cancer, but will worsen existing cancer

Question 42

Symptoms of hypothyroidism

Answer 42

depression, dry skin, weight gain, increased BP, increased cholesterol, PMS, infertility, erectile dysfunction