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21 Cards in this Set

  • Front
  • Back
When does reproductive aging begin?

What # of follicles are typically present @ menarche?

# below which follicular loss accelerates?

# @ which menopause occurs?
i/ embryonic life

300k-400k

~25,000

<1000
If there are no more follicles (aging ovary), the FSH can't stim production of which two things? Result?
Estradiol and Inhibin B

FSH, and later LH lvls rise.
Fertility begins to decline @ age __. More rapid decline starts ~___.
32
37-38
What interval follows the period of declining fertility, and is characterized by cycle irregularity (shortening then lengthening), increasing sx? Duration range is what? Average duration?

How is it dx'ed?
Perimenopause

2-8; 5y average

clinical dx is made based on menstrual cycle pattern.... early follicular phase FSH and Sx may help solidify dx.
What are the sx of perimenopause?

Goals of management?
Vasomotor instability (85%)
... also sleep disturbances, mood disturbances, somatic sx (fatigue, palpitations, HA, increased migrane, breast pain/enlargement).
....oligo-->anovulation
- heavier or irregular cycles

Education, prevent endometrial cancer, give individualized sx relief.
What gives the best "across-the-board" management for perimenopause sx, menstrual cycle control, BC, and endometrial cancer prevention?

How does Progesterone IUD stack up?

EPT? Cyclic progestin tx?
Hormonal contraceptives (Oral/Ring).

little to no sx relief, variable menstrual cycle control... effective BC and cancer prevention tho'.

Cyclic progestin is +/- on sx, MCC, - on BC, and moderate on cancer prevention.

EPT is strong cancer prevention, mild sx relief, and (-) on the other accounts.
What does menopause mark?

Defined as? How dx?

It is the result of egg depletion and estrogen production by the ovary due to either ____ or ____.
the end of reproductive life.

12m w/o menses
clincal dx, (not labs)

aging or surgx.
Do OCP use, Parity, Race, and Height impact menopause onset?

How about maternal age @ menopause, tobacco use, SES/Education, EtOH, BMI?

Range and average of menopause age?
No, Yes

40-55, average @51.
Name some of the key physical changes that go along w/ menopause.
Vasomotor instability
Metabolic Changes
Coronary Artery Disease
Accelerated bone loss
Skin changes
Urogenital atrophy
Cognition (?)
Libido (?)
What is the number 1 complaint to physicians about menopause, found more commonly in overweight women and during times of stress? Nocturnal/Diurinal?

How long can they last (the problem, not the episodes)?
hot flushes

Nocturnal more severe.

1-2y; 25% >5y.
How are hot flushes managed?

Why might Black cohosh and soy/phytoestrogens be effective?

Vit E effective?
lower the ambient temp
E --> 80-95% reduction

..Alternative therapies:
High dose progestins
Tibolone
SSRI’s (Paroxetine, Fluoxetine(+/-))
SNRI (Velafaxine (+/-))
Gabapentin
Clonidine (+/-)

they b/ E receptors. They may have the same SE profile as estrogen too.

Yes, 1 less episode per day.
Can Vasomotor episodes effect sleep quality during menopause/perimenopause?

Is there clear evidence one way or another re: menopause ~ cognition? Clear evidence that HRT is protective?
yes.

no. no.
Does menopause increase adiposity?

What is referred to as the Menopausal Metabolic Sx?

Is Hormone Tx helpful? For which parts?
yes --> increased abdominal and intra-abdominal adiposity.

Lipid Triad: HyperTriG, ^^LDL, \\HDL

Abnormalities in Insulin: resistance, \\insulin elimination, \\secretion, hyperinsulinemia

Endothelial dysfx, ^visceral fat, ^uric acid, \sHBG, ^BP, ^PAI-1

Yes, esp. w/ reducing onset of DM and improving insulin resistance.

***DOESN'T prevent CAHD primarily OR secondarily.
E loss trigger increases in IL1, IL6, and TNF. This ^^osteoclasts --> what complication?
bone loss --> osteoporosis.
Colles' (forearm) fracture, hip fractures, tooth loss, back pain, height loss, postural deformities --> all are risks of what?

When do you measure BMD in postmenopausal women?
osteoporosis.

When they have one or more risk factors:
Age > 65
Caucasian race
Family history
History of fracture
History of falls
Bad eyesight
Dementia
Early menopause (<45)
Smoking cigarettes
Low body weight
ETOH
Immobility*
Poor nutrition
Medications
Certain medical conditions
Are Pharmacologic tx generally recommended for osteoporosis tx? What is used when tx is given? Is Estrogen helpful?
No. If you use it,Raloxifene, and Bisphosphonates are the first line. PTH, calcitonin, and HRT are second line.

It's efficacious, but not recommended due to secondary side effects.
T/F:

Decrease in production of vaginal lubricating fluid
Loss of vaginal elasticity and thickness of epithelium (vaginal atrophy)
Development of uretheral caruncles
Mucosal thinning of urethra and bladder

all are physiologic changes in the Urogenital system with Menopause?

Tx?
T.

Vaginal E w/o Progestogen
HRT
Intercourse is also helpful for lubrication problems.
Is HRT the same as OBC?

Prologned (>3-5y) use of EPT HRT raises risk of what? ET HRT?

Vascular side effect?

^ or \ cardiac events with ET? EPT?

ischemic stroke risk?
No.

Breast cancer.

endometrial cancer.

Increased risk of venous thrombosis/embolism... may be dependent on route of administration.

No, yes.

Probably increase in (ischemic) strokes in older women started on HRT
What are the risks of HRT dependent on?

What are the indications?

Guiding principles of tx?
Risks are dependent on
Age (total mortality reduced by 30% if started at age <60)
Time since menopause
Age at menopause
Duration of therapy
Type of HT
Route of administration
Dose of HT
Benefits are dependent on
Number of menopause related symptoms

Indication: estrogen deficiency symptoms
Vasomotor symptoms
Hot flushes, night sweats
Disturbed sleep patterns
Fatigue, concentration, memory
GU atrophy
Bladder irritability, vaginal dryness, dyspareunia

Minimum dose for shortest time required & consider non-hormonal alternatives.
Sex chromosome abnormalities (usually involving the X Chromosome)
Fragile X premutation
Autoimmune
Chemotherapy/Irradiation

All can cause what? How do you eval for this?

Is this different from menopause? Why?
premature ovarian failure.

Karyotype (<30 years of age)
Assessment for Fragile X premutation (number of CGG repeats)
Survey for other autoimmune diseases (such as hypothyroidism, adrenal insufficiency)

YES!!!
10-20% of women with POF with normal karyotypes will ovulate again
5% spontaneous pregnancy rate
Not normal reproductive aging
What is the tx for premature menopause?

What does HIV infection do to age of menopause?
Hormone replacement therapy!!!
Counseling
Oocyte donation

Mean is 47-48