NAMS MENOPAUSE PAPER CORRECT QUESTIONS
AND ANSWERS SURE A+
✔✔POI (Primary Ovarian Insufficiency) - ✔✔Loss of ovarian follicular activity prior to the
age of 40.
✔✔Prevalence of POI in the US - ✔✔3%.
✔✔Premature Menopause and CAD Risk - ✔✔True - higher risk for abdominal
adiposity, diabetes mellitus, dyslipidemia.
✔✔Etiology of Premature Menopause - ✔✔1) Iatrogenic/Induced (surgery,
chemotherapy, cystectomy, hysterectomy, radiation), 2) spontaneous (genetic
disorders, x-chromosome disorder (monosomy, trisomy); specific mutations: POF1,
POF2, FMR genes), 3) autoimmune causes: polyendocrine syndromes, other
endocrinopathies, nonendocrine autoimmune conditions, 4) idiopathic.
✔✔Diagnosis of POI - ✔✔History & Physical Exam, Labs: TSH, Prolactin, Pregnancy
test, Elevated FSH (>25 IU/L on 2 checks/4-6 weeks apart), AMH, E2 can fluctuate
greatly, Low AFC.
✔✔Assessment of Etiology of POI - ✔✔Genetic testing, Autoimmune workup - TSH,
thyroperoxidase antibody, 21-OH antibodies, fasting glucose, HbA1C, Ovarian
antibodies lack sensitivity and specificity.
✔✔Estrogen Therapy in Premature Menopause - ✔✔Transdermal 17 (100 mcg/d patch
or gel), Oral 17B estradiol 2mg/day, vaginal ring: 17B 0.1mg/day, Oral CEE: 0.9-
1.25mcg/day.
✔✔Estradiol Levels in Premature Menopause - ✔✔Can consider, adjust therapy to
achieve goal range of 80-120 pg/ml.
, ✔✔Use of Progestogen in Premature Menopause - ✔✔No studied General principle,
use higher doses; micronized 200-400 mg/d (continuous/cyclically) or IUD.
✔✔COCs vs Estrogen in Younger Women - ✔✔May be more socially acceptable; lower
cost, better bone outcomes and lower blood pressure with replacement estradiol (limited
evidence).
✔✔Production of Androgens - ✔✔Comes from zona reticularis and ovaries.
✔✔Testosterone Replacement in POI - ✔✔Yes.
✔✔Fat and Lean Mass Changes Prior to Menopausal Transition - ✔✔True.
✔✔Rate of Fat Gain and Lean Mass Decline During Menopausal Transition - ✔✔Rate of
fat gain doubles and lean mass declines during menopausal transition; things stabilize
about 2 years after FMP.
✔✔Weight Gain During Menopausal Transition - ✔✔2-4 fold increase in fat mass (6%,
1.6kg over 3.5 years), 0.5% loss of lean muscle.
✔✔Changes in Weight Gain During Perimenopause/Menopause - ✔✔Premenopause
weight increase, menopausal transition - steady increase, postmenopause no change.
✔✔Calorie Intake in Post Menopause - ✔✔Yes, likely driven by decreased active
energy expenditure.
✔✔HRT on Cardiovascular Risk Factors - ✔✔In women without diabetes mellitus, HRT
(oral or transdermal E+/-P) improves lean body mass, reduces abdominal adiposity,
improves insulin resistance, improves lipids, decreases blood pressure.
✔✔When to Add Anti-Obesity Medication - ✔✔Initiate weight loss medication as adjunct
to lifestyle: if BMI (27-29.9 in presence of comorbid), if BMI >30 and failure of lifestyle.
✔✔Weight Loss with Orlistat - ✔✔~8%, GI lipase inhibitor, may cause diarrhea.
✔✔Weight Loss with Phentermine/Topiramate ER - ✔✔8-12%, contraindications:
glaucoma, hyperthyroid, MAOI; side effects: insomnia, dry mouth, paresthesias,
metabolic acidosis, anxiety, tachycardia.
✔✔Weight Loss with Naltrexone SR/Bupropion SR (Contrave) - ✔✔~5-6.4%, dopamine
and norepinephrine reuptake inhibitor and u-opioid receptor antagonist;
contraindications: hypertension, seizures, eating disorder, opioid use; side effects:
nausea, headache.
AND ANSWERS SURE A+
✔✔POI (Primary Ovarian Insufficiency) - ✔✔Loss of ovarian follicular activity prior to the
age of 40.
✔✔Prevalence of POI in the US - ✔✔3%.
✔✔Premature Menopause and CAD Risk - ✔✔True - higher risk for abdominal
adiposity, diabetes mellitus, dyslipidemia.
✔✔Etiology of Premature Menopause - ✔✔1) Iatrogenic/Induced (surgery,
chemotherapy, cystectomy, hysterectomy, radiation), 2) spontaneous (genetic
disorders, x-chromosome disorder (monosomy, trisomy); specific mutations: POF1,
POF2, FMR genes), 3) autoimmune causes: polyendocrine syndromes, other
endocrinopathies, nonendocrine autoimmune conditions, 4) idiopathic.
✔✔Diagnosis of POI - ✔✔History & Physical Exam, Labs: TSH, Prolactin, Pregnancy
test, Elevated FSH (>25 IU/L on 2 checks/4-6 weeks apart), AMH, E2 can fluctuate
greatly, Low AFC.
✔✔Assessment of Etiology of POI - ✔✔Genetic testing, Autoimmune workup - TSH,
thyroperoxidase antibody, 21-OH antibodies, fasting glucose, HbA1C, Ovarian
antibodies lack sensitivity and specificity.
✔✔Estrogen Therapy in Premature Menopause - ✔✔Transdermal 17 (100 mcg/d patch
or gel), Oral 17B estradiol 2mg/day, vaginal ring: 17B 0.1mg/day, Oral CEE: 0.9-
1.25mcg/day.
✔✔Estradiol Levels in Premature Menopause - ✔✔Can consider, adjust therapy to
achieve goal range of 80-120 pg/ml.
, ✔✔Use of Progestogen in Premature Menopause - ✔✔No studied General principle,
use higher doses; micronized 200-400 mg/d (continuous/cyclically) or IUD.
✔✔COCs vs Estrogen in Younger Women - ✔✔May be more socially acceptable; lower
cost, better bone outcomes and lower blood pressure with replacement estradiol (limited
evidence).
✔✔Production of Androgens - ✔✔Comes from zona reticularis and ovaries.
✔✔Testosterone Replacement in POI - ✔✔Yes.
✔✔Fat and Lean Mass Changes Prior to Menopausal Transition - ✔✔True.
✔✔Rate of Fat Gain and Lean Mass Decline During Menopausal Transition - ✔✔Rate of
fat gain doubles and lean mass declines during menopausal transition; things stabilize
about 2 years after FMP.
✔✔Weight Gain During Menopausal Transition - ✔✔2-4 fold increase in fat mass (6%,
1.6kg over 3.5 years), 0.5% loss of lean muscle.
✔✔Changes in Weight Gain During Perimenopause/Menopause - ✔✔Premenopause
weight increase, menopausal transition - steady increase, postmenopause no change.
✔✔Calorie Intake in Post Menopause - ✔✔Yes, likely driven by decreased active
energy expenditure.
✔✔HRT on Cardiovascular Risk Factors - ✔✔In women without diabetes mellitus, HRT
(oral or transdermal E+/-P) improves lean body mass, reduces abdominal adiposity,
improves insulin resistance, improves lipids, decreases blood pressure.
✔✔When to Add Anti-Obesity Medication - ✔✔Initiate weight loss medication as adjunct
to lifestyle: if BMI (27-29.9 in presence of comorbid), if BMI >30 and failure of lifestyle.
✔✔Weight Loss with Orlistat - ✔✔~8%, GI lipase inhibitor, may cause diarrhea.
✔✔Weight Loss with Phentermine/Topiramate ER - ✔✔8-12%, contraindications:
glaucoma, hyperthyroid, MAOI; side effects: insomnia, dry mouth, paresthesias,
metabolic acidosis, anxiety, tachycardia.
✔✔Weight Loss with Naltrexone SR/Bupropion SR (Contrave) - ✔✔~5-6.4%, dopamine
and norepinephrine reuptake inhibitor and u-opioid receptor antagonist;
contraindications: hypertension, seizures, eating disorder, opioid use; side effects:
nausea, headache.
