Endocrine 08 Part 6

Front 1

What is the median age of menopause in the US?

Back 1

47.5

Front 2

Describe what occurs in the last decade of menstrual life

Back 2

1. There is a dramatic acceleration in the depletion of the primary ovarian follicles stockpile.
2. Follicles recruted during the follicular phase become less responsive to gonadotropin stimulation and produce less estrogen.
3. Thus, there is less activity of the estradiol negative feed back look and gonadotropins (primarily FSH) begin to increase before menopause
4. Later LH concentrations begin to rise

Front 3

What is the ultimate result from the decreasing ovary function in menopause?

Back 3

1. 95% of estradiol is secreted by the ovaries
2. The decrease and ultimate arrest in folliculogenesis results in a sharp decrease in estrogens
3. Only the less potent hormone, estrone, which derives from the perioheral conversion of androgens remains

Front 4

Describe the early symptoms of menopause

Back 4

1. Vasomotor hot flushes occur in 65-70% of menopausal women
a. Symptoms last 3-4 years after which they decrease in intensity
b. The result of estrogen deprivation which affects central thermoregulatory functon
2. Genitourinary changes lead to urinary incontinence and atrophy of the genital organs
a. A major problem is atrophy of the vaginal mucosa which may constrict vaginal introitus and cause dyspareuria (pain at intercourse) and susceptibility to infection
b. This is the result of decreased estrogen

Front 5

Describe the later manifestions of menopause

Back 5

1. Osteoporosis
a. Estrogens and androgens slow the rate of bone remodeling and protect against bone loss
b. The physiological fall in estradiol at menopause leads to increased remodeling
c. No specific symptoms occur until bone loses its structural integrity
2. Atherosclerosis and Cardiovascular disease
a. Estrogens have some beneficial effects on vascular wall cells and tissues

Front 6

What has short-term estrogen replacement therapy used for?

Back 6

-Relief from moderate to severe hot flashes
-For symptoms of vulvar and vaginal atrophy

Front 7

Describe the effect of estrogen on the skeleton

Back 7

1. Stabilizes bone density and prevents further bone loss
2. Does not restore lost bone

Front 8

In whom should estrogen therapy be used to prevent osteoporosis?

Back 8

In women with very low levels of bioavailable estradiol who are at a greater sigificant risk for osteoporosis

Front 9

Describe the effect of estrogen therapy on heart disease

Back 9

No benefit vs risk in regard to protection against heart disease

Front 10

Describe the effect of estrogen therapy on neurocognitive symptoms of menopause

Back 10

Estrogen could potentially relieve neurocognitive symptoms (mood changes, depression, and loss of memory) that may result from estrogen deprivation and protect neurons from cell death

Front 11

In whom is long term estradiol replacement therapy indicated in?

Back 11

Young hypoestrogenic patients

Front 12

What are the potential risks of estradiol replacement?

Back 12

1. Endometrial cacner
2. Breast Cencer
3. Thrombolic events and stroke

Front 13

Describe endometrial cancer from longterm estradiol replacement therapy

Back 13

Unopposed estrogen treatment may increase the risk of endometrial carcinoma, since, physiologically, estrogen is a hormone which promotes endometrial proliferation and hyperplasia

Front 14

Describe how to prevent unopposed estrogenic stimulation in long term estradiol replacement therapy

Back 14

A progestin can be added to the long term estrogen treatment, either cyclically (as occurs in the normal menstrual cycle) or in a combined therapy

Front 15

In whom in long-term HRT beneficial in?

Back 15

Women at risk of osteoporosis

Front 16

What alternative therapies are there for vasomotor symptoms (hot flashes)?

Back 16

1. GABA analogues and other aminergic therapies
-Show effectiveness in reducing the number of hot flashes
2. Botanical products that contain or act like estrogens (phytoestrogens)
-Includes black cohosh
3. Lifestyle changes
a. Dress to avoid being too warm
b. Reduce stress
c. Avoid spicy food, alcohol, and caffeine
d. Get enough sleep
e. Be physically acid

Front 17

What alternative therapies are there for osteoporosis?

Back 17

1. Weight-bearing exercise
2. Stop smoking
3. Adopting a healthy lifestyle that includes adequate dietary measures
4. Supplementary Ca and vitamin D intake
5. Biophosphonates such as alendronate or risedronate
-Taken up preferentially by the skeleton and suppress osteoclast-mediated bone resorption
-Effective as a non-hormonal treatment
6. SERMs

Front 18

What alternative therapies are there for heart disease?

Back 18

1. Lifestyle changes
a. Healthy diet
b. Maintain healthy weight
c. Be physically active
d. Quit smoking
2. Statins