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22 Cards in this Set
- Front
- Back
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What are the 5 steps in the course of menopause
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1. Depletion of responsive ovarian follicles 2. ↑ # of anovulatory cycles 3. ↓ effects of E-P on H-P w/↑ in LH & FSH 4. Ovarian failure 5. Non-ovarian sources of estrogen.
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Are age of menarche, race, parity, height, mothers age at menopause, or better nutrition good indicators of timing of menopause?
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No. There is some evidence of mothers & daughters having similar timing, but better nutrition doesnn't play a role bcs timing hasn't changed since ancient times.
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List 4 possible predictors of menopausal timing.
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Earlier menopause: Smoking hx (dose relationship), Thin, High altitude. Later: Obesity
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List 5 symptoms of menopause
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Change in menstrual cycle, Vasomotor symptoms (hot flashes), Insomnia (poss due to flushes), Fatigue (poss due to insomnia), Forgetfulness (poss due to fatigue)
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Describe the changes in the menstrual cycle seen in menopause.
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Initially decreased due to shortened follicular phase→ Longer cycle due to longer foll phase→Irreg bleeding due to anovulation→Amenorrhea
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How long is the transition period of menopause between having periods & amenorrhea?
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4y or more is average
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Hot flashes only occur in __ exposed individuals, are more frequent at __, and are associated w/ but not caused by __ surges (it's something at the __ level or above).
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estrogen; night; LH; GnRH
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How common are hot flashes before & after menopause?
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25% of women have them before; 50% have them for >5y
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List 4 anatomic changes of menopause
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Breasts atrophy & lose support; Vaginal atrophy; Atrophy of pelvic support (↑ urinary incontinence & pelvic prolapse), Thinning of skin
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What are the changes in endogenous hormones after menopause?
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Elevated LH & FSH (indep of estrogen replacement), Stable testosterone levels (fr ovarian stroma due to LH), ↓Androstenedione by 50% (bcs of adrenals), ↑Estrone (fr androstenedione convrsn), ↓SHBG (so ↑ free hormones)
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What are 2 implications of longer life span in women?
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Most women outlive their spouse & tend to be more economically disadvantaged & Evidence of chronic estrogen deprivation
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What is the definition of osteoporosis?
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Low bone mass; Bone mineral density >2.5 SD's below reference mean
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What is the problem with osteoporosis?
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Bone microarchitecture deteriorates, bone fragility increases, and risk of fracture increases
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What is the typical rate of postmenopausal bone loss? What is the result?
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2-3% bone mass/year for up to 10y & continued loss of 1-2%/yr. 10x increased bone fxr in women compared to men; vertebral fxr is 60% of women >60yo if not tx; Tooth loss
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Which type of bone is more sensitive to estrogen deficiency & remodeling? What does this mean in terms of fxr locations?
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Trabecular bone is more sensitive than cortical bone; vertebral, mandibular, hip, distal radius
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What are the risk factors for osteoporosis?
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Race (Caucasian or Asian), Light colored skin & hair, Underwt, Smoker, Inactivity, Glucocorticoid therapy, FHx, Advanced age, Estrogen deficiency, Low Ca2+, Increased EtOH intake
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Who should get BMD testing? (3)
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All PM women who present w/ fx; All women on tx regimen (to evaluate efficacy of Rx), Women whose decision to begin tx would be influenced by the results
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What is the effect of antiresorptive drugs?
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Decreases both the rates of bone resorption (in wks) & formation (in mo); Increases BMD by 5-10% for first 2-3y then plateaus, reducing risk of fxr by 50%
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Is depression in PM women caused by menopause?
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No, it is reactive depression due to changes in lifestyle, family, aging, being alone, etc
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How are PM women managed?
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Psychological support, Annual exams (screening for CA, metabolic disorders, CVD, degen dz), Behavioral issues (diet, exercise, wt, Ca2+ intake), Hormone/Estrogen replacement
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What are the pros & cons for HRT? What was not addressed by the study?
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Pros: Decreased colorectal CA & fxrs. Cons: Increased CAD, Stroke, PE. Not addressed: Qual of Life, Mental/ Cognitive health, Genital atrophy, Use a prevention, not tx
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What are 4 alternative therapies for HRT. What are the SE's for each?
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Dong Quai: little estrogen effect & sig SE's; Black Cohash; Evening primrose (expensive, doesn't help flushes); Ginseng (often has added caffeine; doesn't help flushes)
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