menopause

Question 1

ovarian hormone comes from granulosa cells. provides negative feedback at the level of hypothalamus. drops five years before menopause occurs,loosing the negative feedback which increases FSH and causes women to go through peri-menopause

Answer 1

inhibin

Question 2

what does a high FSH level do that is constant

Answer 2

LH surge is blocked and thus no ovulation

Question 3

• Defined retrospectively

- Time of the final menstrual period followed by 12 months amenorrhea

Answer 3

menopause- absence of period for a year

Question 4

Hyperthalamic and hypogonadism

Answer 4

perimenopause

Question 5

endometrial ablation procedure

Answer 5

burn the uterine lining and decreases bleeding or causes amenorrheaa

Question 6

vasomotor symptoms of menopause

Answer 6

“hot flashes”

• last 1-5 minutes
• spontaneous
• common at night: night sweats- contributes to sleep disruption and irritability

Question 7

vasomotor symptoms are caused by

Answer 7

thermoregulatory zone narrowing at the level of the hypothalamus which causes decrease in estrogen levels

• African american women more affected
• obese women more affected

Question 8

vasomotor treatments

Answer 8

expectant but no good medical treatment

• herbal treatments are no more effective than placebo but it is widely used

Question 9

most helpful treatment of vasomotor symtpoms

Answer 9

hormone replacement therapy (estrogen the best but if women have uterus you need to give progesterone )

Question 10

women on HRT post-menopausal women (60-70yr)

Answer 10

After 5 years, heart disease, stroke, breast cancer, VTE were significantly increased in HRT users

• osteoporosis decreased

Question 11

bottom line on HRT

Answer 11

1. Use lowest effective dose for the shortest amount of time to achieve desired effect
2. Lower doses now being used than in WHI study
3. Use at younger age (50’s) assd w less risk
4. Always remember progesterone if a uterus is present!

Question 12

non-hormonal treatments for vasomotor symptoms

Answer 12

1. SSRIs- SE decrease libido
2. gabapentin- SE blurri vision, dizziness
3. clonidine- SE hypotension and drowsiness

Question 13

• 10-40% among post-menopausal women

- Symptoms:
Dryness
Discharge
Itching/burning
Dyspareunia

• Vaginal pH more alkaline
  Increases r/o vaginitis

Answer 13

vulvovaginal atrophy

Question 14

vulvovaginal atrophy treatments

Answer 14

1. topical estrogen therapy- has low systemic absorption

2. lubricants