Menopause

Question 1

def. meno

Answer 1

12 months of amen

- associated with permanent cessation of ovarian function

Question 2

def. perimenopause

Answer 2

transtitional period prior to menopause: from end of normal ovulatory cycles to cessation of menses
- heralded by menstrual irregularities

Question 3

what is mech of perimeno

Answer 3

• by mid 40s, cycle is longer due to less E prolonging foll. phase - defines onset
• when length over 42 days can predict within 1-2 years

Question 4

what are normal and premature ages

Answer 4

normal - 51yo

early meno

Question 5

where does E come from in meno

Answer 5

peripheral conversion of andro to E

- correlates with body wieght

Question 6

3 key points

Answer 6

1. meno is clinical diagnosis
2. not biochem
3. no ultrasound diagnosis

Question 7

why is it important to define

Answer 7

any bleeding post meno is abnormal - endo CA until proven otherwise

Question 8

4 causes of PMB

Answer 8

1. atrophic endometriosis/vaiginitis - 43%
2. endo CA - 29%
3. endo/cerv polyps
4. other - trauma, sarcoma

Question 9

what is first test

Answer 9

endo biopsy

Question 10

what is impact of menopausal E deprivation

Answer 10

1. vasomotor Sx
2. urogential atrophy
3. cog. changes
4. CV changes

Question 11

what is hot flush

Answer 11

sudden increase in redness and heat

• second s to minutes
• more often at night and in warm env

Question 12

what is patho of hot flush

Answer 12

• poorly understood

- probably due to hypothalmus in assoc. with E deprivation

Question 13

prevalence of hot flush

Answer 13

perimeno -10-25%
meno - 50-85
10 years past -

Question 14

2 main treatments

Answer 14

firstline - lifestyle

Est - gold standard, but high placebo effect

Question 15

what is urogenital atrophy

Answer 15

E deprivation

- cuases loss of collagen and thinning and friable

Question 16

therapy of atrophy

Answer 16

• sexual activity
• lubricant
• local E - more effective that systemic

Question 17

3 Sx attributable to E deprivation

Answer 17

1. hot flushes
2. decreased sleep
3. urogenital atrophy

Question 18

2 types of HRT

Answer 18

1. estrogen - lower doses than OCP

2. progestin - only from endo CA protection

Question 19

pre 2002 risk and benefits

Answer 19

benefits - vasomotor, osteo, cardo

risk - DVT, brest CA?, CVD?

Question 20

probs with old lit

Answer 20

healthy user bias

Question 21

what was major finding in new lit

Answer 21

increased risk of CAD

Question 22

what was problem

Answer 22

old women in study

Question 23

what is effect on HRT

Answer 23

if there is one, it is small - 25%, but low numbers

Question 24

***what is attrubtable risk

Answer 24

8/10000 - not big

Question 25

what are HRT guidlines

Answer 25

- use only for disabling vasomotor Sx | - can safely be used for 5 years out of menopause