Case Files 4 - Menopause

Front 1

What are the 3 classic signs of perimenopause?

Back 1

-Irregular menses
-Hot flashes
-Feelings of inadequecy

Front 2

What is the age span most women go through the climacteric?

Back 2

40-51

Front 3

What test would you run to confirm the diagnosis of perimenopause/climacteric?

Back 3

Serum FSH and LH

Front 4

What can be given to treat hot flashes?

Back 4

Estrogen/progestin

Front 5

What will NOT work to treat hot flashes?

Back 5

Raloxifene the SERM

Front 6

Why do menses cease in menopause?

Back 6

Due to follicular atresia

Front 7

What is Perimenopause, aka the climacteric?

Back 7

The 2-4 years preceding and after the menopause

Front 8

What is Premature ovarian failure?

Back 8

Cessation of menses and ovarian function BEFORE the age of 40

Front 9

What should be suspected if Premature ovarian failure occurs before age 30??

Back 9

-Karyotypic abnormalities
-Autoimmune disease

Front 10

So what is the mean age of Perimenopause onset?

Back 10

47

Front 11

What hormone change occurs first in menopause; FSH rise, or estrogen loss? WHY?

Back 11

FSH rise - because Inhibin release from the ovary is lost.

Front 12

What are the 2 main reasons for giving HRT in menopause?

Back 12

-Prevent hot flashes
-Maintain bone density

Front 13

What has the WHIS reported a slightly increased risk of with continuous Est/Prog HRT?

Back 13

-Breast cancer
-Heart disease
-Pulm embolism
-Stroke

Front 14

But 2 things that Est/Prog HRT protects against are:

Back 14

-Fractures
-Colon cancer

Front 15

What is the timeframe for which the risk of adverse events is increased by Est/Prog HRT?

Back 15

6 months

Front 16

So how should Est/Prog HRT be given for preventing hot flashes?

Back 16

For the shortest amount of time possible.

Front 17

What can be given to reduce vasomotor hot flashes in women that don't want or can't have estrogen?

Back 17

Clonidine - antihypertensive

Front 18

What does the SERM Raloxifene help with in menopause?

Back 18

Prevents BONE DENSITY loss, but not hot flashes!

Front 19

What are the 4 cornerstones of maintaining bone mass in menopause?

Back 19

-Vit D
-Calcium supplement
-Estrogen/HRT
-Weight bearing exercise

Front 20

Do serum FSH levels change when estrogen HRT is given in menopause? Why/why not?

Back 20

No - because it's the INHIBIN that determines serum FSH

Front 21

What test is done for Bone Mineral Density testing?

Back 21

DEXA
Dual Energy Xray Absorptiometry

Front 22

When should BMD screening begin?

Back 22

AGe 65, or earlier if at increased risk and present with a fracture

Front 23

Best guess as to cause of a 51 yo woman with oligomenorrhea and hot flushes:

Back 23

Ovarian failure

Front 24

What could cause Galactorrhea and Hyperprolactinemia in a 22 yo nonpregnant woman?

Back 24

Hypothalamic dysfunction due to Hypothyroidism

Front 25

How does hypothyroidism lead to Galactorrhea?

Back 25

Lack of NFB leads to increased TSH which stimulates Prolactin release.

Front 26

How does hypothyroidism lead to hypoestrogenic amenorrhea?

Back 26

Prolactin inhibits GnRH release, so no FSH/LH

Front 27

Why are women with PCOS amenorrheic?

Back 27

Because of EXCESS estrogen

Front 28

4 common findings in women with PCOS:

Back 28

-Obese
-Hirsute
-Insulin resistant
-Anovulatory

Front 29

What will induce vaginal bleeding in women with PCOS?

Back 29

Progestin

Front 30

What is the reason for delayed puberty with infantile breasts and amenorrhea in Turners pts?

Back 30

Lack of estrogen due to ovarian failure - they're just streaks!

Front 31

How is excess exercise related to amenorrhea?

Back 31

Hypothalamic dysfunction

Front 32

Woman complicated by postpartum hemorrhage; unable to breastfeed; now is amenorrheic and she did not have a D/C:

Back 32

Sheehan's syndrome

Front 33

So what is the MAIN indication for HRT in the climacteric?

Back 33

Significant vasomotor symptoms - hot flashes

Front 34

What is the most common location of an osteoporosis-associated fracture?

Back 34

In the THORACIC spine - compression fracture.

Front 35

The 4 cornerstones of preventing osteoporosis are:

Back 35

-Vit D
-Calcium
-HRT with estrogen
-Weight bearing exercise

Front 36

The 2 things we're mostly worried about with longterm HRT:

Back 36

-Breast cancer
-Cardiovasc disease