Questions and Answers
What is the climacteric phase?
What is early menopause defined as?
LMP before age 45
What is late menopause defined as?
LMP after age 54
What is primary ovarian insufficiency?
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What characterizes the early menopause transition?
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What characterizes the late menopause transition?
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What does LOOP stand for?
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Obese women are less likely to have anovulatory cycles with high estradiol levels.
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Chinese and Japanese women have higher estradiol levels than women of other ethnic groups.
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What does stage +2 indicate in menopause?
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What happens in stages +1a, +1b, +1c after early post-menopause?
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What do elevated FSH and LH indicate?
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What role do AMH and inhibin B play?
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What changes occur during the menopause transition regarding menstrual cycles?
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When is it appropriate to check an FSH during the cycle?
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What is AMH used to test?
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AMH is a recommended screening tool for fertility.
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What does AFC stand for?
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Which hormones are adrenal androgens?
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Match the estrogen receptor locations:
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What are the effects of estrogen on tissue?
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What are vaginal changes associated with menopause?
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What happens to the vagina and urethra during menopause?
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What type of urinary incontinence does vaginal estrogen help with?
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What treatments are used for FPHL?
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Study Notes
Menopause Definitions and Terms
- Climacteric phase refers to the transitional period with changes in endocrinology, physical symptoms, and psychological effects around menopause.
- Early menopause is defined as the last menstrual period (LMP) occurring before age 45.
- Late menopause occurs when LMP happens after age 54.
- Primary ovarian insufficiency is menopause that occurs before age 40.
Menopause Transition Stages
- Early menopause transition (stage -2) is characterized by a persistent difference of 7 days or more in consecutive menstrual cycle lengths.
- Late menopause transition (stage -1) includes 60 or more consecutive days of amenorrhea.
Hormonal Changes and Effects
- Luteal out of phase event (LOOP) explains elevated estrogen in some perimenopausal women due to high FSH levels recruiting a second follicle.
- Obese women may experience anovulatory cycles with high estradiol levels and are at an increased risk for endometrial cancer due to lower premenopausal and higher postmenopausal estradiol levels compared to women of normal weight.
- Ethnic variations show that Chinese and Japanese women have lower estradiol levels than white, black, and Hispanic women.
Menopause Staging
- Stage +2 occurs 5-8 years after the final menstrual period (FMP), indicating increased somatic aging and genitourinary symptoms.
- Stages +1a, +1b, +1c occur 2 years post-FMP and are marked by rising FSH levels and decreasing estradiol levels alongside predominant vasomotor symptoms (VMS).
Endocrine Changes Post-Menopause
- Elevated levels of FSH and LH are expected in endocrine labs following menopause, indicating changes in hormonal regulation.
- AMH (Anti-Müllerian Hormone) and inhibin B help regulate the ovarian follicle pool during reproductive years.
Menstrual Cycle Dynamics
- Menstrual cycles shorten in menopause transition, with a compressed follicular phase and extended luteal phase, leading to more premenstrual symptoms and irregular periods.
Laboratory Testing Considerations
- Requesting FSH lab tests may have pitfalls due to variability depending on the menstrual cycle phase, and normal or low FSH results may not be informative.
- AMH is considered a superior marker for menopause status.
Hormonal Precursors and Locations
- DHEA (dehydroepiandrosterone) is an adrenal androgen, serving as a precursor for active hormones in peripheral tissues.
- Estrogen receptors are located in the vagina, vulva, urethra, and bladder trigone, affecting various tissues.
Effects of Estrogen
- Estrogen maintains blood flow, collagen, and hyaluronic acid within epithelial surfaces, supporting the microbiome and protecting tissues from pathogens.
- Menopause results in vaginal changes including thinning, loss of elasticity, and absence of rugae, while narrowing of the vagina and urethra occurs as urethra shifts closer to the introitus.
Specific Conditions and Treatments
- Vaginal estrogen therapy is significant for stress urinary incontinence, helping manage this condition.
- Treatment options for Female Pattern Hair Loss (FPHL) include minoxidil, spironolactone, finasteride, and estrogen therapy.
Late Reproductive Years and Hormonal Indicators
- During late reproductive years (-3b and -3a stages), menstrual cycles appear normal in -3b, featuring normal FSH, while subtle changes occur in -3a with variable FSH and decreased AMH, AFC, and inhibin levels.
- FSH testing is most appropriate on cycle day #3 to avoid falsely normal levels due to elevated estradiol suppression.
Ovarian Reserve Testing
- AMH is produced by granulosa cells, used to assess ovarian reserve damage, peaking around age 25. It is not a reliable fertility screening tool and can be influenced by hormonal contraceptives.
- AFC (Antral Follicle Count) refers to the number of detectable follicles via ultrasound, contributing to evaluations of ovarian reserve.
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Description
This quiz covers essential definitions and terms related to menopause, including the climacteric phase and different stages of menopause transition. Learn about hormonal changes and their effects, as well as conditions like early and late menopause. Test your knowledge of this significant life stage.
