Module 7: Midlife Transition,
Menopause Exam-Graded A
There is a highetend awareness of menopause. why is it? - correct Answer-Lengthened
life expectancy = menopause is 1/3 of our lives
= a lot more women entering & going through it (2 million)
life expectancy of women has lengthend from 1800 (age 54) but in 2005, it was 80.5
years old. but the concern of decreased life expectancy currently arises because of
____________ - correct Answer-Obesity
what is the average age of natural menopause in North America? - correct Answer-52
years old
Many women will live ___________ of their lives after menopause - correct Answer-1/3
3 stages of Wilmoth's Model of Women's Growth and Development - correct Answer-1.
disassembling (mourning lost youth)
2. evaluating (deciding if they like themselves)
3. reassembling (coming of age).
5 stages of Ballard, Kuh, and Wadsworth - Women's Growth & Development - correct
Answer-Ballard, Kuh, and Wadsworth describe five stages:
1. expectations of symptoms
2. experience of symptoms and loss of control
3. confirmation of menopause
4. regaining control
5. freedom from menstruation.
Both Wilmouth & Ballad, Kuh, Wadsworth's model have 3 phases in common
what are they? - correct Answer-Assessment
Adjusting to change
Acceptance
The Medicalization of Menopause: A Historical Perspective - correct Answer-Biomedical
model of 20th century perpetuated menopause as deficiency disease.
1960s: Estrogen, hormone replacement therapy (HRT), promised the fountain of youth.
1975: HRT linked to endometrial cancer risk; effective for only hot flashes/vaginal
dryness.
,1980s: Addition of progestogen to estrogen therapy (ET) lowered risk of endometrial
cancer; HT decreased risk of osteoporosis; protected against heart disease.
2004: In WHI study, ET prevents osteoporosis-related hip fractures; protects spine and
small bones against osteoporosis.
( Participants were much older than newly menopausal women. Later analysis of the
study showed that age and timing since menopause affected results. Use of HT
declined. )
2012: NAMS published recommendations for HT use. See Box 12-1.
2015: Menopause is a normal developmental stage. HT is no longer standard practice.
See 2017 NAMS position statement on hormone therapy on Icollege
Definition of perimenopause - correct Answer-Years prior to menopause that
encompass change from normal cycles to cessation of menses
"First symptom of loss of ovarian cycling to *1 year after* last menses"
Definition of menopause transition - correct Answer-Onset of loss of ovarian cycling to
last menses
= transitioning from normal reproductive years to non-reproductive years. = NORMAL
developmental stage
Definition of menopause - correct Answer-The end of menstruation and reproductive
capacity
Permanent/ Complete cessation of menstruation (cessation of menses for 12 months)
What is the average age of menopause? - correct Answer-51.3 years old
Definition of Post menopause - correct Answer->1 year after cessation of menstruation
T/F: Menopause is diagnosed in retrospect - correct Answer-True
How long does the estrogen replacement delay menopause? - correct Answer-~ 2 years
Smokers go through menopause EARLIER/ LATER - correct Answer-Earlier
- speeds up break down of estrogen --> decreases estrogen levels before & after
menopause
Stages of Reproductive Aging Workshop - correct Answer-"Straw" staging system
When does FSH increase in reference to STRAW? - correct Answer-late stage of
reproductive phase of women's life.
,- early menopause have variable cycle length & late menopause may experience
ammenorrhea >60days.
- perimenopausal last 1year, starting with final menstrual period
- early Postmenopausal lasts 5 years (1 year perimenopausal + 4 years)
- late menopausal transition to early postemnopausal experiences the most vasomotor
symptoms
T/F: Perimenopausal period duration varies from woman to woman - correct Answer-
True. 2~ 10 years!
Classic from 40 - 55 years, has hormone shifts, resulting in vasomotor instability.
the time around menopause when menstrual periods first become irregular and
menstrual flow is lighter
T/F: Perimenopausal period goes through symptoms that are subtle. - correct Answer-
False: abrup changes also.
- incredibly variable individually
What are the hormone changes during perimenopausal period? - correct Answer-
Decrease: Estrogen & Progesterone [ Ovaries are less responsive = ovarian gradual
decline]
Increase: FSH & LH (stimulated through the feedback system)
= Anovulatory cycle + more frequent cycles (the beginning of the perimenopause = FSH
kicks the estrogen up time to time --> then less frequent cycles
"Ovaries are tired & not going to respond as much after working for years"
T/F: FSH & LH can help to determine when the women goes into menopause - correct
Answer-FALSE
The increased level can measure the symptoms, but not when the woman goes through
menopause
= standard of practice, but NOT standard of care. NOT DIAGNOSTIC
Plasma concentrations of FSH begins to increase several years in advance of actual
menopause, when the FSH is generally found to be >30mIU/ml. What causes this
increase? - correct Answer-With advancing reproductive age, the remainging oocytes
become increasingly resistant to FSH
T/F: Perimenopausal menses are always anovulatory - correct Answer-False: not all
cycle is anovulatory
, = Pregnancy risk!
fertility has decreased but not ceased
Why do women have frequent cycles during perimenopausal phase? - correct Answer--
loss of ovarian function = frequent periods = shortened follicular phse = frequent periods
- luteal phase is constant at 13-14 days, but variation of cycle length is r/t a change in
follicular phase
= unexpected menses
eventually stops & lengthened.
what is the typical menstrual period like during perimenopausal years? - correct
Answer-irregular bleeding
increased flow for day or two (changes in predominant estrogen = excess estrogen)
decreased menstrual flow eventually
increased estrogen level during perimenopausal phase causes - correct Answer-
increasing cramps, clots
Menopause is caused by - correct Answer-# of follicles have decreased to a 'critical
level'
lack of estrogen.
persistently elevated FSH (> 30) and ovaries don't respond to FSH anymore, so there is
no estrogen.
reduced synthesis of ovarian steroids despite high levels of gonadotropin hormones.
= 1 year of menses
what is the critical level of follicles - correct Answer-<5000
T/F: women continue to produce estrogen & androgens after menopause - correct
Answer-True.
3 types of estrogen exists: Estradiol (E2), Estriol (E3), Estrone (E1)
Which estrogen is the most potent of the three, and is the main estrogen produced
during the reproductiv eeyars?
Menopause Exam-Graded A
There is a highetend awareness of menopause. why is it? - correct Answer-Lengthened
life expectancy = menopause is 1/3 of our lives
= a lot more women entering & going through it (2 million)
life expectancy of women has lengthend from 1800 (age 54) but in 2005, it was 80.5
years old. but the concern of decreased life expectancy currently arises because of
____________ - correct Answer-Obesity
what is the average age of natural menopause in North America? - correct Answer-52
years old
Many women will live ___________ of their lives after menopause - correct Answer-1/3
3 stages of Wilmoth's Model of Women's Growth and Development - correct Answer-1.
disassembling (mourning lost youth)
2. evaluating (deciding if they like themselves)
3. reassembling (coming of age).
5 stages of Ballard, Kuh, and Wadsworth - Women's Growth & Development - correct
Answer-Ballard, Kuh, and Wadsworth describe five stages:
1. expectations of symptoms
2. experience of symptoms and loss of control
3. confirmation of menopause
4. regaining control
5. freedom from menstruation.
Both Wilmouth & Ballad, Kuh, Wadsworth's model have 3 phases in common
what are they? - correct Answer-Assessment
Adjusting to change
Acceptance
The Medicalization of Menopause: A Historical Perspective - correct Answer-Biomedical
model of 20th century perpetuated menopause as deficiency disease.
1960s: Estrogen, hormone replacement therapy (HRT), promised the fountain of youth.
1975: HRT linked to endometrial cancer risk; effective for only hot flashes/vaginal
dryness.
,1980s: Addition of progestogen to estrogen therapy (ET) lowered risk of endometrial
cancer; HT decreased risk of osteoporosis; protected against heart disease.
2004: In WHI study, ET prevents osteoporosis-related hip fractures; protects spine and
small bones against osteoporosis.
( Participants were much older than newly menopausal women. Later analysis of the
study showed that age and timing since menopause affected results. Use of HT
declined. )
2012: NAMS published recommendations for HT use. See Box 12-1.
2015: Menopause is a normal developmental stage. HT is no longer standard practice.
See 2017 NAMS position statement on hormone therapy on Icollege
Definition of perimenopause - correct Answer-Years prior to menopause that
encompass change from normal cycles to cessation of menses
"First symptom of loss of ovarian cycling to *1 year after* last menses"
Definition of menopause transition - correct Answer-Onset of loss of ovarian cycling to
last menses
= transitioning from normal reproductive years to non-reproductive years. = NORMAL
developmental stage
Definition of menopause - correct Answer-The end of menstruation and reproductive
capacity
Permanent/ Complete cessation of menstruation (cessation of menses for 12 months)
What is the average age of menopause? - correct Answer-51.3 years old
Definition of Post menopause - correct Answer->1 year after cessation of menstruation
T/F: Menopause is diagnosed in retrospect - correct Answer-True
How long does the estrogen replacement delay menopause? - correct Answer-~ 2 years
Smokers go through menopause EARLIER/ LATER - correct Answer-Earlier
- speeds up break down of estrogen --> decreases estrogen levels before & after
menopause
Stages of Reproductive Aging Workshop - correct Answer-"Straw" staging system
When does FSH increase in reference to STRAW? - correct Answer-late stage of
reproductive phase of women's life.
,- early menopause have variable cycle length & late menopause may experience
ammenorrhea >60days.
- perimenopausal last 1year, starting with final menstrual period
- early Postmenopausal lasts 5 years (1 year perimenopausal + 4 years)
- late menopausal transition to early postemnopausal experiences the most vasomotor
symptoms
T/F: Perimenopausal period duration varies from woman to woman - correct Answer-
True. 2~ 10 years!
Classic from 40 - 55 years, has hormone shifts, resulting in vasomotor instability.
the time around menopause when menstrual periods first become irregular and
menstrual flow is lighter
T/F: Perimenopausal period goes through symptoms that are subtle. - correct Answer-
False: abrup changes also.
- incredibly variable individually
What are the hormone changes during perimenopausal period? - correct Answer-
Decrease: Estrogen & Progesterone [ Ovaries are less responsive = ovarian gradual
decline]
Increase: FSH & LH (stimulated through the feedback system)
= Anovulatory cycle + more frequent cycles (the beginning of the perimenopause = FSH
kicks the estrogen up time to time --> then less frequent cycles
"Ovaries are tired & not going to respond as much after working for years"
T/F: FSH & LH can help to determine when the women goes into menopause - correct
Answer-FALSE
The increased level can measure the symptoms, but not when the woman goes through
menopause
= standard of practice, but NOT standard of care. NOT DIAGNOSTIC
Plasma concentrations of FSH begins to increase several years in advance of actual
menopause, when the FSH is generally found to be >30mIU/ml. What causes this
increase? - correct Answer-With advancing reproductive age, the remainging oocytes
become increasingly resistant to FSH
T/F: Perimenopausal menses are always anovulatory - correct Answer-False: not all
cycle is anovulatory
, = Pregnancy risk!
fertility has decreased but not ceased
Why do women have frequent cycles during perimenopausal phase? - correct Answer--
loss of ovarian function = frequent periods = shortened follicular phse = frequent periods
- luteal phase is constant at 13-14 days, but variation of cycle length is r/t a change in
follicular phase
= unexpected menses
eventually stops & lengthened.
what is the typical menstrual period like during perimenopausal years? - correct
Answer-irregular bleeding
increased flow for day or two (changes in predominant estrogen = excess estrogen)
decreased menstrual flow eventually
increased estrogen level during perimenopausal phase causes - correct Answer-
increasing cramps, clots
Menopause is caused by - correct Answer-# of follicles have decreased to a 'critical
level'
lack of estrogen.
persistently elevated FSH (> 30) and ovaries don't respond to FSH anymore, so there is
no estrogen.
reduced synthesis of ovarian steroids despite high levels of gonadotropin hormones.
= 1 year of menses
what is the critical level of follicles - correct Answer-<5000
T/F: women continue to produce estrogen & androgens after menopause - correct
Answer-True.
3 types of estrogen exists: Estradiol (E2), Estriol (E3), Estrone (E1)
Which estrogen is the most potent of the three, and is the main estrogen produced
during the reproductiv eeyars?
