Menopause

Front 1

Menopause - Difference between Premature menopause, Early menopause and Perimenopause

Back 1

Premature < 40years old
Early < 45 years old
Peri = the time preceding menopause where have irregular cycles and increase in anovulatory cycles

Front 2

Menopuase - Factors which may trigger early onset

Back 2

SELECT:
• Smoking
• Epilepsy
• Lack of children
• Exposure to toxins
• Chemotherapy
• Treated depression

Front 3

Menopause - Factors delaying onset

Back 3

MOA:
- Multiparity (having more than 1 child)
- Obesity
- Alcohol use

Front 4

Menopause - Estrogen is mainly produced in the ___

Back 4

Ovaries

Front 5

Menopause - Mechanism of Physiology

Back 5

When reach menopausal age, run out of follicles(containing eggs).

Follicles usually respond to FSH, grow and produce estrogen and progesterone.

Body increases FSH and LH but to no avail as ovaries don't respond.

Front 6

Menopause - Sites other than the ovaries can produce estrogen (True/False)

Back 6

True.

Converts androgens to estrogen.

Front 7

Menopause - Post menopause, estrogen decreases to about ___% of premenopausal levels.

Back 7

~10%

Front 8

Menopause - Post menopause the main estrogen is ___ and it has ___% of the estrogenic activity.

Back 8

Estrone.

~33% (1/3)

Front 9

Menopause - Symptoms

Back 9

- Vasomotor symptoms
- Sleep pattern changes
- Mood and cognition changes
- Genitourinary changes
- Sexual changes
- Bleeding changes

Front 10

Menopause - Hot flashes - Management - How to avoid triggering them

Back 10

W SCARS:
- Weight control
- Spicy foods (don't eat)
- Caffeine reduction
- Alcohol reduction
- Relaxation (increase)
- Smoking cessation

Front 11

Menopause - Hot flashes - Pharmacotherapy - 1st line

Back 11

Estrogen therapy (with or without progestin) - 77% effective in controlling hot flashes

Lowest possible dose to achieve symptom control

Front 12

Menopause - Hot flashes - Pharmacotherapy -2nd line

Back 12

Progestins (eg depo provera) - effective but SE profile not as good

Low dose OCPs - has added benefit of contraceptive

Front 13

Menopause - Hot flashes - Pharmacotherapy - 3rdline (when don't want or CI with hormone replacement)

Back 13

Serotoninergic Antidepressants:
- Venlafaxine
- Paroxetine
- Fluoxetine
- Citalopram

Front 14

Menopause - Hot flashes - Risk factors for

Back 14


HOWLS:
- Hx of premenstrual complaints

- Obesity

- Warm air temperature

- Less physical activity
- Smoking

Front 15

Menopause - Insomnia - General recommendations

Back 15

- Sleep hygiene
- Valerian
- Hypnotics
- Antidepressants

Front 16

Menopause - Estrogen has effects on brain functioning (True/False)

Back 16

True.

Estrogen receptors in brain for learning and memory.
Also possible effect on serotonin and NA.

Front 17

Menopause - Menopause causes vaginal atrophy (True/False)

Back 17

True.

Many estrogen receptors in vagina. Will see dryness and increase in pH to 6-8 (before was 4.5-5).

Front 18

Menopause - Vaginal symptoms improve gradually after menopause (True/False)

Back 18

False.

Unlike hot flashes, they will not go away and serious atrophy need estrogen therapy (ET).

Front 19

Menopause - Treatment of vaginal atrophy

Back 19

- Estrogen vaginal cream
- Can use Replens or KY for sexual indication

Front 20

Menopause - Androgen deficiency is one of the causes of sexual dysfunction in women (True/False)

Back 20

True.

Decreased testosterone may decrease libido, pleasure and sense of well being : fatigue.

Front 21

Menopause - Abnormal uterine bleeding is uncommon with menopause (True/False)

Back 21

False.

It is common during menopause transition period.

Front 22

Menopause - Abnormal uterine bleeding(AUB) just means irregular menstrual cycles (True/False)

Back 22

True

Front 23

Menopause - Potential cause of AUB is ___

Back 23

DUB.

Dysfunctional uterine bleeding (anovulation).
Other causes are endometrial hyperplasia, cancer and benign lesions/polyps.

Front 24

Menopause - Weight gain is seen in menopause (True/False)

Back 24

True.

On average, 2 - 4kg weight gain due to decreased metabolic rate (not from HRT).

Front 25

Menopause - Oral health is affected by menopause (True/False)

Back 25

True.

Estrogen decreases gingival inflammation.

Front 26

Menopause - Elasticity of the skin is related to estrogen (True/False)

Back 26

True.

Post menopause will see skin collagen content and thickness decrease.

Front 27

Menopause - Why add progestins to estrogen replacement therapy?

Back 27

Decreases unopposed estrogen which may increase risk of developing endometrial cancer.

Front 28

Menopause - Topical progestins reduce the estrogen related risk of endometrial hyperplasia or cancer. (True/False)

Back 28

False.

Systemic progestins do that.

In a dose dependent and duration fashion. Use for a minimum of 12-14 days a month.

Front 29

Menopause - Estrogens derived from plant and animal species may be less effective than human derived. (True/False)

Back 29

False.

They are all effective.

Front 30

Menopause - Estrogens and Estrone are not readily absorbed by the GIT so they are ___ to enhance bioavailability (3).

Back 30

- Conjugated
- Esterified
- Micronized

Front 31

Menopause - Estrogen patches are not as good as the oral form in terms of reducing menopausal symptoms (True/False)

Back 31

False.

They are equally effective.

In fact, they avoid the first pass effect and have less nausea, headache, and breast tenderness. Also less clotting and DVTs, and does not increase TGs.

Front 32

Menopause - MPA (medroxyprogesterone acetate) is a natural form of progesterone (True/False)

Back 32

False.

It is synthetic.

Front 33

Menopause - The progestin that is most chemically identical to natural ones in the body are those found in oral micronized progesterone (Prometrium) (True/False).

Back 33

True

Front 34

Menopause - Micronized oral progesterone advantages over MPA (3)

Back 34

- Does not antagonize the HDL benefits of oral estrogen
- May have less menstrual bleeding
- Lower incidence of edema and mood changes

Front 35

Menopause - Continuous combined Estrogen and Progesterone is the most common method of HRT (True/False)

Back 35

True.

Easy to remember, E and P are taken daily.

Unpredictable bleeding is a concern.

Front 36

Menopause - Common AE of Estrogen (4)

Back 36

- Nausea
- Breast tenderness
- Headache
- Bloating

Front 37

Menopause - Common AE of Progestin

Back 37

PMS like symptoms:
- Irritability
- Mood swings
- Bloating
- Weight gain
- Decreased libido
- Breast tenderness
- Headache

Front 38

Menopause - CI to Estrogen:

Back 38

- Undiagnosed vaginal bleeding
- Breast cancer
- Endometrial hyperplasia / cancer
- Active Thromboembolic dx: DVT, PE, Stroke, MI
- Active liver dx

Front 39

Menopause - Estrogen lowers LDL and increases HDL (True/False)

Back 39

True

Front 40

Menopause - Estrogen lowers clotting factors Fibrinogen and Plasminogen-activator inhibitor type 1 (True/False)

Back 40

True.

Front 41

Menopause - Estrogen has inflammatory effects (True/False)

Back 41

True.

C-reactive protein increases and so do markers of thrombosis.

Front 42

Menopause - Provera(synthetic progestin) blunts HDL effect of Estrogen (True/False)

Back 42

True.

HDL levels do not rise in response to estrogen.

Front 43

Menopause - Prometrium(micronized progestin) blunts HDL effect of Estrogen (True/False)

Back 43

False.

No effect on the increased HDL effect of estrogen.

Front 44

Menopause - Topical estrogen triggers DVTs (True/False)

Back 44

False.

Estrogen patches avoid thrombolic effect of systemic estrogen.

Front 45

Menopause - Protective effects of estrogen on CV risk diminish over time after menopause (True/False)

Back 45

True.

10-19 years no effect on CV risk.

>20years post menopause have increased risk.

Front 46

Menopause - Comparing ET vs EPT(estrogen progestin therapy), ET has less CHD risk (True/False)

Back 46

True.

Low or ultra low ET is preferred in older post menopausal women.

Front 47

Menopause - HT and breast cancer risk - Should HT be used for symptomatic treatment of menopause if have family Hx of breast cancer?

Back 47

Yes.

Since duration of therapy is short (<5years) and risk goes back to baseline upon discontinuation, then should use HT.

Front 48

Menopause - For women with a uterus, which therapy should be used, ET or EPT?

Back 48

EPT.

Progestin opposes the endometrial hyperplasia/cancer that estrogen tends to increase risk of.

Front 49

Menopause - Vasomotor symptoms refer to which symptoms?

Back 49

- Hot flashes
- Vaginal dryness
- Insomnia
- Night sweats