Menopause : Hormonal Replacement Therapy
Questions with Correct Answers
Define Menopause Correct Ans ✓✓ Loss of ovarian function and
hormone deficiency
Permanent cessation of menses following the loss of ovarian follicles
occurs after 12 consecutive months of amenorrhea
Define the cycle from perimenopause to post menopause Correct Ans
✓✓ Perimenopause: menopausal transition, 1-2 year prior to actual
menopause
Natural menopause: menopause between 45-55 years of age
Post menopause: time after 12 months consecutive months of
amenorrhea
What is the pathophysiology of menopause? Correct Ans ✓✓ Ovaries
produce ESTROGEN and PROGESTERONE. When the hormones are
not produced anymore, cyclic bleeding ends. Serum and urine FSH and
LH are elevated because when you do not have anymore hormones the
brain (pituitary) continues to produce more FSH and LH to regulate the
ovaries not realizing the ovaries isn't functional. Estradiol (the most
prominent estrogen) is still LOW, however.
What is secreted by the post-menopausal ovary? Correct Ans ✓✓
Androstenedione and testosterone, not estrogen anymore
,What would the lab value be of FSH in Menopause? Perimenopause?
Correct Ans ✓✓ Menopause: FSH > 40
Perimenopause: FSH on Day 2 or 3 of menstrual cycle >10-20
Case: MM is a 53 year old female that presents to your Women's clinic
with a chief complaint of night sweats and hot flashes for the past 5
months. She states that she has not been sleeping well lately and has
problems with concentration at work. MM also admits that she has
vaginal dryness and painful intercourse.
What are the symptoms? Correct Ans ✓✓ 1. Night sweats
2. Hot flashes
3. Insomnia
4. Not concentrating
5. Vaginal dryness and painful intercourse
What are clinical presentations of Menopause?
**Know** Correct Ans ✓✓ Vasomotor (night sweats and hot flashes)
Sleep disturbance
Genital and breast atrophy
Osteoporosis
Sexual dysfunction (vaginal dryness and painful intercourse)
Psychological (anxiety, depression, difficulty concentrating, mood
changes)
, What is Hot flashes? When do hot flashes typically occur? Correct Ans
✓✓ Sudden sensation of flushing and extreme warmth that may follow
sweating and shaking
episodes occur at irregular intervals
What can increase hot flashes?
When is the prevalence of hot flashes usually higher? Correct Ans ✓✓
increase with caffeine, alcohol, or spicy food
prevalence is higher in the first two post-menopausal years
Why does osteoporosis occur in menopausal women? Correct Ans ✓✓
Low estrogen causes accelerated rate of demineralization
How does genital and breast atrophy occur in menopausal women?
Correct Ans ✓✓ B/c vaginal pH becomes more alkaline and may lead to
chronic vaginitis with itching, discharge, and local tenderness
This also causes cervix, uterus, and Fallopian tubes to shrink
How are hot flashes and menopausal symptoms assessed clinically? FYI
screw it Correct Ans ✓✓ 1. Hot flash score (looks at number of hot
flashes a day)
2. Greene Climacteric Score (assess symptoms and quality of life 0-63)
Questions with Correct Answers
Define Menopause Correct Ans ✓✓ Loss of ovarian function and
hormone deficiency
Permanent cessation of menses following the loss of ovarian follicles
occurs after 12 consecutive months of amenorrhea
Define the cycle from perimenopause to post menopause Correct Ans
✓✓ Perimenopause: menopausal transition, 1-2 year prior to actual
menopause
Natural menopause: menopause between 45-55 years of age
Post menopause: time after 12 months consecutive months of
amenorrhea
What is the pathophysiology of menopause? Correct Ans ✓✓ Ovaries
produce ESTROGEN and PROGESTERONE. When the hormones are
not produced anymore, cyclic bleeding ends. Serum and urine FSH and
LH are elevated because when you do not have anymore hormones the
brain (pituitary) continues to produce more FSH and LH to regulate the
ovaries not realizing the ovaries isn't functional. Estradiol (the most
prominent estrogen) is still LOW, however.
What is secreted by the post-menopausal ovary? Correct Ans ✓✓
Androstenedione and testosterone, not estrogen anymore
,What would the lab value be of FSH in Menopause? Perimenopause?
Correct Ans ✓✓ Menopause: FSH > 40
Perimenopause: FSH on Day 2 or 3 of menstrual cycle >10-20
Case: MM is a 53 year old female that presents to your Women's clinic
with a chief complaint of night sweats and hot flashes for the past 5
months. She states that she has not been sleeping well lately and has
problems with concentration at work. MM also admits that she has
vaginal dryness and painful intercourse.
What are the symptoms? Correct Ans ✓✓ 1. Night sweats
2. Hot flashes
3. Insomnia
4. Not concentrating
5. Vaginal dryness and painful intercourse
What are clinical presentations of Menopause?
**Know** Correct Ans ✓✓ Vasomotor (night sweats and hot flashes)
Sleep disturbance
Genital and breast atrophy
Osteoporosis
Sexual dysfunction (vaginal dryness and painful intercourse)
Psychological (anxiety, depression, difficulty concentrating, mood
changes)
, What is Hot flashes? When do hot flashes typically occur? Correct Ans
✓✓ Sudden sensation of flushing and extreme warmth that may follow
sweating and shaking
episodes occur at irregular intervals
What can increase hot flashes?
When is the prevalence of hot flashes usually higher? Correct Ans ✓✓
increase with caffeine, alcohol, or spicy food
prevalence is higher in the first two post-menopausal years
Why does osteoporosis occur in menopausal women? Correct Ans ✓✓
Low estrogen causes accelerated rate of demineralization
How does genital and breast atrophy occur in menopausal women?
Correct Ans ✓✓ B/c vaginal pH becomes more alkaline and may lead to
chronic vaginitis with itching, discharge, and local tenderness
This also causes cervix, uterus, and Fallopian tubes to shrink
How are hot flashes and menopausal symptoms assessed clinically? FYI
screw it Correct Ans ✓✓ 1. Hot flash score (looks at number of hot
flashes a day)
2. Greene Climacteric Score (assess symptoms and quality of life 0-63)
