A 51-year-old woman G3P3 presents to your office with a 6-month history of amenorrhea. She complains of debilitating hot flushes that awaken her at night; and she wakes up the next day feeling exhausted and irritable. She tells you she has tried herbal supplements for her hot flushes, but nothing has worked. She is interested in beginning HRT, but is hesitant to do so because of its possible risks and side effects. The patient is very healthy. She has no medical problems, and the only medication she takes are calcium supplements. She has a family history of osteoporosis. Her height is 5 ft 5 in and her weight is 115 lb.
What should you tell her regarding the psychologic symptoms of menopause?
The Women’s Health Initiative helped establish that the use of ERT/HRT increases the user’s risk of a thromboembolic event two to threefold. The use of combined HRT does not increase the risk of uterine cancer, colon cancer, melanoma, or Alzheimer disease. There is much literature that indicates that HRT reduces the risk of both colon cancer and Alzheimer disease. Estrogen use has a proven beneficial effect on serum lipid concentration. It decreases total cholesterol and LDL and increases HDL and triglycerides.
The hot flush is the first physical symptom of declining ovarian function. More than 95% of perimenopausal/menopausal women experience these vasomotor symptoms. Hot flushes may begin several years before the cessation of menstruation. When a woman experiences a hot flush, she typically feels a sudden sensation of heat over the chest and face that lasts between 1 and 2 minutes, followed by a sensation of cooling or a cold sweat. The entire hot flush lasts about 3 minutes total. Estrogen therapy will usually cause resolution of the hot flush within 3 to 6 weeks. Without estrogen therapy, hot flushes on average resolve spontaneously within 2 to 3 years after cessation of menstruation. Although hot flushes are normal, they may interfere with a woman’s sleep, causing significant interference with her sense of well-being. Psychological symptoms during the climacteric occur at a time when much is changing in a woman’s life. Steroid hormone levels are dropping, and the menses is stopping. However, studies show these two factors to be unrelated to emotional symptoms in most women. Many factors, such as hormonal, environmental, and psychiatric elements, combine to cause the symptoms of the climacteric such as insomnia; vasomotor instability (hot flushes, hot flashes); emotional lability; and genital tract atrophy with vulvar, vaginal, and urinary symptoms.
Defined by the presence of virilizing signs in girls.
For the description, select the type of precocious puberty with which it is most likely to be associated.
Gonadotropin dependent precocious puberty is also known as central or true precocious puberty. It is characterized by normal gonadotropin levels (as opposed to expected low prepubertal gonadotropin levels) and a normal ovulatory pattern. It represents premature activation of a normally operating hypothalamic-pituitary axis. In these patients, the sexual characteristics are isosexual, or appropriate for the child’s gender. Although it is usually idiopathic, true precocious puberty can arise from cerebral causes such as tumors, radiation, trauma, or inflammatory diseases. Gonadotropin independent precocious puberty is also called peripheral or pseudo precocious puberty. This may be caused by excess secretion of sex hormones (estrogens or androgens) from either intrinsic or exogenous sources. Gonadotropins are suppressed in the prepubertal range. This type of puberty may be isosexual (appropriate for the child’s gender), or contrasexual (virilization of girls). Ovarian tumors are the most common cause of isosexual precocious pseudopuberty; some ovarian tumors, including dysgerminomas and choriocarcinomas, can produce so much gonadotropin that pregnancy tests are positive. Incomplete precocious puberty is usually idiopathic, and is characterized by only partial sexual maturity, such as premature thelarche or premature adrenarche (pubarche). Incomplete precocious puberty can be accompanied by abnormal function of the CNS. Gonadotropin levels are frequently normal in these patients. In gonadotropin-producing tumors, high levels of gonadotropins such as FSH are produced with subsequent production of estrogen.
Characterized by the presence of premature adrenarche, pubarche, or thelarche.
Can arise from cranial tumors or hypothyroidism.
Results from premature activation of the hypothalamic-pituitary system.
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