Repro: Perimenopause - (Nelson) - JCN

What is the median duration of hot flashes for all women?

10.20 years Most common age: 45 - 49 years

The average age of onset for perimenopause is ___ years... The average age of onset for 95% woman is between _____-____

46 years 39-51 years

What are the two times of greatest menstrual cycle length variabilities?

7 years after menarche 8 years before menopause

Between the ages of 45 to 49 years, the hot flashes last about ____ years Which groups have longer durations?

8.1 years African American woman - longer duration Lighter BMI - symptoms lasted longer

Over ___% of pregnancies in the late 40's will _____

85% spontaneously abort

The average duration of perimenopause is? What is the duration for 95% of women going through perimenopause?

Average: 5 years 95%: 2 - 8 years

Menopause is the deterioration of a woman's ____ ____ meaning the ___ ___ which is important to the reproductive cycle

Biological clock Circadian rhythm

Perimenopause is heralded by what signs and symptoms? The transition may start how many years before any break in menstrual cycling?

Decreased bone density Decreased fertility Poor implantation Increased spontaneous abortion The transition may start 10 years before any break in menstrual cycling

Why is menopause an ovarian event?

Depletion in the number of follicles

Importantly, during menopause the glandular secretion of ____ however the secretion of _____ is unchanged.

Estrogens decreased Testosterone unchanged

T/F - there is a strong association between the age at menarche and the age at menopause?

FALSE - no association

T/F - serum hormone levels are useful to confirm menopause

False

Peri-Menopause is different from the menopausal transition in that it has a ____ how is this defined??

Final menstrual period We know after the woman has gone 12 months with no other menstrual period

Without any pre-monetary signs, the finger temperature increases ______F, the pulse rate would increase ____ BPM and what happens to skin conduction??

Finger temperature: 7.5°F Poll trade: 9 to 20 BPM Skin conduction increases

****Which hormones are elevated in menopause?

Gonadotropins: FSH>LH

***** Dr. Santoro was able to study perimenopausal Women for 170 days, this study shows the variability in which two hormones? What is the term she used to refer to menopause? What was a result of this study?

Hormones: FSH, E1 "Hormonal chaos" hormone tests are useless and can cause harm....

Again, one of the main vasomotor symptom complexes of perimenopause/menopause is?

Hot flashes

Perimenopause is characterized by changes in all levels of the ____ _____ ____ axis and in ____ ____ ____

Hypothalamic - pituitary- ovarian axis ALL reproductive organs

What are the two hormones that are part of the closed feedback loop in menopause management?

INHIBIN and FSH

This one study also related hot flashes to abdominal adiposity For every standard deviation increase in total or subcutaneous abdominal adiposity, The odds of hot flashes did what?

Increased by > 25%

What things cause menopause to occur at a later age?

Increased parity Higher socio-economic status Less frequent past/current smoking Oral contraceptive use

Peri-menopause starts at the same time as the regular menopausal transition, this is typically when there is a change in?

Menstrual cycles Anything reflecting changes in hormones

The average duration for a hot flash is: Perceived: Actual Physiologic changes:

Perceived duration: 2.7 minutes Physiologic: 20 to 30 minutes

While the glandular secretion of estrogen decreases the _____ ____ of androstenedione to ____ INCREASES.

Peripheral conversion to ESTRONE

How do you diagnose menopause?

Retrospectively Based off of menstrual history

According to the SWAN study, African-American women are more likely to report ___ ____ and have higher rates of __ ____ Why?

SWAN study- African-American: heavy bleeding, high rates of hot flashes Higher rates of fibroids

Case 1 answers:

She is having periods monthly, so she is not menopausal....we need to find what is causing the hot flashes

What is a hot flash?

Sudden sensation of warmth, begins in the thorax, neck and extends to face and down arms.

What types of women, are which groups of women, have higher rates of hot flashes?

Those eating soy and Mexican yams- hi in phytoestrogens Surgical patients GnRH analogues (meds) can also cause strong hot flashes

What are some perimenopausal symptoms?

Vasomotor: Hot flashes, Night sweats, insomnia Psychological: Anxiety, emotional liability/irritability, Impaired memory/concentration

In the perimenopausal time period, a higher BMI gave you ____ VASOmotor symptoms

WORSE