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Flashcards in Menopause + HRT Deck (45):
1

Impacts age of menopause onset (earlier)

smoking

2

one year without menses

Menopause

3

symptoms of menopause, but periods (45-55y/o)

Perimenopause

4

Women spend ___ of their life in menopause

1/3

5

End of reproductive life about __ y/o

43

6

After repro life ends, Ovary continues to produce:

sporadic + abnormal eggs

7

After repro life ends, how do estrogen levels change (even w ovulation)?

decrease

8

How do FSH levels change around menopause?

FSH rises

9

Menopause defined as:

No menses for a year
FSH >30

10

Symptoms of Menopause:
Most common, and why?

Hot flashes + night sweats which affect sleep
Probably due to gonadotropin spikes as much as estrogen deficiency

11

Symptoms of Menopause:
Less common?

Skin changes/vasodilation

12

T/F: White women have worse hot flashes than black women.

F: white women are just annoying and whiney.

13

FDA-Approved Indications for HT:

estrogen + (if pt has uterus) progestin

14

Why would you give progestin to a patient?

rx with estrogen if patient has a uterus to prevent endometrial CA

15

Postmenopausal HT is indicated for:

1. trx of moderate-to-severe vasomotor symptoms
2. trx of vulvar and vaginal atrophy*
3. Prevention of postmenopausal osteoporosis

16

The preferred trx for women with vaginal symptoms only:

low doses of vaginal estrogen
(no need for progestins, non-systemic)

17

Can you give topical estrogen to patients with ER+ breast cancer?

Dr. Phillips thinks so--very little becomes systemic, so no issues

18

Women who are s/p hyst need estrogen (with, without) progesterone.

without--no uterine cancer risk

19

Estradiol is made from:

a plant derivative

20

Associated with menopause?
Depression

No!
(what else is going on in her life? did her kids just go to college, etc?)

21

Associated with menopause?
Vaginal dryness

Yes

22

Associated with menopause?
Decreased libido

No

23

Associated with menopause?
vaginal atrophy

Yes

24

Medical Illnesses Associated with Menopause:

Osteoporosis
Heart Disease
Cancer

25

High risk groups for Osteoporosis :

Caucasian/Asian
Thin
Smoker
Alcohol Use
Steroid Use
Family History

26

Estrogen therapy approved for ______ of osteoporosis.

prevention
**NOT trx!

27

Bone Density Measurements for screening purposes begin at age __.

65

28

How does estrogen affect osteoporosis?

Affects osteoclast and osteoblast activity = prevention (even low doses have some effects!)

29

How does HRT affect bone fracture risk?

significant reduction in fractures (hip + vertebrae in study)

30

Early loss of endogenous estrogen is associated with:

CVD

31

Women appear protected from CVD until:

menopause (compared to men)

32

Systemically, what are effects of endogenous estrogen (3)?

increases smooth muscle proliferation
lowers cholesterol
improves vascular tone

33

What evidence of CVD is present in a 35 y/o F?

fatty streaks and minimal atherosclerotic plaques

34

What evidence of CVD is present in a 45-55 y/o F?

active progression of athrosclerotic lesions

35

What evidence of CVD is present 5-8 yrs after menopause?

increase in plaques and intima-media thickening

36

When do CVD complications start to develop in women? WHy is this significant?

Aged > 65
At this age, women’s rate is equal to men’s

37

What drugs may not have the benefit in women as they do in men?

Statins and ASA

38

What are the theorized benefits of perimenopausal use of HT , in terms of CVD?

1. Positive effects on vasc remodeling
2. Decreased intimal thickening
3. Decreases the incidence of plaques

39

Why isn't Postmenopausal Use of HT beneficial, in terms of CVD?

In women > 65:
Plaques already formed, so estrogen (thrombogenic) clots off the artery

*MIs in year 1 of E

40

Should you give a post-menp patient with hot flashes but no hx of CVD estrogen?

yes!

41

Estrogen increases the risk of:

DVT
stroke (women 60-69 y/o)
breast cancer (if >5yrs)

42

Estrogen decreases the risk of:

colon CA

43

Risk of breast cancer with estrogen use (persists/decreases) after HT stopped

decreases--back to baseline

**risk is small and may be due to progestin

44

T/F: The option of MHT should be made on a patient by patient basis.

T

45

Why was the study which related CVD to estrogen therapy crappy?

average age of women was 65, which is when the effects of low E/CVD really kicks in