Repro - 2-5 - Menopause

Front 1

Hormone profile during menopause

Back 1

Decreasing estrogen and progesterone

Increase in gonadotropins

Front 2

Ovulatory cycle changes

Back 2

(in order)

1. Shorter prolif phase so cycle interval btwn menses is shorter.

2. Abnormalities in luteal function

3. anovulatory cycles resulting in elongation of menstrual interval

4. cessation of menses.

Front 3

Mean age of menopause

Back 3

51

Front 4

Why does FSH increase during menopause

Back 4

Decrease in inhibin and estrogens.

Front 5

How does menopausal female compensate for decreased estradiol levels?

Back 5

doubling rate of conversion of androstenedione to estrone.

Front 6

Where in ovary is testosterone produced

Back 6

ovarian stroma.

Front 7

Where does estrone come from?

Back 7

Conversion of androstenedione peripherally.

Front 8

Postmeno women with abnormal bleeding have...

Back 8

too much estrone.

worried because this could progress to endometrial hyperplasa and then carcinoma.

often in obese women.

Front 9

Mech of vasomotor response

Back 9

Likely withdrawal of estrogens bc people who never had estrogen to begin with never get them.

Also the event that governs release of GnRH is linked to the thermoregulatory center. (affects pulse, BP, etc.)

Front 10

How to tx woman with hot flahses (vasomotor sx) when estrogens are contraindicated

Back 10

alpha agonists.

Front 11

Mechanism of osteoporosis in menopausal women

Back 11

Estrogen normall inhibits bone reabsorp through inhibition of parathyroid hormone (increases blood Ca++ at expense of bone) and increasing intestinal abs of calcium.

Front 12

Osteopor more common in which type of bone?

Back 12

Trabecular vs. cortical.

Front 13

HRT to prevent bone loss

Back 13

It actually increases bone density - but must be done within 3 years of menopause.

Especially good to use estrogen + progestins.

Front 14

Tx menopausal woman with sexual dysfunc

Back 14

if dyspareunia is there - estrogen therapy replacement.

if not - further eval.

Front 15

Main sx to warrant HRT

Back 15

vasomotor sx or vaginal dryness.

Front 16

Why to tx asymp pt who is hyperestrogenic?

Back 16

Provera challenge to prevent unopposed estrogen stimulation and thus stop CA development.

Front 17

Factors that can lead to breast CA

Back 17

unopposed estrogen (promotes presence of breast malig but doens't initiate oncogenic process)

def of progesterone, genetic, viral, env factors.

Front 18

Rx menopausal women with at least...

Back 18

Vitamin D and calcium.

Front 19

What is menopause?

Back 19

PERMANent cessation of menses due to loss of eggs.

The menopause is diagnosed when the patient has gone 1 year without a menstrual period.

Front 20

does a woman make eggs after childbirth?

Back 20

no

Front 21

After menopausa, where do androgens come from?

Back 21

medullary portion of ovary.

Front 22

Thermoneutral zone

Back 22

the range of temp that doesnt make you sweat/shiver.

Person with hot flases has a small zone.

Alpha antag, norepinephrine decrease this zone.

alpha agonists, serotonin, SSRIs increase the zone.

Front 23

Most effective tx for vasomotor sx

Back 23

estrogen.

Front 24

alternatives to estrogen

Back 24

Phytoestrogens
Cimicifuga racemosa (Black Cohash) 40mgs/day
Venlafaxine (Effexor) 75 mgs/day
Fluoxetine (Prozac) 20 mgs/day
Paroxetine (Paxil) 12.5 - 2mgs/day
Clonidine TDS (Catapres) 0.1-0.4mgs/day
Gabapentin (Neurontin) 300mgsTID
Behavioral RX

Front 25

Menopausal changes in skin

Back 25

skin tone, hair loss, smaller breasts, facial hair growth

Front 26

Increase in Colles fractures in menopausal women?

Back 26

no

wrong kind of bone and people brace falls less.

Front 27

Tx of symptomatic person with low estrogen and uterus in place.

not in place?

Back 27

in place - HRT

not in place - ERT

Front 28

Tx of Asymptomatic person with high estrogen and uterus in place.

not in place?

Back 28

in place - progestin

not in place - do nothing

Front 29

Contraind to HRT

Back 29

Pregnancy

Cancer of the breast

Estrogen-dependent cancer, undiagnosed vaginal bleeding
E.g. endometrial

Active or past history of estrogen-associated thrombophlebitis, thromboembolism, or stroke

Hypersensitivity to estrogen- or progestin-containing products


And warnings include gallbladder disease, elev BP, blood clotting, visual disturbances

Front 30

Ways to give estorgen

Back 30

orally, patches...

Front 31

Adv to cyclic estrogen and progestin

Back 31

estrogen given daily, progestin added 12-14 days a month

gives predictable withdrawal blled just like OCPs.

but there is less compliance and some people don't like how unpreditable the bleed can last.

Front 32

Adv to continuous estrogen and progestin

Back 32

amenorrhea achieveed, better compliance.

but unpreditable spotting and some women may not tolerate daily progesterone.

Front 33

Womens health init - ERT

Back 33

inc in stroke and PE

no change in others

Front 34

WOmens health init - HRT

Back 34

inc in coronary heart disease, stroke, PE, invasive breast CA.

protective against colorectal CA and osteoporosis.

Front 35

Estrogen and CV

Back 35

increase HDL and NO. Decreases endothelin (a vasoconstrictor)


destabilizes plaques once they form - so you need to start estrogen early!!!

Front 36

Estrogen ring good for...

Back 36

treating vaginal atrophy.