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26 Cards in this Set
- Front
- Back
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Definition of menopause
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Cessation of menses due to ovarian failure
Amenorrhea for 12 months |
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Definition of perimenopause
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Time from first features approaching menopause to 12 months after last period
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Menopausal transition
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Time before final period when variability of menstrual cycle is increased
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Premature menopause
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Onset of menopause before age 40
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Average time of onset of menopause
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51
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Ovarian changes in menopause
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Depletion of oocytes
Lack of granulosa cell aromatase Marked decrease in ovarian estrogen synthesis Elevation of serum FSH - best way to differentiate etiology of low estrogen |
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Sequelae of ovarian failure
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Hot flushes and diaphoresis
Urogenital atrophy - dyspareunia and atrophic vaginitis Osteoporosis Breast changes Decreased sense of well-being |
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Pathophysiology of hot flushes
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Lasts 30 seconds to 5 minutes
Due to loss of estrogen Begin as vasodilation in the skin and increased blood flow Triggers persipration Chill and shiver In most women, diminishes over time Main reason for estrogen replacement therapy |
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Reason for many emotional signs and symptoms of menopause
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Lack of sleep
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Libido changes
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Decrease if intercourse hurts - vaginal estrogen helps
Some have increased libido |
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Problem of osteoporosis
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37-50% of women over 50 have osteopenia
13-18% have osteoporosis Increases risk of fracture Hip fracture causes morbidity and mortality Thoracic spine fracture causes pain, deformity, and loss of independence |
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Definition of osteoporosis and osteopenia
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T and Z scores from DXA
T score from SD from normal young adult population bone density Z score based on reference population for same sex, race, and age T score used in clinical practice Osteopenia - T score of -1 to -2.5 Osteoporosis - T score of < -2.5 |
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Risk factors for fracture
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Low estrogen
History of prior fracture Family history of osteoporosis Chronic low calcium intake Smoking and alcoholism Caucasian race Poor nutrition Inadequate physical activity Medications |
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Screening for osteopenia and osteoporosis
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DNA of lumbar spine and proximal femur
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Therapy for osteopenia and osteoporosis
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Weight bearing exercise
Adequate calcium intake Lifestyle changes HRT Bisphosphonates SERMS Recombinant PTH Salmon calcitonin |
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Activity of bisphosphonates
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Inhibit osteoclasts
Cause stomach upset and esophagitis Can cause osteonecrosis of jaw Cause brittle bones with long term use |
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Activity of SERMs
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Inhibit bone resorption
Side effects - hot flushes, vaginal atrophy, dyspareunia Risk of thrombosis Diminishes risk of breast cancer Can increase risk of endometrial cancer |
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ACOG recommendations
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Treatment started for post-menopausal women with T score of <-2 or <-1.5 and 1 or more risk factors
Screen all women age 65 and older or younger with risk factors |
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Non-prescription therapy for menopause
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Black cohosh
Red clover Soy |
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Prescription therapy for menopause
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Anti-depressants
Anti-hypertensive Anti-seizure |
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Hormone replacement therapy
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Estrogen treats hot flushes and vaginal atrophy
Progestin protects against endometrial carcinoma |
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Benefits of HRT
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Improved sense of well being
Decrease in hot flushes Decrease in osteoporosis Decrease in colon cancer |
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Risks of HRT
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Increase risk of breast cancer
Increase risk of thrombosis or stroke |
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Benefits of ERT
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No effect on heart disease
No effect on breast cancer Decrease in hip fracture Increase in stroke Best therapy for women without a uterus |
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Risk of thrombosis with HRT
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HRT associated with increased risk of venous thrombosis, DVT, and PE
Higher risk with increasing age and BMI |
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Treatment of dyspareunia
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Local estrogen
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