Menopause

Question 1

Define Menopause

Answer 1

Permanent end of menstruation & fertility, defined as occurring 12 months after the last menstrual period

Question 2

When does menopause typically occur?

Answer 2

Typically occurs between 45 & 55 years of age

Question 3

What factors promote early menopause?

Answer 3

1. Women w/ partial hysterectomy average 3.7 years earlier than expected age
2. Factors promoting earlier onset (1-3 yr)
   A. Smoking or being extremely thin

Question 4

What symptom is commonly experienced by women approaching menopause?

Answer 4

DUBis often experienced by women approaching menopause

Question 5

What are the 2 types of menopause?

Answer 5

1. Physiologic menopause

2. Artificial menopause

Question 6

What is physiologic menopause?

Answer 6

Oocyte response to gonadotropin stops

Question 7

What is artificial menopause?

Answer 7

Permanent cessation of ovarian function brought on by surgical removal of ovaries or by radiation therapy

Question 8

What hormonal changes occur during menopause?

Answer 8

1. ↑ Testosterone
2. ↓ Estrogen
3. ↓ Progesterone
4. ↑ FSH & LH

Question 9

What sxs may occur with menopause?

Answer 9

1. Gradual dec in both amount & duration of menstrual flow leads to spotting and amenorrhea
2. Atrophic changes of vaginal epithelium
   A. Thinning of epithelium
   B. ↓ cervical & vaginal mucus production
   C. ↓ size in uterus & ovaries
3. Atrophic bladder changes
   A. Urinary freq, urgency, dysuria
4. Regression of breast size
5. Hot flashes
   A. Feeling heat or burning in face, neck, chest, followed by outbreak of sweating
6. Osteoporosis
7. Skin & hair
   A. Both become thinner

Question 10

What diagnostic tests are used for menopause?

Answer 10

1. Testosterone
2. Estradiol
3. Progesterone
4. FSH/LH
5. TSH
6. Endometrial histology

Question 11

How are the symptoms of menopause treated?

Answer 11

1. Hormone replacement therapy

2. Bisphosphonates

Question 12

What complications are associated with HRT?

Answer 12

1. Endometrial cancer
2. Breast cancer
3. HTN
4. Thromboembolic Dz

Question 13

What are the contraindications to HRT?

Answer 13

1. Undiagnosed vaginal bleeding
2. Acute or chronic liver Dz
3. Acute vascular thrombosis
4. Endometrial cancer
5. Breast cancer

Question 14

What are the indications for HRT?

Answer 14

1. Vasomotor Sx’s
   A. Leads to ↓ frequency of hot flashes
2. Urogenital tract
   A. Reverses postmenopausal atrophy of vulva, urethra and trigone
3. Osteoporosis
   A. ↓ Resorption of bone but has no effect on bone formation
   B. ↓ Frequency of hip fx

Question 15

What alternative therapy may be used for the symptoms of menopause?

Answer 15

1. Soy has isoflavones (plant estrogens)
   A. Food form only
2. Flaxseed- omega-3 fatty acids & lignans (plant estrogen –like)
3. Avoidcaffeine& alcohol
4. Vit E: only up to 400 IU per day for hot flashes
5. Estroven: hot flashes
6. Vit B complex: hot flashes and mood swings
7. Black cohoshderived from buttercup
   A. May lowerBP & in rare cases hepatitis reported

Question 16

What prescriptions may be used for menopause?

Answer 16

1. Effexor XR (venlafaxine)
2. Neurontin (gabapentin)
3. Catapres TTS (clonidine)
4. Bellergal-S (ergotamine/belladonna/phenobarbital): bedtime only
5. Brisdelle (paroxetine)
6. Osphena (ospemifene) for vag dryness

Question 17

What does menopause increase the risk of?

Answer 17

1. The risk ofacute MI& atherosclerosisrises sharply after menopause
2. Increased risk ofosteopenia& osteoporosis
3. ↑risk ofstroke&blood clots w/HRT