Climacteric phase -answer The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause. Early menopause -answer LMP before age 45 Late menopause -answer LMP after age 54 Primary ovarian insufficienc

Climacteric phase -answer The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause. Early menopause -answer LMP before age 45 Late menopause -answer LMP after age 54 Primary ovarian insufficiency -answer Menopause that occurs before age 40 Early menopause transition (stage -2) -answer Persistent difference of 7 days or more in the length of consecutive cycles. Late menopause transition (stage -1) -answer 60 or more consecutive days of amenorrhea Luteal out of phase event (LOOP) -answer Explains why some perimenopausal women have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels are adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion superimposed on the mid-to-late luteal phase of the ongoing ovulatory cycle. Obese women and estradiol levels during menopause -answer Obese women are more likely to have anovulatory cycles with high estradiol levels. They are also more likely to have lower premenopause yet higher postmenopause estradiol levels compared with women of normal weight. (why they are at higher risk of endometrial cancer) Chinese and Japanese women -answer These ethnic groups have lower estradiol levels then white, black and hispanic women. stage +2 -answer late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms. Stages +1a, +1b, +1c -answer early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate. Elevated FSH, LH -answer Endocrine labs after menopause AMH, inhibin B -answer These hormones work during reproductive years to not deplete follicle pool too quickly. Phases during menopause transition and PMS symptoms -answer Menstrual cycle shortenes, follicular phase compresses, women spend more time in luteal phase.. meaning more premenstrual symptoms and more frequent menstrual periods. How to respond if a patient requests FSH lab? -answer many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is not helpful. The potentially superior marker of menopause, a lab. -answer AMH DHEA (dehydroepiandrosterone) -answer Adrenal androgens: precursor hromones produced by the adrenal gland that are enzymatically converted to active androgens or estrogens in peripheral tissues. Location of estrogen receptors -answer Vagina, vulva, urethra, trigone of the bladder Effects of estrogen on tissue -answer maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome and protects tissue from pathogens. Vaginal changes with menopause -answer Thinning, loss of elasticity, loss or absence or rugae. Vagina and urethra in menopause -answer vagina narrows, urethra moves closer to the introitus. Stress urinary incontinence -answer Vaginal estrogen and urinary incontinence: what type does it help with? Treatment for FPHL -answer Minoxidil, spironolactone, finasteride, estrogen therapy Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? -answer -3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low. -3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low. When it is appropriate to check an FSH during the cycle if you check it? and why? -answer Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level. AMH produced by... used to test... Is it a screening tool for fertility? When does it peak? -answer produced by granulosa cells used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve. not recommended as a screening tool to predict fertility. Peaks at around 25 years old. So before age 25, this test is not helpful. It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing. AFC -answer Antral follicle count Number of follicles that are detectable with ultrasound. They are sensitive to FSH and considered to represent the availability poo of follicles. Late menopause transition (-1) FSH level on random draw -answer 25 or higher Black women have higher or lower FSH levels? -answer Higher Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? -answer lower Menopause transition-changes in SHBG and testosterone? ratio? -answer SHBG decreases Testosterone/SHBG ratio increases by 80%. Testosterone/SHGB ratio is called what? -answer The free androgen index What stage are VMS more likely? -answer +1b (generally last 2 years) What hormone is generally higher in obese women? -answer Estrone-via aromatization. The postmenopausal ovary continues to produce what two hormones? -answer testosterone and androstenedione Surgical menopause causes women to have lower levels of what hormone? -answer testosterone. 40-50% lower than in women w/ intact ovaries. Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and AMH? -answer inhibin and AMH decrease therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle pool. In the menopause transition, women spend more time in what phase? -answer Luteal-more PMS symptoms, more frequent menstrual periods. HPO axis theory and the menopause transition -answer It is felt that the HPO axis may become less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges can fail which can lead to more cycle irregularity. In the first year after the FMP, there is no production of what hormone? -answer progesterone What region of the adrenal gland secretes the androgens? -answer zona reticularis what are considered the 'adrenal androgens'? -answer DHEA, DHEAS, Androstenedione. Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors. -answer Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary. What part of the pituitary gland secretes adrenocorticotropic hormone? -answer Anterior pituitary. The posterior only secretes vasopressin and oxytosin. Cortisol and HRT -answer Most serum cortisol circulates bound to cortisol binding globulin. Oral estrogen increases the cortisol binding globulin, which increases total cortisol concentration. Oral tamoxifen acts similarly. Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration. Do cortisol levels associate with VMS severity? -answer No, cortisol levels have NOT been associated with more severe VMS. Local DHEA has been proven to help with what? -answer vaginal pain and dyspareunia How to DX POI? -answer Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months. AND elevated FSH over 25 on two occasions at least 4 weeks apart. Anyone <40years old who misses 3+ consecutive cycles gets these labs -answer prolactin FSH estradiol TSH pregnancy test treatment of POI -answer 100 microgram estradiol patch 1.25 mg CEE 2mg oral estradiol If intact uterus-progesterone for 12 days of the month. Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen patch, or if really not wanting to risk pregnancy, continuous HRT can be used. Hair loss. Difference between FPHL and telogen effluvium? -answer FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss. FPHL pattern -answer thinning at the crown of the head and widening of the hair part Treating FPHL -answer MINOXIDIL spironolactone finasteride What ethnicity has the least likely chance of having bad hot flashes? -answer Japanese What ethnicity is the most likely to have bad hot flashes? -answer black more frequent, longer duration. Median length of hot flashes -answer 10 years, early menopause transition women have them the longest. Theories about etiology of hot flashes (6) -answer lower ovarian estradiol thermoregulation zone is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation endothelial dysfunction. VIN low grade-what to do high grade-what to do differentiated VIN-what to do -answer low grade is not precancerous high grade is precancerous-GYN ONC differentiated-wide local excision-high risk of invasive carcinoma. most common type of vulvar cancer -answer squamous cell carcinoma Vulvar disorder commonly misdiagnosed as eczema or dermatitis? -answer paget's disease will not improve on steroids screen for co-existing breast, GI or GU cancer. They are present 20-30% of the time. Normal PVR -answer <100mL systemic and vaginal estrogen will not help with this type of urinary incontinence? -answer will NOT help with stress incontinence. Which topical vaginal estrogen has the highest dose? -answer the vaginal rings FEMRING IS THE HIGHEST Most common cause of vulvovaginitis? -answer BV post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET? -answer desquamative inflammatory vaginitis. treat different with clindamycin or hydrocortisone+ET What hormones are associated with sexual desire in women? -answer circulating androgens Women who have had a BSO experience an abrupt and persistent decline in what hormone? -answer circulating androgen levels HSDD and FSAD were combined into a single dysrunction called -answer female sexual interest/arousal disorder HSDD treatments -answer flibanserin and bremelanotide FGAD treatments (genital arousal disorder) -answer L-arginine, topical alprostadil, wellbutrin, oxytosin. phosphodiesterase inhibitors-lacking in efficacy Eros therapy device $300- vaccum-like the penis pump FOD (orgasmic disorder) treatments -answer directed masturbation is most researched behavioral treatment. Does systemic ET cause fibroids to resume growth? -answer Rarely. They often shrink after menopause. What is true about cognition and menopause? -answer Difficulty concentrating and remembering are common. What is true about cognition and surgical menopause -answer memory for verbal information can be compromised immediately after surgical menopause, especially if it is before the typical age of mesopause. Meta analysis of RCTs have shown small benefit of what diet/exercise for global cognition and memory? -answer Mediterranean diet with olive oil and tai chi exercise helps with global cognition Mediterranean diet with olive oil and isoflavone supplements helps with memory. effect of HRT on cognition -answer small or no overall effect on cognition What HRT can increase your risk for dementia based on the WHIMS study in 65+ year old healthy women? -answer EPT replacement was shown to double the risk of developing dementia. There was no significant increased risk in ET alone. this is why HRT is not recommended after 65 for primary prevention of dementia 3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance of developing alzheimer's disease? -answer 1. Observational studies imply it 2. Clinical trial of transdermal estradiol during the early postmenopause stage is associated with reductions in AD pathology. 3. 18 year cumulative follow up data from WHI found that women randomized to ET had significantly lower risk of dying from AD or dementia compared with women randomized to receive placebo. Migraine headache and pregnancy -answer typically migraines improve-estrogen levels stabilize Migraine without aura after menopause -answer usually decrease with natural menopause menstrual migraine after menopause -answer should resolve completely When to consider preventative medication for migraines -answer >2 times per week or severe and effecting QOL Triptans are contraindicated in what? -answer patients with cardiovascular disease, as are NSAIDs Menstrual migraine treatment -answer NSAID or triptan 2 days before expected to get your period, and take for 5-7 days. cdc and who guidelines for migraine treatment -answer migraine with aura-advise to not use combined hormone contraception caution in women with migraine without aura How long can it take for arthralgia from vitamin d deficiency or hypothyroidism to fully resolve? -answer it can take several months. what is th emost common form of arthritis? -answer osteoarthritis what areas of th ebrain have th emost estrogen receptors? -answer hippocampus and prefrontal cortex what is the most common thyroid disorder in women? -answer hashimoto thyroiditis if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? -answer recheck 6-8 weeks later. anticipate that the dose of levothyroxine may need to be increased. oral estrogens increase thyroid binding globulin which in turn reduces the levels of free T4. when is treatment of subclinical hypothyroidism recommended? -answer when the TSH level is higher than 10. are hot or cold thyroid nodules typically most likely to be malignant? -answer cold nodules how does HRT impact gallbladder disease? -answer increases risk of gallstones with oral HRT, lower risk with transdermal. when did they start screening blood for hep c? -answer 1992, so women who have received blood products or organ transplants prior to 1992 may have acquired heptatitis c why do we screen for hep C? -answer most infections become chronic and most are asymptomatic until liver damage is detected years later. Our treatments are improving so if we catch this earlier in people, outcomes will be better all adults born from what year to what year should recieve one time hep c testing? -answer 1945 to 1965 routine screening of all adults for hepatitis c. is it reocmmended? -answer routine screening for all adults is not recommended, however baby boomers are at the highest risk. infection rates are 5x other birth cohorts. what hpv is high risk? -answer 16 and 18 by age 50 what percentage of US women will have acquired a genital HPV infection? -answer 80%-HPV is very common, but it is the high risk ones to worry about what is the most commonly sexually transmitted infection in the US? -answer HPV What percentage of bone loss do women have from the menopause transition? -answer 10-12% on average, about 1 t score What t score defines osteopenia -answer -1.5 to -2.5 what t score defines osteoporosis -answer less than -2.5 what z score defines osteoporosis before menopause? -answer z score less than 2.0 and a history of a fragility fracture Who is at highest risk of osteoporosis? -answer white and hispanic populations What amount of women require long term care after hip fracture? What amount of women have long term loss of mobility after hip fracture? -answer 1 in 4 women (25%) require long term care 1 in 2 woemn (50%) have long term loss of mobility Asians have ____BMD than white people? -answer lower Black women have ____BMD than white people? -answer higher Over 3 servings of alcohol daily and risk for fracture? -answer 38% for osteoporotic fracture and 68% for hip fracture What 4 ethnic specific versions of FRAX are there? -answer white, asiain, black, hispanic Dairy free diet amount of calicum. How much do they need to supplement? -answer dairy free diet-300mg calcium daily. Needs 800-1200mg Tibolone and osteoporosis where is it approved? why wasn't it submitted for approval in the US and canada? -answer approved in mexico decreased risk of vertebral and nonvertebral fracture increased risk of stroke Why was estrogen not approved for osteoporosis? -answer decreased risk of vertebral and hip fracture in low fracture risk population, but estrogen has not been shown to decrease fracture risk in women with osteoporosis. More prevention than treatment. Black box warning for PTH receptor agonists? -answer osteosarcoma caution using PTH receptor agonists in what condition? -answer hypercalcemia when would you use PTH receptor agonists? -answer someone incredibly high risk for vertebral fracture raloxifene helps with what kind of fractures? -answer vertebral fractures raloxifene risk factors -answer increased risk of death from stroke in high risk patients, estrogen like risk of VTE, worsens hot flashes atypical femur risk in women on bisphosphonate? -answer 1 in 1000 after 2-3 years. Salmon calcitonin and osteoporosis? -answer small increase in spine BMD. daily SQ injections or nasal.