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MENOPAUSE QUIZ

MENOPAUSE QUIZ. Round 1 History / Famous Personalities Round 2 Physiology of menopause Round 3 Pharmacology Round 4 Osteoporosis Round 5 Cancer Round 6 VISUAL ROUND Round 7 Cardiovascular & Genitourinary issues Round 8 Mental health & Public Health issues. R O U 1 N D.

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MENOPAUSE QUIZ

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  1. MENOPAUSE QUIZ Dr Mona Shroff www.obgyntoday.info

  2. Round 1 History / Famous Personalities • Round 2 Physiology of menopause • Round 3 Pharmacology • Round 4 Osteoporosis • Round 5 Cancer • Round 6 VISUAL ROUND • Round 7 Cardiovascular & Genitourinary issues • Round 8 Mental health & Public Health issues Dr Mona Shroff www.obgyntoday.info

  3. R O U 1 N D HISTORY / FAMOUS PERSONALITIES Dr Mona Shroff www.obgyntoday.info

  4. TEAM A BORN ON JUNE 14 1864 IN GERMANY. HIS FIRST NAME WAS ALOIS. NEUROPATHOLOGIST & PSYCHIATRIST WHO ALONG WITH FRANS NISSL EXTENSIVELY STUDIED THE NORMAL AND PATHOLOGICAL ANATOMY OF CEREBRAL CORTEX. Dr Mona Shroff www.obgyntoday.info

  5. ALOIS ALZHEIMER Dr Mona Shroff www.obgyntoday.info

  6. TEAM B American endocrinologist born on 12 jan 1900. Extensively studied pathophysiology of parathyroid & gave distinction b/w osteoporosis & disorders of calcium metabolism. Pioneer of replacement therapy for menopause & birth control by hormone therapy & has multiple syndromes named after him. Dr Mona Shroff www.obgyntoday.info

  7. FULLER ALBRIGHT Dr Mona Shroff www.obgyntoday.info

  8. TEAM C Born in lausanne, switzerland in 1933, passed away on 15 may 2007. Instrumental in the creation of the european foundation for osteoporosis in 1987, which became the international osteoporosis foundation in 1998. Pioneering work led to the discovery of a new class of therapeutic agents, the bisphosphonates Dr Mona Shroff www.obgyntoday.info

  9. PROFESSOR HERBERT FLEISCH Dr Mona Shroff www.obgyntoday.info

  10. TEAM D • Associate Dean for Ethics, David Geffen School of Medicine at UCLA • Major areas of research interest. Polycystic Ovary Disorder (PCOS) , long-term effects of treatment with growth hormone of growth hormone-deficient persons,research ethics besides longstanding interests in the hormone changes occurring with aging in both men and women. • Proposed the “estrogen window” hypothesis for carcinogenesis of breast carcinoma. Dr Mona Shroff www.obgyntoday.info

  11. PROF. S.G. KORENMAN Dr Mona Shroff www.obgyntoday.info

  12. TEAM E Americanbiochemist. He received the Nobel Prize in Physiology or Medicine in 1943 In 1929-1930 he succeeded in isolating oestrone, a feat independently accomplished at about the same time by Butenandt in Germany. Worked with biologist Edgar Allen to study the ovarian systems of rats and mice. He later isolated two other related products, oestriol and oestradiol-17 Dr Mona Shroff www.obgyntoday.info

  13. EDWARD DOISY Dr Mona Shroff www.obgyntoday.info

  14. ROUND 2 PHYSIOLOGY Dr Mona Shroff www.obgyntoday.info

  15. TEAM A • What causes A menopausal woman to have • Hirsutism? • Decreased libido? • What is free testosterone index ? What does it indicate Dr Mona Shroff www.obgyntoday.info

  16. Hirsutism - altered androgen : estrogen ratio Reduced libido – decreased testosterone • Ratio of total testosterone to SHBG. If <25% of premenopausal value: indicates androgen insufficiency Dr Mona Shroff www.obgyntoday.info

  17. TEAM B • Out of LH & FSH what rises more in menopause & why? • What is the only marker of perimenopausal transition? Dr Mona Shroff www.obgyntoday.info

  18. FSH rise(> 10 times) more compared to LH rise (3 times) due to shorter half life of LH . • Menstrual irregularity Dr Mona Shroff www.obgyntoday.info

  19. TEAM C • What leads to shortening of menstrual cycle in perimenopause & thereafter irregular cycles near menopause? • What is the critical threshold of follicles below which menopause occurs regardless of age Dr Mona Shroff www.obgyntoday.info

  20. Shortening in early perimenopause due to rising FSH –faster follicular maturation – shortened follicular phase.Later more anovulatory cycles-irregular,delayed. • 1000 follicles Dr Mona Shroff www.obgyntoday.info

  21. TEAM D • How do you explain the rise in fsh levels in perimenopausal transition inspite of normal to slightly raised estradiol levels? • What is the average postmenopausal estrogen production rate? Dr Mona Shroff www.obgyntoday.info

  22. Reduced inhibin secretion from follicles – feedback on FSH levels. • 45-60 microgm/24 hrs Dr Mona Shroff www.obgyntoday.info

  23. TEAM E • Mention 2 other causes of hot flushes. • Name 3 drugs useful in treatment of hot flushes besides HRT. Dr Mona Shroff www.obgyntoday.info

  24. Thyroid abnormalities,leukemia, Carcinoid,pheochromocytoma,pancreatic tumor. • Tibolone,transdermal clonidine,gabapantene,venlafexine Dr Mona Shroff www.obgyntoday.info

  25. TEAM F • What does the term “continuation of ovarian function postmenopausally” refer to? • What is the avg weight & volume of a postmenopausal ovary? Dr Mona Shroff www.obgyntoday.info

  26. As the ovary fails, it continues to produce testosterone and perhaps in increased amounts…for a variable number of years. This is the so called… “continuation of ovarian function postmenopausally”. i.e. progressive androgenisation • Wt. < 10 gms Vol. < 8 cucc. Dr Mona Shroff www.obgyntoday.info

  27. R O U 3 N D PHARMACOLOGY Dr Mona Shroff www.obgyntoday.info

  28. TEAM A • When can a woman who is on OCPills for contraception,be shifted to HRT if necessary? Dr Mona Shroff www.obgyntoday.info

  29. When FSH on D6-D7 of pill free week is high.(>20) • If in mid fifties can change directly. Dr Mona Shroff www.obgyntoday.info

  30. TEAM B • NAME 4 SERMS .WHICH OF THE SERMS COMES NEAREST TO THE IDEAL SERM. Dr Mona Shroff www.obgyntoday.info

  31. - • Clomiphene • Tamoxifen • Toremifene • Droloxifene • Iodoxifene • Raloxifene • Ormeloxifene-NEAREST TO IDEAL Dr Mona Shroff www.obgyntoday.info

  32. TEAM C • The U.S. Food and Drug Administration is now requiring that a new, highlighted (boxed) warning be placed on all estrogen products for use by postmenopausal women. The warning highlights the increased risk for which diseases? Dr Mona Shroff www.obgyntoday.info

  33. stroke • blood clots • invasive breast cancer • heart disease and heart attacks Dr Mona Shroff www.obgyntoday.info

  34. TEAM D • Why is the max duration for which teriparatide can be used for Rx of late postmenopausal osteoporosis? • Why? Dr Mona Shroff www.obgyntoday.info

  35. In male and female rats, teriparatide caused an increased incidence of osteosarcoma that was dependent on dose and treatment duration. (In rats, osteosarcoma was seen at doses 3 to 60 times the human exposure following a 20 µg dose) • Long-term use (>2 years) is not recommended • Transient orthostatic hypotension (infrequent) Dr Mona Shroff www.obgyntoday.info

  36. TEAM E • What are the implications of progesterone challenge test in menopausal women? Dr Mona Shroff www.obgyntoday.info

  37. If NEGATINE : No estrogen primed endometrium hence reassuring • If POSITIVE : May have proliferative , Hyperplastic or Neoplastic endometrium Dr Mona Shroff www.obgyntoday.info

  38. TEAM F • What is a tissue selective estrogen complex? Dr Mona Shroff www.obgyntoday.info

  39. A TSEC is the partnering of a SERM and other estrogens to achieve clinical results based on their blended tissue selective activity profiles. • One option for a TSEC is the pairing of a SERM(Bazedoxifene) with CEE. Dr Mona Shroff www.obgyntoday.info

  40. R O U 4 N D OSTEOPOROSIS Dr Mona Shroff www.obgyntoday.info

  41. TEAM A • WHAT ARE THE CRITERIA FOR A MENOPAUSAL WOMAN TO UNDERGO BMD TESTING? Dr Mona Shroff www.obgyntoday.info

  42. All women aged 65 years or older, regardless of other risk factors for osteoporosis. • Postmenopausal women younger than 65 years with 1 or more risk factors for osteoporosis (other than being white, postmenopausal, and female). • All postmenopausal women who have had a fragility fracture. Dr Mona Shroff www.obgyntoday.info

  43. TEAM B • On BMD testing when will a woman be diagnosed as having osteopenia & osteoporosis? Dr Mona Shroff www.obgyntoday.info

  44. Normal BMD : T-score is 1.0 or above (no lower than 1.0 SD below the BMD norm for ‘‘young normal’’ women). • Osteopenia : T-scores between 1.0 and 2.5 SDs (between 1.0 and 2.5 SDs below that of ‘‘young normal’’ women). • Osteoporosis : T-score is 2.5 or lower (at least 2.5 SDs lower than the norm for ‘‘young normal’’ women) Dr Mona Shroff www.obgyntoday.info

  45. TEAM C • What are the criteria for starting pharmacotherapy for treatment of postmenopausal bone loss? Dr Mona Shroff www.obgyntoday.info

  46. T-scores below 2.0 by central DXA with no risk factors, • T-scores below 1.5 by central DXA with 1 or more risk factors, • Prior fragility fractures. • Some authorities,including the World Health Organization, designate an intervention threshold T-score of 2.5 SDs.(if no risk factors). Dr Mona Shroff www.obgyntoday.info

  47. TEAM D • Name 2 drugs each,recommended for primary prevention & secondary prevention of postmenopausal osteoporosis. Dr Mona Shroff www.obgyntoday.info

  48. PRIMARY PREVENTION • HRT • SERMS • TIBOLONE • Biophosphonates(vertebral#) • SECONDARY PREVENTION • Biophosphonates • Calcitonin (>5 yrs menopause) • Teriparatide Dr Mona Shroff www.obgyntoday.info

  49. TEAM E • Give one example each of cortical bone & trabecular bone. • Which are the most comman sites for compression vertebral fractures in menopause? Dr Mona Shroff www.obgyntoday.info

  50. Cortical : all perepheral bones Trabecular : spine,pelvis,proximal femur • D 12, L1-2-3 Dr Mona Shroff www.obgyntoday.info

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