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50 Cards in this Set
- Front
- Back
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This is the transitional passage that a women has from their reproductive to nonreproductive stage.
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Climacteric
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At what age and with what specific physiological marker does the climacteric occur?
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1. Starting in the mid-thirties
2. Ovarian follicular apoptosis accelerates leading to a steady decline in estradiol production |
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True of False, Climacteric is longer than perimenopause?
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True
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This is the Phase of the climacteric which is usually 3-5 years before and the 1st year after the last menses
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Perimenopause
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Perimenopause is usually characterized by?
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Characterized by irregular menses and other climacteric symptoms
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Defined as the cessation of ovarian function and identified as the final menstruation during climacteric phase
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Menopause
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At what point is menopause established?
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Established when menses has been absent for 1 year
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When does menopause usually occur and what is the mean onset?
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Usually occurs between the ages of 50-55 with a mean onset of 51 years of age
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Women who reach menopause before 40 years of age are said to have ?
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Premature menopause or premature ovarian failure
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Phase of life after menopause
Ovaries produce little estrogen and no progesterone; ovulation has stopped |
Post menopause
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AKA: Premature Ovarian Failure
Natural menopause occurring before the age of 40 |
Premature Menopause
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What are the risk factors for premature menopause?
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Smoking, Living at high altitudes, Undernutrition
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What is the physiology/pathophysiology of menopause (long answer)?
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When all the oocytes have been ovulated or gone through follicular atresia, the ovary is no longer capable of responding to pituitary gonadotropins (Follicle Stimulating Hormone and Luteinizing Hormone) therefore the production of estrogen (estradiol), inhibin, progesterone and other androgens is reduced
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What, in regards to the feedback loop, happens with menopause?
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1. Ovarian Estradiol (E2) declines
2. Ovarian Inhibin declines 3. Progesterone declines 4. Testosterone gradually declines over 3 to 4 years 5. LH and FSH are elevated |
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If you measured FSH in a menopausal woman, what would it most likely be?
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FSH usually >40 IU/L
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What are the vasomotor menopausal symptoms?
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Headache
Palpitations Hot Flashes Night Sweats Insomnia/Sleep Disturbances |
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What are the genitourinary menopausal symptoms?
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Vaginal and Vulvar Dryness & Thinning
Dyspareunia Vaginal Itching & Burning (Atrophic Vaginitis) Urinary Frequency, Dysuria, Urgency |
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Conception is still possible during?
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Perimenopause
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What is a weaker estrogen - an estradiol, made in the peripheral tissues, especially in adipose, it is weaker than the estrogen produced in the ovaries.
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Estrone
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What should you rule out with menopause?
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Pregnancy, cancer
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Vasomotor menopausal symptoms are caused by?
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Estrogen withdrawal
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Genitourinary menopausal symptoms are caused by?
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Prolonged withdrawal of estrogen
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What will the administration of estrogen not treat?
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Depression
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Associated with sweating, flushing of the face, neck and upper chest
May be accompanied by dizziness and palpitations and chills May occur as frequently as every 30-40minutes; usually 8-15 times per day lasting approximately 4 minutes on average Increase with fatigue and stress Most severe usually occur at night disrupting sleep |
Hot Flashes
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How do you Tx hot flashes?
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Hormonal therapy
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Clinical signs of osteoporosis include?
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loss of height >1.5 inches and wrist and hip fractures
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Majority of the calcium lost in osteoporosis is from the?
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Trabecular bone
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What are the risk factors of osteoporosis?
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Family history, slender body habitus, caucasian and asian ethnicities, sedentary lifestyle, alcohol consumption, cigarette smoking, thyroid excess, corticosteroid use
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North American Menopause Society recommends bone mineral density screening in females with risk factors at age?
And in females without risk factors at age? |
1. 50
2. 65 |
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What type of imaging is used in osteoporosis bone mineral density screening?
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Duel Energy X-ray Absorptiometry (DEXA) measurements of the hip and spine
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Hormone replacement therapy is recommended for?
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Moderate to severe vasomotor symptoms and vulvar/vaginal atrophy in symptomatic women and for the prevention of postmenopausal osteoporosis
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What should be performed within the previous 12 months prior to initiating hormone replacement therapy?
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A comprehensive H&P and mammography
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Unopposed estrogen should be prescribed for?
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Women who have had a hysterectomy
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Women with a uterus should use what for hormone replacement therapy?
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Combination estrogen/progesterone therapy to prevent endometrial thickening and decrease the risk of uterine adenocarcinoma
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This is considered gold standard for the treatment of hot flashes and night sweats; long term therapy is usually not needed
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Hormone replacement therapy
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This is the most effective treatment for vaginal atrophy & is preferred over systemic estrogen
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Local estrogen replacement
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When treating symptoms with hormonal replacement therapy, how often should these symptoms be reassessed
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Symptoms should be reassessed after 8-12 weeks of therapy
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What are the absolute contraindications for HRT?
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Estrogen Responsive Breast Cancer
Endometrial Cancer Undiagnosed Abnormal Vaginal Bleeding Active Thromboembolic Disease History of Malignant Melanoma |
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What are the relative contraindications of HRT?
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Chronic Liver Disease
Severe Hypertriglyceridemia Endometriosis Previous Thromboembolic Disease Gallbladder Disease |
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What are the two oral forms of estrogen?
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Conjugated Estrogen: Premarin
Micronized Estradiol: Estrace |
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What are the two transdermal forms of estrogen?
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Estradiol: Alora, Climara,
Progestins |
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What is the oral progestin?
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Medroxyprogesterone acetate: Provera
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Which progestin is vaginal?
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Progesterone: Prochieve 4%
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What are the combined preparations for HRT?
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Oral Sequential
Conjugated estrogens and MPA: Premphase Oral Continuous Conjugated estrogens and MPA: Prempro Transdermal Continuous Estradiol/Norethindrone: Combipatch |
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What are the non estrogen treatments of hot flashes?
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Selective Serotonin Reuptake Inhibitors (SSRIs)
Fluoxetine (Prozac) Paroxetine (Paxil) Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) Venlafaxine (Effexor) |
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What are the treatment options of vaginal symptoms?
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Vaginal Cream
Conjugated estrogen: Premarin Micronized Estradiol: Estrace Vaginal Tablet Estradiol hemihydrate: Vagifem Vaginal Ring Estradiol: Estring |
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What are some of the alternative treatments for menopause?
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Soy Products
Contain isoflavones which are similar to human estrogen when metabolized Effective in reducing hot flashes, bone loss, total and LDL cholesterol levels Black Cohosh Thought to suppress LH Used to relieve hot flashes Vitamin E Considered safe but has not been proven to more effective than placebo |
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What are the general measures to take in treating menopause?
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High Fiber, Low Fat Diet and rich in antioxidants
Cardiovascular, weight-bearing and strengthening exercise Smoking cessation Decrease alcohol intake |
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This HRT can cause increased LDL, decreased HDL, bloating, and breast tenderness.
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Progestins
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This is for females with increased BP, increased lipids/hypertriglycerides. This has a decreased risk of DVT compared to systemic drugs.
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Transdermal estrogen - Estradiol: Alora, Climara
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