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23 Cards in this Set
- Front
- Back
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What's the definition for menopause?
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permanent loss of menstrual bleeding caused by cessation of ovarian activity. serum FSH > 30 mlU/ml.
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What's the average age for menopause?
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50.7 years. 95 % range 44-56 yo.
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What are some causes for menopause?
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Normal: exhaustion of oocytes through apoptosis (monthly loss is irrelevant)
Iatrogenic: surgica, radiotx, chemotx Premature: ovarian failure before 35 yo, may be genetic (mosacism) or autoimmune (anti-ovarian Ab), or idiopathic. |
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What events are associated with the perimenopausal transition?
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menstrual irregularity, continued ovulation but lower quality, high rate of spontaneous abortions, elevated FSH levels (not at menopause level), decreasing inhibin.
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What hormone levels change with menopause?
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Estrogen: greatly decreased
FSH: greatly increased LH: moderately increased Testosterone: moderately decreased |
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What are the clinical effects associated with menopause?
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oligo-ovulation
atrophic changes (vaginal, urothelial, skin) vasomotor symptoms mental health changes coronary artery disease osteoporosis |
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What's the incidence of vasomotor symptoms and what are they?
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hot flashes, 50-80 % of women at menopause, 20% of women 4 years later.
More frequent at night. Associated with LH pulses (hypothalamic origin) but are present even in hyposecretory women Lead to embarassement, sleep deprivation, fatigue, depression |
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What other causes are there for vasomotor symptoms?
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hyperthyroid, pheochromocytoma, carcinoid, leukemia, pancreatic tumors, psychosomatic/stress disorders.
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What are mental health changes attributed to?
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life changes, sleep loss, hormonal changes.
in vitro, estrogen is shown to increase neuronal growth and synaptic proliferation. |
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How does coronary artery disease present in menopause?
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risk of CAD doubles for women after menopause-- catch up with men!
One study: HRT decreases CAD by 50%. However, there's no protection if CAD already exists (if so, there's an initial adverse effect, then no/pos effect) |
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What are some explanations for estrogen's cardioprotective effect?
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improved lipid profile
direct athersclerotic effect on arteries vasodilation anti platelet aggregation antioxidant |
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What is the incidence of osteoporosis among women in the US?
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loss of bone mass with no change in mineral to matrix ratio, so increased fractures.
15 % of white women have a lifetime risk of hip fractures, and 15-20 % of patients die w/in three months. Vertebral compression fractures (50 % of women over 65 yo) |
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What causes osteoporosis in menopause?
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estrogen --> decreased bone resorption, facillitates absorption of Ca in the intestine.
Low estrogen --> bone remodeling and less Ca absorbed |
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What are the medications available for menopause?
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hormones: estrogen, estrogen + progestin, estrogen + androgen
SERMs herbal estrogen (black cohosh, soy, red clover) Non-estrogenic (bisphosphonates, calcium, calcitonin, vit D, E, statin, vaginal lubricant, ASA, anti-HTN |
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Why would you want a transdermal or transvaginal administration for HRT?
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it avoid first-pass metabolism, which produces pro-inflammatory and pro-thrombotic proteins, eg C-reactive protein. Avoiding this decreases DVTs and PEs.
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What's the recommended duration of estrogen therapy?
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It seems to be safe at least 5 years when begun at menopause. Give at lowest effective dose for as short a time possible.
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What are the benefits of estrogen therapy?
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relieves vasomotor symptoms
prevents osteoporosis prevents vaginal and urothelial atrophy prevents CAD (if before CAD is established) prevents Alzheimer's (?) prevents colon cancer prevents tooth loss (?) |
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What are the adverse effects of estrogen therapy?
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endometrial stimulation (vaginal bleeding, endometrial hyperplasia/carcinoma)-- eliminate with progestin, but this may have neg CV effects and increase breast cancer
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What are contraindications to estrogen replacement therapy?
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Current breast or endometrial cancer
Past history of breast or endometrial cancer Unexplained vaginal bleeding Pregnancy Chronic or acute liver disease Active venous thrombosis/ thromboembolic disease |
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What are nonhormonal treatments for vasomotor symptoms, vaginal dryness, osteoporosis and CAD?
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vasomotor: clonidine, SSRIs, herbal estrogens
vaginal dryness: lubricants, moisturizers osteoporosis: SERMs, bisphosphonates, calcitonin, calcium, vit D, wt-bearing exercise, smoking cessation CAD: statins, low-dose ASA, control of HTN and DM, diet, exercise, smoking cessation |
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What did the WHI study on HRT show?
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increased relative risk in breast cancer, heart attack, stroke and thrombosis. However the absolute magnitude of these risks remain small.
Decreased risk of colorectal cancer and hip fracture. |
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Why has the WHI study been criticized?
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the average age of the participants was 63 years old and gave HRT to women who had already established CAD (which explains the early harmful effect)
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What's the effect of estrogen vs estrogen and progestin on CAD?
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Estrogen alone (in women without a uterus) shows no increase in CAD or breast cancer-- it must be due to progesterone, used to protect the uterus of non-hysterectomy women.
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