Promoting Health For Women At Menopause

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Menopause

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-permanent amenorrhea in a previous cycling woman
-natural menopause: caused by teh exhaustion of the ovaries

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Perimenopause

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period immediately prior to teh menopause and the first year after the LMP

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Circulating estrogen

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-mostly produced by the ovary
-E1: estrone; produced by fat cells
-E2: estradiol
-E3Estriol

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Premature Menopause

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cessation of menstrual periods before 40 years of age

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Dx of Menopause

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-1 year after LMP
-FSH levels are usaully greater than 40

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Vasomotor symptoms of Menopause

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-hot flashes followed by chill are most common
-due to sudden change in hypothalamic control of temperature regulation
-more common: AA women; obesity

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Tx of Vasomotor sx

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-low dose estrogen
-Estrogen alternatives: gabapentin, Venlafaxine, paroxetine, clonidine, megestrol acetate

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Urogenital Sx of Menopause

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-due to decline in estrogen: mucosa thins and collagen support is lost
-glycogen content declnes and lactobacilli are less prominent increasing pH
-atrophic vaginitis is common

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Osteoporosis

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-bone loss begins in premenopausal years and accelerates in early postmenopause
-risk factors: poor intake of Ca and Vit D, sedentary lifestyle, low body weight, caucasian, smoking, prolonged amenorrhea (athletes)

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Tx of Osteoporosis with hormone replacement

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-only while tx continues
-decrease use of HT for tx and prevention

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Bisphosphonates for tx of Osteoporosis

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-most commonly used tx
-potent inhibitors of bone resorption
-Alendronate (Fosamax)
-Risedronate (Actonel)
-Ibandronate (Boniva); monthly
-Zolendronic acid (Zometa) IV for malignant bone dz

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Other Classes for tx of Osteoporosis

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-SERM (selective estrogen receptor modulators): Raloxifene
-Human Parathyroid hormone (Forteo): stimulates osteoblastic activity

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Menopausal Hormone Therapies

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-ET in a woman without a uterus
-CHT: with uterus to decrease risk of endometrial CA

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Risks/Benefits of HT

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-not cardioprotective
-increase risk of breast cancer
-increase risk in dx of Alzheimer's
-2-point decline in MMSE score

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Androgens

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-Exogenous testosterone has a benefical efffect on bone density and libido
-lacking long term safety data

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Selective Estrogen Receptor Modulators (SERMs)

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-Tamoxifen
-Raloxifene
-Toremifene

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Tamoxifen

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-breast CA prevention in high-risk women
-risk for DVT
-estrogenic effect on endometrium: endometrial hyperplasia, AUB, increased risk of endometrial CA
-hot flashes and increase stroke risk

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Raloxifene

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-tx of osteoporosis
-less effective than estrogen or alendronate
-may replace Tamoxifen b/c less adverse events