Support Through Perimenopause & Menopause Flashcards
How soon should a woman dial in her hormone and reproductive health to support a smooth and symptom-free transition?
15-20 years before menopause
When is perimenoapuse?
Considered the average 5-10 years before a woman’s final period.
For some women, this transition can be longer, or shorter, depending upon their systemic health and genetics.
Why are many of the symptoms associated with perimenopause are synonymous with PMS?
Because with infrequent ovulation comes infrequent doses of progesterone as well as higher levels of estrogen.
What can the decrease in progesterone due to more frequent anovulation do?
May interfere with the HPA axis and overall stress resiliency, factoring into symptoms of depression and anxiety.
The loss of progesterone during this time can also contribute to symptoms of heart palpitations, sleep issues, and the development of autoimmune diseases, as progesterone plays a role in modulating the immune system.
What can cause symptoms such as hot flashes, vaginal dryness, and low libido and then heavy periods, period pain, breast tenderness, and weight gain?
Estrogen may fluctuate widely, at times dropping to very low levels and then fluctuate to extremely high levels (sometimes very quickly), contributing to various estrogen-related symptoms such as heavy periods, period pain, breast tenderness, and weight gain.
Why can excess testosterone be common during perimenopause?
Because during this time, levels of SHBG go down, increasing levels of free testosterone in the system.
SHBG = sex-hormone binding globulin, a protein that transports and regulates the amount of sex hormones in the blood, including androgens and estrogens
If a woman is experiencing BLANK insufficiency throughout perimenopause and menopause, she may not bounce back quite efficiently, and she may experience more symptoms such as fatigue and a decreased ability to handle stress.
Adrenal
When does a woman know that she’s reached menopause?
Once a woman ceases to have a period for over a year.
How is menopause diagnosed?
By a consistent FSH level higher than 30 mIU/mL. Keep in mind that FSH can vary with perimenopause due to anovulation and cycle irregularities, and may even appear very high at certain times, but menopause is specifically diagnosed through a consistent FSH reading, rather than a fluctuating one.
Menopause is that it is a naturally lower BLANK state, so low BLANK levels during this time does not indicate dysfunction.
Estrogen; estrogen
Why do estrogen levels decline during menopause?
Because the ovaries stop producing it as the follicles no longer develop and ovulation halts.
The primary estrogen in charge during menopause is BLANK
Estrone
However, it is still estradiol that is the bioactive estrogen that supports bone health, brain health, and heart health post-menopause.
What is ecellular intracrinology?
The majority of estradiol that is synthesized post-menopausally is produced from the aromatization of estrone locally within peripheral tissues on an as-needed basis through this process.
How is estradiol synthesized post-menopausally?
Produced from the aromatization of estrone locally within peripheral tissues on an as-needed basis through a process called cellular intracrinology.
It is also produced via aromatization within the abdominal adipose tissue which may explain why weight gain is so common in post menopausal women.
Why is hormone replacement thearpy often recommended to peri and postmenopausal women?
Although menopause is a natural hypo-estrogenic state, too little estrogen during this time can be very problematic and can increase the risk for the loss of bone mineral density, cardiovascular disease, and dementia.
What is Primary Ovarian Insufficiency?
Sometimes referred to as Premature Ovarian Failure, or Premature Menopause is considered when a woman before the age of 40 has not experienced a period for 4 or more months, has demonstrated menopausal FSH levels, low estrogen levels, and a loss of ovarian reserve, which is defined as a decreased number of primordial follicles within the ovary before the age of 40, determined by testing levels of Antimüllerian Hormone (AMH) in the follicular phase.
Where is AMH produced and what does it do?
In the granulosa cells of healthy growing follicles in response to FSH.
AMH has an inhibitory effect on other follicles, preventing them from growing large enough to compete. Thus, AMH plays a role in ensuring that the healthiest follicle is chosen to be the primary follicle that will go on to ovulate an egg.
Can direct measurement of ovarian reserve cannot technically be determined?
No
How can you get a rough estimation of a woman’s ovarian reserve? Why is this?
Determining the primordial follicle pool count through evaluating levels of AMH.
Because AMH levels rise when there are more growing follicles present, giving a decent representation of ovarian function and primordial follicle pool count.
Women with BLANK often show higher levels of AMH than average, which is probably due to the higher number of pre-antral follicles that are present during the early follicular phases.
Why may this be problematic?
PCOS
This may problematic and a potential contributing source to anovulation in women with PCOS, as the higher levels of AMH are said to interfere with normal FSH levels, disturbing antral follicle development and inhibiting ovulation
BLANK levels naturally decrease once an antral follicle reaches around 9mm in size, further suggesting the role of higher BLANK levels in polycystic ovaries with multiple, smaller, ovarian follicles.
AMH
Is it rue that we run out of eggs and primordial follicles upon menopause?
This isn’t necessarily true as it has been shown that we don’t necessarily “run out of eggs”, rather ovarian function begins to decline.
True or False: AMH is suggestive, not definitive. Every woman is bioindividualistic, and her AMH levels may not necessarily be an accurate description of her actual ovarian reserve.
anti-Mullerian hormone, plays a role in sexual development in males and females. It is produced int he ovaries.
True
True or False: Some women who have low AMH levels may present the same number of follicles as a woman with normal-high levels of AMH on ultrasound, suggesting that her AMH levels may be lower for a reason other than a low ovarian reserve
True
Can you assess ovarian reserve via ultrasound?
Yes, this may give more understanding as to if there is a structural issue impacting ovarian function or follicle count.
True or False: AMH levels will naturally rise in the follicular phase and drop in the luteal phase as the body is preparing for ovulation.
True
Is it important to take note when an AMH test is being taken?
Yes, many doctors suggest that AMH can be taken on any day of the cycle. However, this is may not be super accurate as in theory, AMH levels will naturally rise in the follicular phase and drop in the luteal phase as the body is preparing for ovulation.
What are other factors can impact AMH levels that may not have anything to do with total ovarian reserve?
Exposure to heavy metals and environmental toxins, chronic stress, and vitamin D deficiency
New findings suggest that testing AMH levels alone may not be the best indicator for determining a woman’s fertile statu
True or False: testing AMH alone is the best indicator for determining a woman’s fertile status.
False
True or False: AMH levels are malleable and can change over time through nutrition and lifestyle support.
True
What can one do to promote healthy AMH levels?
Make sure they ar minimizing their toxin exposure, including exposure to endocrine-disrupting chemicals and heavy metals, such as cadmium, lead, and mercury, along with proper stress management and ensuring adequate levels of vitamin D.
