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Questions and Answers
What is the primary physiological change that defines menopause?
What is the primary physiological change that defines menopause?
What is the duration of amenorrhea required to establish a diagnosis of menopause?
What is the duration of amenorrhea required to establish a diagnosis of menopause?
What is the term for the physiological period in a woman's life during which ovarian function regresses?
What is the term for the physiological period in a woman's life during which ovarian function regresses?
Which hormone is relatively increased after menopause?
Which hormone is relatively increased after menopause?
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What is the most common and troublesome symptom for women at the climacteric?
What is the most common and troublesome symptom for women at the climacteric?
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What is the effect of estrogen on cardiovascular disease?
What is the effect of estrogen on cardiovascular disease?
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What is the percentage of women who experience hot flashes within 3 months of menopause?
What is the percentage of women who experience hot flashes within 3 months of menopause?
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What is the characteristic pattern of menstrual changes in most women approaching menopause?
What is the characteristic pattern of menstrual changes in most women approaching menopause?
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What is the function of osteoclasts in the bone?
What is the function of osteoclasts in the bone?
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What is the normal rate of bone loss per year after peak bone density is reached in the 20s?
What is the normal rate of bone loss per year after peak bone density is reached in the 20s?
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What is the effect of calcitonin on osteoclastic bone resorption?
What is the effect of calcitonin on osteoclastic bone resorption?
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What is a major mechanism of osteoporosis in older women?
What is a major mechanism of osteoporosis in older women?
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What is a risk factor for osteoporosis that cannot be changed?
What is a risk factor for osteoporosis that cannot be changed?
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What is a common site of fracture in osteoporosis?
What is a common site of fracture in osteoporosis?
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What is the primary reason for the increased vulnerability of vaginal tissue to infection and ulceration after menopause?
What is the primary reason for the increased vulnerability of vaginal tissue to infection and ulceration after menopause?
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What is the estimated rate of vertebral fracture in women by age 65?
What is the estimated rate of vertebral fracture in women by age 65?
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What is the primary mechanism by which estrogen replacement therapy can help mitigate skin collagen loss during menopause?
What is the primary mechanism by which estrogen replacement therapy can help mitigate skin collagen loss during menopause?
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What is a modifiable risk factor for osteoporosis?
What is a modifiable risk factor for osteoporosis?
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What is the primary consequence of the imbalance between osteoclastic and osteoblastic activity in osteoporosis?
What is the primary consequence of the imbalance between osteoclastic and osteoblastic activity in osteoporosis?
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What is the most common symptom of genitourinary atrophy experienced by women during menopause?
What is the most common symptom of genitourinary atrophy experienced by women during menopause?
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What is the estimated percentage of skin collagen loss that can occur during the first five years of menopause?
What is the estimated percentage of skin collagen loss that can occur during the first five years of menopause?
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Which of the following is NOT a psychological change associated with menopause?
Which of the following is NOT a psychological change associated with menopause?
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Study Notes
Menopause and Climacteric
- Menopause: permanent cessation of menstruation due to failure of ovarian follicular development in the presence of adequate gonadotropins.
- Diagnosis of menopause is established when menstruation stops for 12 months in absence of an organic or a pathological cause.
- Climacteric: physiological period in a woman's life during which ovarian function regresses, characterized by endocrine, somatic, and psychological changes.
Hormonal Changes
- FSH and LH levels are elevated (>25 IU/L).
- Estrogen levels decrease.
- Progesterone and inhibin levels decrease.
- Testosterone levels are relatively increased.
Clinical Changes
Menstrual Changes
- Gradual tapering in both amount and duration of flow.
- A minority of women experience more frequent and heavier bleeding.
- Abrupt cessation of menses is rare.
Vasomotor Instability (Hot Flashes)
- Most common and troublesome symptoms for women at the climacteric.
- Obese women are less troubled by hot flashes than thin women.
- 75% of women experience hot flashes within 3 months of menopause.
- Hot flashes lessen in frequency and intensity with advancing age.
Cardiovascular Changes
- Estrogen is cardio-protective.
- Estrogen increases HDL and decreases LDL.
- Risk of cardiovascular disease increases after menopause.
Genitourinary Atrophy
- Vaginal walls become pale and thin due to diminished vascularity.
- Vaginal epithelial cells contain less glycogen, leading to loss of acidic pH and increased risk of infection and ulceration.
- Vagina loses its rugae and becomes shorter and inelastic.
- Symptoms: dyspareunia, vaginitis, vaginal dryness, dysuria, urgency, frequency of urination, and suprapubic pain.
Psychological Changes
- Irritability, anxiety, and depression.
- Lack of concentration.
- Change of libido.
- Increased risk of Alzheimer's disease.
Skin Collagen
- Up to 30% of skin collagen is lost during the first five years of menopause.
- Loss can be prevented and reversed with Estrogen Replacement Therapy (ERT).
Osteoporosis
- Reduction of bone mass density with micro-architectural alteration, leading to increased bone fragility.
- Imbalance between osteoclastic and osteoblastic activity (defective remodeling).
- Loss in total mineralized bone.
- Disruption of normal balance of bone breakdown and build-up.
- Major mechanisms: slow down of bone build-up, accelerated bone breakdown.
- Normal loss: 0.5% per year after peak in 20s.
- Up to 5% loss per year during first 5 years after menopause.
Risk Factors for Osteoporosis
Unchangeable Factors
- Gender
- Heredity
- Age
- Fracture history
- Medical conditions (e.g., hyperthyroidism, parathyroidism)
- Medications for chronic diseases (e.g., steroids)
Changeable Factors
- Calcium consumption
- Vitamin D intake
- Quit smoking or vaping
- Alcohol consumption
- Physical activity
- Posture
- Low body weight (BMI < 20)
- Some medications
Complications of Osteoporosis
- Fractures: most common sites are vertebrae, femur neck, and distal radius.
- One-third of women will suffer vertebral fracture after 65 years of age and hip fracture by age 90.
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Description
This quiz covers the definitions and diagnosis of menopause and climacteric in women. Learn about the physiological changes and symptoms associated with these stages.
