Term
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Definition
- Permanent cessation of menses with the loss of ovarian follicular activity
- Defined as occuring after 12 months of amenorrhea
- Typical age is 40-55 years
- Impact on quality of life |
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Term
| What are the three different types of menopause? |
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Definition
- Menopause --> One year after last period
- Peri-Menopause - Just after last period
- Premature ovarian failure |
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Term
| What is the pathophysiology of menopause? |
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Definition
- 1-2 million oocytes at birth
- Ovary is responsible for release of estrogen, progesterone, and androgens
- After 35 years, decrease in hormones produced by ovaries, lose negative feedback
- Causes surge of LH and FSH hormones
- Rising FSH levels are big sign we look for in menopause |
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Term
| What are the different FSH levels at different ages (mIU/mL)? |
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Definition
Childhood - < 4
Reproductive years - 6-10
Peri-menopause - 14-24
Menopause > 30-40 |
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Term
| What are the risk factors of menopause? |
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Definition
- Smoking
- Poor nutrition
- Ovarian Failure
- Hx of histerectomy
No effect of age on Menopause: Age of menarche, Number of ovulations/pregnancies, use of OC's, Race/Socioeconomic status |
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Term
| What are the risk factors for Pre-mature Ovarian Failure? |
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Definition
- Genetic factors
- Autoimmune disorders
- Smoking
- Chemotherapy
- Hysterectomy
- Low body weight |
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Term
| What is the clinical presentation of menopause? |
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Definition
- Menstrual cycle alterations
- Hot flashes
- Sleep disturbances
- Dryness
- Mood changes
- Skin, hair, and nail changes
- Osteoporosis
- CV changes
- Misc. s/s |
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Term
| What might change with the menstrual cycle around the time of menopause onset? |
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Definition
- After 1st menstural cycle, regular menses occur until approximately age 40
- Considerations with menopause are frequency of menses and length of menses |
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Term
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Definition
- 1st physical manifestation of ovarian failure
- Affects > 95% of women
- Intense feeling of heat radiating from face to upper arms, could last 1-2 years (33% have them longer)
- Rapid onset and resolution ~ 3 minutes
- Excessive upper body sweating
- Triggers include stress, hot weather, caffeine, alcohol, spicy foods |
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Term
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Definition
- Result of declining estrogen?
- Latent sleep phase is lengthened (time it takes to fall asleep)
- Actual sleep period is shortened (time you ARE asleep for)
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Term
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Definition
- Vaginal mucosa, cervix, endocervix, and endometrium are all estrogen dependent
- Tissues become atrophic, thin, and secretions decrease
- Dyspareunia (painful intercourse)
- Atrophic vaginitis
- B/c of lack of estrogen, some itching/burning as well |
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Term
| What is the cause of the mood changes in menopause? |
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Definition
- Presents as depression, apathy, crying spells
- Could be secondary to estrogen deficiency and sleep disturbances
- Encourage counseling and support systems |
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Term
| How does menopause affect the skin, hair, and nails? |
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Definition
- Skin becomes thin and less elastic due to estrogen decrease
- Changes in hair and nails (more brittle maybe? Dry?) |
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Term
| Why does osteoporosis occur, and what are the risk factors for this? |
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Definition
- Bone demineralization
- Occurs 15-20 years earlier in women
Risk Factors
- Reduced weight
- Family Hx
- Early menopauase
- Low calcium intake
- Tobacco use**
- High alcohol/caffeine intake
- Nulliparity (not had children) |
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Term
| What happens to the cardiovascular system in menopause? |
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Definition
- Coronary heart disease risk
- Changes in the lipid profile
- Increasing total cholesterol
- HDL decreases and LDL increases
- Changes in lipids secondary to menopause and estrogen deficiency |
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Term
| Because many sx of menopause are secondary to estrogen deficiency, it makes sense that we treat the deficiency to treat the sx. What are the risks/benefits of a estrogen-progestin HRT? |
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Definition
Risks
- CHD
- Breast CA
- Stroke
- PE
- DVT
Benefits
- Decrease hip fracture
- Decreased Colorectal CA |
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Term
| What are the risks and benfits of estrogen-only HRT? |
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Definition
- Must have uterous removed to use estrogen alone
Risks: Increase in stroke, PE, DVT.
No changes : CHD, breast CA, colorectal CA
Benefits - Decrease in fractures |
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Term
| What were the key limitations in the WHI HRT studies? |
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Definition
- Patients were older, mean age of 63 y/o
- Particpants were asymptomatic for menopausal symptoms |
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Term
| In summary, what are the only benefits of HRT? |
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Definition
- Osteoporosis
- Colorectal Cancer |
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Term
| In summary, what are the risks of HRT? |
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Definition
- Breast Cancer
- CHD
- Stroke
- VE
- Cognition and Dementia
- Endometrial CA
- Ovarian CA
- Cholecystectomy
*If estrogen alone, increased risk of endometrial cancer and ovarian cancer |
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Term
| What are the main points of HRT therapy? |
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Definition
- Use at lowest dose for shortest duration
- US Preventative task force recommends against use of HRT's for chronic conditons
HRT's do NOT provide cardioprotection, can increase risk of breast CA and stroke, may decrease risk of fractures and colorectal CA |
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Term
| What are the non-pharmacological treatments of menopause? |
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Definition
For hot flashes --> avoid hot places, wear lighter clothing, don't eat spicy foods, try and avoid stress
For dryness --> lubricants, enjoy other activities, seek counseling (holy crap)
For Osteoporosis --> stop smoking, reduce alcohol intake, excercise for 20 min/day 3x a week, increase calcium and vitamin D intake
For CV changes --> Stop smoking, exercise and healthy diet, management of other risk factors |
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Term
| What are the pharmacological treatments for Hot flashes? |
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Definition
Hormonal therapy - Think of age, RF's, s/s. Weight risk and benefit. Could last 2 years, reassess every 6 months. For estrogen only, can't be at CV risk. Must have hx of histerectomy. Use progestin if they have a uterous for endometrial protection for 12-14 days per month. Can do continuous cyclic (estrogen only then a progestin), or continuous combined (both at same time all the time). Only these two provide endometrial protection. Androgens only used in combo with estrogens in menopause secondary to surgery
Antidepressants - Venlafaxine 61% reduction when 75mg-150mg qd. Paroxetine 62-65% reduction in sx when taking 20mg/day
Clonidine - 38-78% reduction at 0.1mg/day
Gabapentin - 45% reduction, dose response relationship |
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Term
| What are the pharmacological treatments for dryness? |
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Definition
- Hormonal therapy
- Local treatment: moisturizers, vaginal estrogen cream, estrogen ring.
Stil reasses every 6 months, weight risks/benefits, still use Progestin add-on |
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Term
| What are the pharmacological treatments for Osteoporosis? |
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Definition
- Calcium/Vitamin D
- Hormonal therapy
- SERMS --> Raloxifine
- Bisphosphonates
- Calcitonin
- Teriparatide
Hormonal should be LAST resort for chronic conditions |
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Term
| What are the pharmacological treatments for CV changes? |
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Definition
- Treat other RF's: diabetes management, HTN, lipid management
Non-pharm: Smoking cessation, diet, exercise |
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Term
| What are some KEY points of HRT's in terms of patients? |
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Definition
- Primary role for HRT's is in vasomotor sx and vaginal atrophy in menopause
- NOT recommended for chronic disease
- reasses every 6 months
- HTR only for hot flashes and dryness
- Use lowest dose for shortest duration
- Risk/benefit more for symptomatic relief in younger patients
- Has been increase in lung cancer in HRT, correlation between timing of HRT with menopause and age and incidence of breast CA |
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