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43 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Objectives:
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Define menopause
Understand frequent physiologic changes and potential medical diseases related to menopause Understand risks, benefits, and goals of hormone replacement therapy |
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What is Menopause?
*******EXAM |
Cessation of menses for 1 yr
This is defined as TRUE menopause |
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What is Perimenopause?
************EXAM |
period immediately before and after the menopause
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What is Climacteric?
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A period of life characterized by physiological and psychic change that marks the end of the reproductive capacity of women and terminates with the completion of menopause.
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When do we see climateric?
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encompasses both menopause and perimenopause
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What is the mean age of menopause?
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51-52 yrs old
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What is the median age of onset for perimenopausal women?
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Median age of onset at perimenopause is 47.5 years and lasts about 4 years
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What percent of women skip perimenopause and rapidly cease cycling?
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10% of women skip perimenopause and rapidly cease cycling
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If a women smoke how does this affect her age of onset for menopause?
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Smoking decreases the age of menopause by 2 years
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What are some symptoms that a women is entering menopause?
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Disturbance on the menstrual pattern
Vasomotor instability-”hot flashes” Atrophy- dyspareunia, pruritis, urinary difficulties and incontinence Psychological issues-anxiety, depression, insomnia, decreased libido |
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What are some physiological alterations that occur after menopause?
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Body mass-body wt and total body fat increases after menopause
skin-decreased collagen leading to thnning and wrinkling Genitourinary Tract - decreased collagen in the uterosacral and cardinal ligaments - leads to pelvic organ prolapse |
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What is the MAJOR thing to worry about in a post menopausal women?
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Osteoporosis
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When is osteoporosis usually detected?
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Presence usually detected after a fracture
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At what rate do women lose bone due to menopause?
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Bone loss at a rate of 1-2%/year the first few years after menopause then slows down
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Does a women lose more cortical bone or trabecular bone?
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Loss occurs more rapidly in trabecular bone than cortical bone
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What happens MOA for osteoporosis?
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Bone resorption increases while rate of formation is unchanged
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These are screening things you need to know ok
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ok
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When should a women have a:
Mammography? |
yearly after age 40
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When should a women have a:
Lipid profile |
every 5 yrs at 45
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When should a women have a:
Fasting Blood Glucose |
every 3 yrs at 45
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When should a women have a:
TSH |
every 5 yrs after 45
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When should a women have a:
colorectal screening? |
yearly after 50
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When should a women have a:
cervical cancer screening |
yearly to every 2-3 yrs
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How do you measure bone density in a person?
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Typically Dual-energy X-ray absorptiomerty (DEXA)
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If a women has NO risk factors for osteoporosis at what age should you start DEXA scans?
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Begin at age 65 for women with no risk factors
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If a women HAS risk factors for osteoporosis at what age should you order a DEXA scan?
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Age 60 for those with risk factors
OR any post-menopausal woman with one or more risk factors |
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What are the risk factors for osteoporosis?
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White or Asian race
Cigarette smoking Menopause Low-low normal BMI Alcohol use Chronic illness Diet poor in calcium /vitamin D******EXAM |
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Where are DEXA scans taken?
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Measured at the spine and femoral neck
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Which is better the T-score or the Z-score of the DEXA scan?
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T-score is better
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What is the T-score?
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T score-difference between the BMD of the test subject and the mean BMD divided by the standard deviation of the mean of young normal adults of the same gender
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What is the z-score?
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Z score-age and gender matched controls
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When you look at a DEXA scan are asked to Dx a pt.....
what is the difference between? Osteopenia and Osteoporisis? |
Osteopenia-
T score between -1 and -2.5 Osteoporosis T score less than -2.5 |
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What are treatments for menopause and osteoporosis?
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ESTROGEN******EXAM
Body Mass- shown to decrease wt gain and the propencity for abdominal fat Skin-prevents the loss of collagen GU-prevents collagen loss and treats atrophy Hot Flashes/Flushes-stabilizes estrogen levels Osteoporosis-hypothesized inhibition of parathyroid hormone |
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If a women has a uterus and is on estrogen for her menopause what else MUST you give her?
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PROGESTERONE******EXAM
Progesterone Necessary to prevent endometrial hyperplasia in women with a uterus Cycling hormones can cause “periods” Continuous therapy an option |
Remember that estrogen proliferates the uterus
this can lead to endometriosis |
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If a women is on estrogen hormone for menopause and you give her progesterone what must you tell her might happen?
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cycling hormones can cause periods
may experience bleeding *************EXAM |
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What was the Women's Health Initiative?
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1991
Was to address the most common causes of death/disability in post-menopausal women Cardiovascular disease Cancer Osteoporosis All post-menopausal Ages 50-79 Tested the effects of HRT, diet, Calcium and Vitamin D on heart disease, fractures, breast and colorectal cancer |
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Why did the NIH stop the Estrogen + Progesterone treatment?
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NIH stops the E+P arm of the trial citing an increased risk of Venous Thromboembolism
DVT***** |
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Why did the NIH stop the Estrogen only drug?
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NIH stops the estrogen only arm of the study citing an increased risk of breast cancer
Breast Cancer********* |
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What were the actual findings of the Women's health initiative?
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Of 10,000 post-menopausal women
8 more will have invasive breast cancer 7 more will have MI 8 more will have CVA 18 more will have blood clots |
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What is Estrogen effects on Coronart Artery Calcium?
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Coronary Artery Calcium lower in women aged 50-59 on estrogen
decreased MI risk :) |
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What is risk of hormone Rx and Breast cancer?
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Breast cancer-decreased risk in women already at low risk-converse is also true
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What is the risk of a VTE from hormone replacement?
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VTE- increased risk of 0.22-0.30 per woman per year
venous thrombus emboli |
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Are Bioidentical hormones safer?
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NO
they are still hormones |
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