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59 Cards in this Set
- Front
- Back
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Perimenopause: defn
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menopausal transition.
Variation in menstrual cycle >7 days from normal, >2 skipped cycles, increased FSH. Ends in menopause. |
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Menopause: defn
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>12 months of amenorrhea after final menses.
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Why does menopause occur?
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Genetically programmed loss of ovarian follicles bc the better follicles respond early in life, leaving follicles with less competence for later.
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T/F Estradiol gradually wanes in years before menopause
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F. Remains normal until follicular growth and development ceases.
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Avg age of menopause
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51.4 years.
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T/F the average age of menopause has declined
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F.
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Premature ovarian failure: defn
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menopause prior to age 40
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How does smoking affect age of menopause?
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decreases it by ~ 2 years
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How does parity affect age of menopause?
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no children, tendency for earlier menopause.
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Clinical manifestations/symptoms of menopause
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irregular bleeding
hot flashes sleep disturbances vaginal dryness due to thinning epithelium sexual dysfunction urinary symptoms mood changes |
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T/F THere is variation in severity of menopause
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T
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Characteristics sexual dysfunction after menopause?
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decreased blood flow to vagina/vulva --> atrophy
dyspareunia. |
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How does estrogen affect bone mass?
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It does not increase it; it just reduces bone resorption
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T/F Hormone levels need to be drawn to dx menopause.
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F. Hormone levels vary across the transition.
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What was the Women's Health Initiative and what key finding came from it?
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It was a huge study that determined hormonal replacement therapy in SOME women increased risk for CVD and breast cacner.
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What are the guidelines for hormone replacement therapy?
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HT should be used to treat vasomotor symptoms of menopause at the lowest effective dose and for the shortest duration.
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T/F Hormone replacement therapy is used for prevention of bone loss.
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F
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T/F SSRIs are effective in menopause for vasomotor symptoms
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T.
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How does estrogen reduce bone resorption?
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Blocks action of PTH.
Increases calcitonin. Stimulates osteoblasts. Increases calcium absorption. |
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What is included when HRT is given?
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Need progestins to oppose estrogen effects in the uterus. Estrogen and progestin given together (unless uterus is removed)
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Unopposed estrogen HRT is a risk factor for ________
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endometrial cancer
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Levels of what are responsible for the increase in FSH in menopause?
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Decreasing levels of inhibin. (NOT lack of estrogen)
Inhibin decreases because it's being made by the ovary, and the ovary is failing. |
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All osteoporosis therapies work by ________
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reducing bone resorption.
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___ is the biggest killer of menopausal women
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CHD
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What effect does clomiphene have in humans?
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induces ovulation. infertility treatment.
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How does clomiphene induce ovulation?
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Clomifene appears to inhibit estrogen receptors in hypothalamus, thereby inhibiting negative feedback of estrogen on gonadotropin production
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How does clomiphene act at hypothalamus?
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Inhibits estrogen at the hypothalamus (normally estrogen inhibits the hypothalamus, so it's inhibiting an inhibitor, resulting in <b>increased GnRH release</b>)
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How does clomiphene act at the pituitary?
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It stimulates the hypothalamus to release GnRH in more rapid pulsations, thus <b>increasing FSH and LH release</b>.
(sensitize pituitary cells to GnRH and enhance release of FSH and LH) |
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How does clomiphene act at target tissues?
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appears to act as competitive antagonist because of occurrence of hot flashes, reverse hot flashes with estrogen. It mimics menopause.
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How does clomiphene act in postmenopausal women?
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as estrogen agonist and suppresses LH and FSH release
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What are contraindications to clomiphene?
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Ovarian cysts
Gestational administration Liver disease unexplained ovulatory infertility |
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What are adverse effects of clomiphene?
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Hot flashes (secondary effects, due to acting as estrogen antagonist on tissues)
Multiple gestations (7% twin rate) Dysmucorrhea Abortion |
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What is human menopausal gonadotropin?
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Fertility drug that consists of gonadotropins that are extracted from the urine of postmenopausal women, made of FSH and LH.
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Clinical use of human menopausal gonadotropin (hMG)?
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Most effective in patients with low gonadotropin (LH and FSH) levels. Promotes follicle growth and maturation and subsequent synthesis and secretion estradiol.
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Adverse reactions of hMG
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1) Ovarian hyperstimulation syndrome
2) Multiple gestations 3) Ectopic pregnancy 4) Abortion 5) Hypersensitivity |
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How must GnRH be administered?
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Pulsatile!
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GnRH agonists: clinical use
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treatment of anovulation when presented to target cells in PULSATILE fashion.
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Leuprolide: clinical use
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used in conjunction with hMG to delay premature luteinization.Also effective in treating prostate cancer.
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Leuprolide: what is it?
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GnRH analog
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Adverse Reactions of Leuprolide
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Hot flashes
Gynecomastia Edema and thromboembolism |
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Bromocriptine: MOA
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dopamine agonist. It inhibits prolactin if there is a tumor. Prolactin inhibits GnRH release, so inhibiting prolactin STIMULATES GnRH release
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Bromocriptine: Clinical use
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Treatment of anovulation resulting from hyperprolactinema
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Dexamethasone: how is it useful in infertility?
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When there is too much androgen production from the adrenals, it decreases androgen synthesis. Clinical use is hyperandrogenic anovulatory patients ONLY when there is adrenal androgen excess.
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Why do obese women have fewer menopausal symptoms?
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Peripheral adipose tissue converts androstenedione (from adrenals) to estrone.
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Where does most estrogen come from after menopause?
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No more ovarian estrogen.
Now it's coming from peripheral fat which converts androgens from adrenal gland to estrone. |
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Why is there hair growht on upper lip and chin after menopause?
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The postmenopausal women is still producing testosterone and androstenedione, which isn't getting converted to estrogen.
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What are the vasomotor symptoms of menopause?
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Hot flashes, sweating
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What are meds that aggravate osteoporosis?
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Corticosteroids, heparin, lithium, phenytoin, thyroxine
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What is the MOA of estrogen on bone?
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Inhibits resorptions, increases calcium reabsorption.
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What are other treatments for osteoporosis (than HRT?)
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bisphosphonates, calcitonin, soy
Raloxifene (SERM) |
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Why is there an increase in UTIs after menopause?
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There is vaginal drying --> due to drop in estrogen. Less vaginal mucosa, less protection against pathogens.
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What are positive effects of estrogen as HRT in menopause?
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1) Relieve symptoms (hot flashes)
2) Protect bone 3) Preventing of thinning skin |
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What are HRT regimens for an intact uterus?
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Estrogen + progesterone. Can have different combos/cycles.
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Why is progesterone necessary in an intact uterus?
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It's protective of the endometrium - prevents endometrial carcinoma.
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T/F Estrogens restore bone already lost
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F
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What is medroxypregesterone acetate?
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It's a progesterone derivative. Used in conjunction with estrogen when the uterus is intact to reduce occurrence of endometrial cancer. May be effective in relieving vasomotor symptoms and preventing bone loss.
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When should estrogen-containing products be used for relief of postmenopausal symptoms?
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Only when the symptoms are moderate to severe.
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combo of LH and FSH used for infertility. promoted follicle growth and maturation, synthesis and secretion of estradiol and LH surge
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hMG
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What are conjugated estrogens?
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represent a combo of estrogens that are used effectively for treating menopausal symptoms
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