SM_211b: Menopause and HRT Flashcards
Menopause is ____
Menopause is the final menstrual period in a women resulting from ovarian ageing / loss of ovarian follicles
- Officially diagnosed after 12 months of amenorrhea
- Average age is 52
Menopause at < 40 yo is ___
Menopause at < 40 yo is primary ovarian insufficiency
Menopausal transition is ___
Menopausal transition is the time of waning ovarian function leading up to the final menstrual period
- Signs: menstrual cycle change, vasomotor symptoms, sleep disturbance, mood changes, vaginal dryness / dyspareunia
- Average age: 47.5
- Time period averages 4 years
Perimenopause is ____ + ____ + ____
Perimenopause is menopause transition + menopause (moment in time) + first postmenopausal year
____ is expected in a post-menopausal female
Elevated serum FSH is expected in a post-menopausal female
Women experience a lifelong ___ in ovarian reserve
Women experience a lifelong decrease in ovarian reserve
- Number of eggs decreases over time
In menopause, the HPO axis changes in that ____ and ____
In menopause, the HPO axis changes in that inhibin production decreases and estradiol production decreases
Describe physiology of the menopause transition
Physiology of the menopause transition
- Follicle depletion
- Decreased inhibin B
- Increase in FSH but with fluctations
- Initial increase in Estradiol
- Decrease in anti-mullerian hormone
- Unremitting follicle depletion with E2 decline
- Permanent amenorrhea
____ is the key finding in postmenopause
Elevated serum FSH is the key finding in postmenopause
Decrease in eggs over lifetime until depletion in postmenopause is reflected by ____
Decrease in eggs over lifetime until depletion in postmenopause is reflected by decreasing anti-mullerian hormone
Describe diagnosis of menopause
Menopause diagnosis
- Age 40-45 with irregular menstrual cycles: exclude pregnancy (hCG), hyperprolactinemia and thyroid dysfunction
- FSH level is too variable to rely on during the transition
- Not clinically necessary but unclear if can measure the blood levels of these hormones: FSH > 25, E2: low, AMH: low
____ are a better predictor of postmenopausal stage than serum FSH
Changes in menstrual bleeding patterns are a better predictor of postmenopausal stage than serum FSH
Describe vasomotor symptoms of menopause
Vasomotor symptoms of menopause
- Recurrent transient episodes of flushing
- Sensation of heat that begins in upper body, face / neck, and spreads throughout
- Increased HR, palpitations, and / or anxiety
- Sweating, often followed by chills
- 60-80% of women
____ of women experience hot flashes
60-80% of women experience hot flashes during menopause transition
Vasomotor symptoms in menopause occur due to ____
Vasomotor symptoms in menopause occur due to a narrowed thermoneutral zone in the hypothalamus
- Genetic polymorphisms of estrogen metabolism and receptors
- Reduced reproductive hormones play an integral role and the thermoregulatory process
- Inherent thermoregulatory process within the individual
Describe health problems arising in menopause
Health problems arising in menopause
- Menopausal symptoms: vasomotor symptoms, vulvovaginal atrophy, genitourinary syndrome of menopause
- Depression
- Osteopenia / osteoporosis
- Coronary heart disease
Screen for ____ during menopause
Screen for depression during menopause
- 2x increased risk of depression over baseline especially if history of depression
- Risk returns to baseline postmenopause
Osteoporosis is ____
Osteoporosis is low bone mass and architectural deterioration of bone tissue leading to enhanced bone fragility and increase in fracture risk
- Can treat with estrogen replacement
- High mortality with hip fracture
- DEXA T score ≤ 2.5 is osteoporosis
____ is the most prevalent disease to present in the menopause years and is a leading cause of death in women
Coronary heart disease is the most prevalent disease to present in the menopause years and is a leading cause of death in women
- Declining estrogen levels after menopause are associated with a sharp increase in CHD risk
Decreased estrogen leads to ____, ____, and ____
Decreased estrogen leads to increased total cholesterol / LDL / triglycerides, vasoconstriction, and insulin resistance
- Women with premature menopause have earlier onset CHD
- Surgical menopause without estrogen treatment leads to higher CHD mortality than hormone users
____ initiation of estrogen hormone therapy is associated with less progression of atherosclerosis during perimenopause
Early initiation of estrogen hormone therapy is associated with less progression of atherosclerosis during perimenopause
- However current guidelines say estrogen hormone therapy should not be used for CHD prevention
Which patient should receive systemic hormone therapy?
Which patient should receive systemic hormone therapy?
- 55 yo with well-controlled HTN, moderate hot flashes, LMP 3 years ago
Describe who should be treated with estrogen hormone therapy
Who should be treated with estrogen hormone therapy
- Women without contraindications: breast cancer, CHD, previous VTE, active liver disease, unexplained vaginal bleeding
- Women with moderate to severe vasomotor symptoms affecting quality of life
- Initiate therapy in perimenopausal women if: < 10 years from final menstrual period and/or < 60 years of age
Describe how to treat menopause symptoms
Treating menopause symptoms
- Conservative measures: lowering room temperature, using fans, dressing in layers, avoiding triggers
- Systemic estrogen: most successful therapy (widens thermoneutral zone), use lowest dose for symptom relief if menopausal, and use for shortest duration
- Menstruating women need pregnancy protection: higher dose such as birth control pills
