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Menopause Flashcards
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Menopause Flashcards
Menopause ESPECIFICO
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1
Question
What are the origins of physiological changes during the menopausal transition?
Answer
The atresia of the existing pool of ovarian follicles and the cessation of reproductive hormone production.
2
Question
What is the principal event leading to the ultimate loss of ovarian activity and menopause?
Answer
The atresia process of the non-dominant cohort of follicles, largely independent of menstrual cyclicity.
3
Question
What hormone levels fluctuate erratically during the menopausal transition, leading to physical and psychological symptoms?
Answer
Female reproductive hormones.
4
Question
Name some symptoms related to menopausal transition
Answer
Menstrual pattern changes, vasomotor symptoms (hot flashes, night sweats), psychological/cognitive issues (depression, irritability), sexual dysfunction, and somatic symptoms.
5
Question
What is the average duration of hot flashes?
Answer
1-5 minutes
6
Question
How much does skin temperature increase during hot flashes due to peripheral vasodilation?
Answer
10°C-15°C
7
Question
How much does the heart rate increase during hot flashes?
Answer
7-15 beats per minute.
8
Question
What is the primary neurotransmitter thought to reduce the thermoregulatory set point and trigger heat loss mechanisms?
Answer
Norepinephrine.
9
Question
How does estrogen affect adrenergic receptors in the context of vasomotor symptoms?
Answer
Decreases in estrogen levels reduce hypothalamic α-2 adrenergic receptor concentrations, leading to higher norepinephrine levels.
10
Question
What is the implication of KND-y neurons in vasomotor symptoms?
Answer
KND-y neurons contain estrogen receptors and act in response to E2. Neurokinin B, which is released by KND-y neurons, induces hot flashes.
11
Question
What is a major long term consequence of ovarian senescence due to menopause?
Answer
Loss of bone density and the development of osteopenia/osteoporosis.
12
Question
How does aging affect adrenal steroid production of DHEAS?
Answer
Adrenal production of DHEAS decreases with age. Women in their 70s and 80s experience a 74% decrease.
13
Question
What are the risk factors for Vasomotor Symptoms?
Answer
Early or surgical menopause, race/ethnicity, BMI, sedentary lifestyle, smoking, SREMs or aromatase inhibitors. Other risk factors are premenstrual dysphoric disorder, anxiety, stress, and depression.
14
Question
What is a frequent cause of erratic bleeding during the menopausal transition?
Answer
Anovulation
15
Question
What causes the endometrium to become atrophic after menopause?
Answer
Lack of estrogen stimulation
16
Question
What is the 'timing hypothesis' regarding estrogen and vascular tissue?
Answer
Estrogen has a differential effect on vascular tissue depending on the stage of atherosclerosis. In early stages, it may decrease progression, while in advanced atherosclerosis, it may precipitate vascular occlusion and thrombosis.
17
Question
What were the primary findings of the Women's Health Initiative (WHI) regarding estrogen-progesterone therapy?
Answer
The WHI found that estrogen-progesterone therapy increased the risk of cardiovascular events, stroke, and breast cancer, leading to early termination of the study arm. However, further analysis suggested that hormone therapy initiated closer to menopause may reduce the risk of coronary heart disease.
18
Question
What is the relationship between age at the start of hormone therapy and the risk of coronary heart disease?
Answer
Women who started hormone therapy closer to menopause showed a trend toward reduced risk of coronary heart disease compared to those who started it later.
19
Question
What are the risks and benefits of hormone therapy (HT) when initiated shortly after menopause?
Answer
Benefits: Effective treatment for vasomotor symptoms, prevents bone loss and fractures, and may reduce rates of coronary heart disease, improve insulin action, and prevent Alzheimer's disease. Risks: Modestly increased risk of stroke, VTE, and gallbladder disease. May increase the risk of breast cancer with estrogen-progesterone therapy for more than 4-5 years.
20
Question
What are the contraindications for using menopausal hormone therapy?
Answer
Undiagnosed abnormal genital bleeding, known or suspected breast cancer, estrogen-dependent neoplasia, active or previous VTE, active or previous stroke, myocardial infarction or transient ischemic attack, known thrombophilia, liver dysfunction or disease, untreated hypertension, hypersensitivity to ingredients, known or suspected pregnancy.
21
Question
What are the precautions for using estrogen?
Answer
Use estrogen with caution in women with the following conditions: Dementia, gallbladder disease, hypertriglyceridemia, previous cholestatic jaundice, hypothyroidism, fluid retention plus cardiac or renal dysfunction, severe hypocalcemia, previous endometriosis, elevated risk of breast cancer, or hepatic hemangiomas.
22
Question
What is the recommendation for the duration of systemic hormone therapy?
Answer
The duration of hormone therapy should be personalized, based on vasomotor symptoms, quality of life, risk of osteoporosis, comorbidities, and patient preferences, rather than being arbitrarily stopped based on age.
23
Question
How does estrogen-progesterone therapy affect endometrial cancer risk?
Answer
Daily continuous estrogen-progesterone therapy carries a lower or comparable endometrial cancer risk to no hormone therapy. Sequentially administered progestogens may slightly increase the risk.
24
Question
What are some common side effects of estrogen use?
Answer
Common side effects of estrogen use include breast tenderness, bloating, and uterine bleeding.
25
Question
What is a SERM, and how does bazedoxifene work?
Answer
A SERM (selective estrogen-receptor modulator) is an agent that can act as an estrogen agonist or antagonist depending on the tissue type. Bazedoxifene, combined with conjugated equine estrogen, offers the benefits of estrogen while mitigating estrogen's stimulation of the endometrium and breasts.
26
Question
What are some non-hormonal options for treating vasomotor symptoms?
Answer
Non-hormonal options with proven efficacy include SSRIs (selective serotonin-reuptake inhibitors), SNRIs (serotonin norepinephrine-reuptake inhibitors), gabapentinoids (gabapentin and pregabalin), and clonidine.
27
Question
What is the tissue-selective estrogen complex (TSEC)?
Answer
It is a combination of conjugated equine estrogen (CEE) and bazedoxifene (BZA). It provides the benefits of estrogen but BZA compensates for the estrogen stimulation of the endometrium and breasts.
28
Question
List the oral preparations discussed in the text.
Answer
The oral preparations mentioned in the text are: Premphase®, Prempo®, Angeliq®, Activella®, Femhrt®, Bijuvab®, Duavee®, Provera®, Prometrium®
29
Question
List the transdermal preparations discussed in the text.
Answer
The transdermal preparations discussed in the text are: Menostar®, Climara®, Vivelle-Dotb®, Minivelleb®, Climara Pro®, Combi Patch®
30
Question
¿Cuál es la dosis del mesilato de paroxetina para los síntomas vasomotores?
Answer
Inhibidor selectivo de la recaptación de serotonina, dosis: 7.5 mg