Menopause Management and Care
Climacteric phase - ANS>>The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause - ANS>>LMP before age 45
Late menopause - ANS>>LMP after age 54
Primary ovarian insufficiency - ANS>>Menopause that occurs before age 40
Early menopause transition (stage -2) - ANS>>Persistent difference of 7 days or more
in the length of consecutive cycles.
Late menopause transition (stage -1) - ANS>>60 or more consecutive days of
amenorrhea
Luteal out of phase event (LOOP) - ANS>>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 - ANS>>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 - ANS>>These ethnic groups have lower estradiol levels
then white, black and hispanic women.
stage +2 - ANS>>late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANS>>early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH - ANS>>Endocrine labs after menopause
AMH, inhibin B - ANS>>These hormones work during reproductive years to not deplete
follicle pool too quickly.
Phases during menopause transition and PMS symptoms - ANS>>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? - ANS>>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. - ANS>>AMH
DHEA (dehydroepiandrosterone) - ANS>>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 - ANS>>Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - ANS>>maintain blood flow, the collagen, and HA within
the epithelial surfaces. Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - ANS>>Thinning, loss of elasticity, loss or absence
or rugae.
Vagina and urethra in menopause - ANS>>vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence - ANS>>Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL - ANS>>Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH,
AFC, inhibin? - ANS>>-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? -
ANS>>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? - ANS>>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.
Climacteric phase - ANS>>The period of endrocrinologic, somatic, and transitory
psychologic changes that occur around the time of menopause.
Early menopause - ANS>>LMP before age 45
Late menopause - ANS>>LMP after age 54
Primary ovarian insufficiency - ANS>>Menopause that occurs before age 40
Early menopause transition (stage -2) - ANS>>Persistent difference of 7 days or more
in the length of consecutive cycles.
Late menopause transition (stage -1) - ANS>>60 or more consecutive days of
amenorrhea
Luteal out of phase event (LOOP) - ANS>>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 - ANS>>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 - ANS>>These ethnic groups have lower estradiol levels
then white, black and hispanic women.
stage +2 - ANS>>late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms.
Stages +1a, +1b, +1c - ANS>>early post menopause: 2 years after FMP. FSH rises,
estradiol decreases. VMS predominate.
Elevated FSH, LH - ANS>>Endocrine labs after menopause
AMH, inhibin B - ANS>>These hormones work during reproductive years to not deplete
follicle pool too quickly.
Phases during menopause transition and PMS symptoms - ANS>>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? - ANS>>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. - ANS>>AMH
DHEA (dehydroepiandrosterone) - ANS>>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 - ANS>>Vagina, vulva, urethra, trigone of the bladder
Effects of estrogen on tissue - ANS>>maintain blood flow, the collagen, and HA within
the epithelial surfaces. Supports microbiome and protects tissue from pathogens.
Vaginal changes with menopause - ANS>>Thinning, loss of elasticity, loss or absence
or rugae.
Vagina and urethra in menopause - ANS>>vagina narrows, urethra moves closer to the
introitus.
Stress urinary incontinence - ANS>>Vaginal estrogen and urinary incontinence: what
type does it help with?
Treatment for FPHL - ANS>>Minoxidil, spironolactone, finasteride, estrogen therapy
Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH,
AFC, inhibin? - ANS>>-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? -
ANS>>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? - ANS>>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.
