Amenorrhea for how many months followed by cessation of menstruation is known as menopause?
12 or more months
Age of menopause
In india 47 yrs
Worldwide 51yrs
Age of premature menopause of POI
Less than 40 yrs
Age of late menopause
More than equal to 55 yrs
What is first sign of perimenopause?
Increase in cycle length more than equal to 7 days
What is HMG
Human menopausal gonadotropin
(FSH and LH extreted in urine of postmenopausal females)
Cause of hyper gonadotropic hypogonadism
Menopause/POI
MC symptom of menopause
Hot flashes
Why does hot flahes occur in menopause
Decrease in estrogen
Which
Resets the thermostat
Imbalance between serotonin and norepinephrine
Define episode of hot flashes
Less than 5 mins(3-4 times)
Define time period of hot flushes
3-4 yrs before menopause and 5 yrs after
(Occurs qt the time of LH surge)
What is only indication for post menopausal HRT
Severe hot flashes
MC affected bones in menopause
Trabecular bones
IOC for osteoporosis and its indication and report
DEXA scan
>= 65yrs of age
Site 1-4th lumbar vertebrae
T and Z score
DOC for osteoporosis
Bisphosphonates
Is there a role of HRT in preventing CAD
No role
Never given
Local examination of vagina in senile or atrophic vaginitis
Shiny mucosa
Loss of vaginal rugosity
Thin atrophied mucosa
Indicate first and second line mx of hot flushes
I line is HRT
II line is SSRI like fluoxetine
Paroxetine
Venlafaxine
SERM used
Bazedoxifen + E
What is 1 and 2 line mx and SERM used in osteoporosis
1 - alendronate
2-HRT
SERM- Raloxifen
Mx of senile vaginitis
1- vaginal lubricants
2- local estrogen therapy
SERM- ospemifen or bazedoxifen +E
How is confirmation of POI is done
FSH levels on 2 different occasions 1 month apart
If <10 IU-normal
If >=25 - suggestive of POI
If >= 40- confirmation of POI
Causes of POI
Chemotherapy or radiotherapy
Mumps
Galactosemia
AI ds
Syndromes turner mosaic, fragile X
Min duration for which progesterone has to be given to have a protective effect on endometrium
12 days
What is that disadv of E only HRT that turns into adv on E+P HRT
Decrease chances of endometrium Ca
Disadvantages of E+P HRT
Chances of Venous thromboembolism increase
Risk of ovarian ca
Risk of breast cancer
MC E used in HRT its route and dose
17 beta estradiol
Route - transdermal>oral
Dose
Oral 1mg/day (started at 0.5mg/day)
Transdermal- 0.05mg/day (started at 0.025mg/day)
MC progesterone used in HRT
Micronized oral P(DOC)
Does 100-200mg/day
Which drug is used in hot flashes if HRT is C/I
Fluoxetine
Indications of HRT
What are C/I of HRT
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