What's Your Menopause IQ? Take Our Quiz and Find Out
If you haven't read the online educational article on menopause
before taking this test, and you want to have a reasonable chance of
Click here to read about menopause
- To be able to define the diagnosis of menopause and its symptoms
- To describe the effect of menopause on sexual desire
- To describe the effect of menopause on heart and vascular disease
- To list other important effects of menopause and hormone replacement
- To understand the current relationship between breast cancer and hormone replacement
The following 5 question quiz will test the above objectives concerning menopause. We hope you have read the accompanying article and learn from this quiz in addition to evaluating what you already have learned.
Read each question carefully and then select the ONE best answer.Menopause is a midlife physiologic event in which a woman's ovaries stop functioning. It is often associated with hot flashes. Many other symptoms are rightly or wrongly attributed to menopause.
- Almost women who are menopausal get hot flashes
- The average age of menopause is approximately 45 years of age
- A blood test, serum FSH is the gold standard to diagnose menopause
- Depression is more common during menopause
- Hot flashes are diagnostic of menopause
There is a perimenopausal time period before menopause that may be associated
with fluctuating estrogen levels. This can cause abnormal menstrual bleeding
and sporadic hot flashes. The perimenopause starts, on the average, about
4 years prior to menopause.
Hot flashes may be due to stress or medications or even foods.
Also during the perimenopause, hot flashes may occur. In order be to sure
of the diagnosis of menopause, the FSH blood test is often ordered, especially
if a woman is considering long term estrogen replacement therapy.
There is a hazard of not diagnosing menopause for certain if a woman is
going to be started on hormone replacement therapy. Her ovaries will still
ovulate, on occasion, producing fluctuating estrogen levels. This in turn
will cause irregular uterine bleeding which is falsely attributed to the hormones.
The irregular bleeding is likely to discourage a woman from continuing to
use the hormones for their long term benefit.
While many women attribute mood changes to the menopause, the incidence
of depression is actually less during menopause than at other times
in a woman's life. Lack of estrogen at this time may worsen preexisting
symptoms of depression or irritability, but it doesn't seem to
cause the new occurance of depression.
Hot flashes may be due to stress or medications or even drink and foods.
In fact, stress reaction is probably the most common cause of a hot flash.
It is hazardous to diagnose menopause on hot flashes alone.
- Fear of pain with intercourse due to vaginal dryness can be improved by using pain medicines
- Less frequent intercourse will lead to less pain with subsequent intercourse
- The most common reason for decreased sexual desire after menopause is because of vaginal discomfort
- There is a natural decrease in sexual desire after menopause even if estrogen is replaced
- Sexual desire after menopause is usually not related to a woman's partner's desire
Pain medicines often decrease sexual desire and would not be used to treat the vaginal problems. It would be more likely to use estrogen therapy to treat the vaginal discomfort because the skin usually responds very well to it.
Painful intercourse can be more prominent after menopause because
decreased estrogens cause a thinning of the skin lining the
opening to the vagina (introitus) and the vagina itself. There
is decreased lubricating fluid and a loss of elasticity of the
vagina also which contributes to discomfort.
Women having frequent intercourse after the menopause (once a
week or more) tend to have less problems with vaginal discomfort
or pain even if they are not taking estrogen replacement. The
frequent vaginal friction seems to forestall skin thinning and a
loss of vaginal elasticity that takes place without estrogens.
Menopausal women who are having intercourse less than weekly and
who are not taking estrogen often have more and more difficulty
and pain with vaginal intercourse because the skin is so thin and
inelastic around the vaginal opening that it cracks and may even
bleed. It becomes like chapped lips and the opening may also
decrease in size over time.
In spite of all that is said about more vaginal discomfort after
menopause due to lack of estrogen, sexual desire is affected by
many other circumstances. Irritation or anger at one's partner
is probably the most common cause of decreased sexual desire at
any age. As women get older, they or their spouse may be on
medications that interfere with sexual desire. These factors are
usually more common than the fear of vaginal discomfort as a
cause of decreased sexual desire.
Beyond the physical changes caused by lack of estrogen, there is still a decreased level of sexual desire after the menopause that scientists cannot fully explain. This doesn't happen to all women but it happens enough that it affects many women, even if they are taking estrogen replacement and don't have the other life circumstances that are associated with decreased sexual desire such as:
- taking antidepressant, antihypertensive or pain medications
- having a partner who has decreased sexual desire or lack of sexual skills
- fear of intimacy
- previous sexual trauma
- religious beliefs containing sexual prohibitions
Incorrect Women have lower cholesterol values than men and have a lower incidence of heart attacks. The lower heart disease incidence is much more prominent before menopause than it is after menopause when women start catching up to men.
- estrogens cause blood clots
- estrogens decrease heart disease by 50%
- estrogens decrease good cholesterol blood levels
- estrogens increase the incidence of hypertension
- estrogens increase total cholesterol levels
In the premenopausal age range, estrogen containing oral contraceptives
increase blood clots in the legs and to the lungs. These are much higher
estrogen doses than are used after menopause. Postmenopausal estrogen
replacement is NOT associated with blood clots.
Most studies have shown that taking estrogen replacement (ERT) after menopause
reduces the new occurrence of heart disease by 50%. Since heart disease
is so common, estrogen replacment increases the life span of women as compared
to not taking any ERT. Even if there is a small increase in breast cancer
from ERT after many years (and it is not certain that this is so), the decrease
in death due to heart attacks far outweighs deaths due to any increased breast cancer.
Actually estrogen therapy increases good cholesterol or
high density lipoprotein. It is thought that this effect accounts for
about 25% of the decrease in heart disease due to estrogens. The cause of
the other 75% of the decrease in heart disease is unknown but it is postulated
to be by a direct effect of estrogen on the blood vessels.
The incidence of hypertension in women increases after menopause but
estrogen replacement dosen't cause this. In fact estrogen replacement may
slightly lower blood pressure. This is in contrast to the high doses of estrogens
in oral contraceptives which may increase blood pressure in premenopausal
Estrogen replacement therapy (ERT) after the menopause tends
to increase good cholesterol (high density lipoproteins) and
lower bad cholesterol (low density lipoproteins). Instead of the
net effect being no change, there is actually a lowering of total
cholesterol. When a postmenopausal woman starts on ERT, the cholesterol
is usually lowered by 15mg/dl, eg. 220 mg/dl to 205 mg/dl.
- depression is more common after the menopause
- estrogen replacement may lower the incidence of Alzheimer's disease
- estrogen replacement can reverse the bone loss of osteoporosis
- progestins added to estrogen replacement usually improves irritability symptoms
- overweight women are more likely to develop osteoporosis
Yes, there are studies that suggest all senile dementias, including
Alzheimer's disease, are decreased in menopausal women who take estrogens
versus those who do not. There are also studies that suggest that in general,
memory and concentration are also better in women taking estrogen replacement.
In general, bone loss is prevented by taking estrogen replacement but there isn't much, if any, more bone laid down. That is why many physicians advocate starting estrogen replacement immediately after menopause starts, in order to prevent the bone loss in the first place.
There is a suggestion by some studies that estrogen plus some of the other
nonhormonal osteoporosis prevention medicines can actually result in more
bone mass if they are both taken together. It remains to be seen if this combined
therapy will have a net result on prevention of spontaneous fractures.
Overweight women have greater bone mass similar to that of men because the
bones have been under more weight stress and lay down more calcium
accordingly. It is one of the few benefits of being overweight.
- addition of progestin to estrogen replacement therapy is likely to lower the incidence of breast cancer
- if breast cancer develops while taking estrogens, it is likely to develop in the 1st five years of taking the medicine
- estrogens increase the risk of breast cancer by 4 times (risk ratio 4.0 or more)
- there is a higher incidence of breast cancer during and immediately after pregnancy, which is a very high estrogen situation
- long term use of estrogen replacement therapy during the menopause may be associated with a small risk (risk ratio less than 2.0) of breast cancer
Most of the studies that show an increase in the risk of breast
cancer with estrogen replacement only show a small increase, not
a large increase. Risk ratios of positive studies are usually
There are enough studies that show a small, but real, increase in the incidence of breast cancer with the long term use of estrogen replacement after the menopause, especially after 5-10 years of use. It may be that this takes place only in women who are genetically susceptible but at the current time we are not sure.
We are sure that more women live longer because of the lower
incidence of heart disease when taking estrogen replacement and
that this decrease outweighs deaths due to an increase in breast
cancer. Any women taking estrogen replacement should have an
annual mammogram so that breast changes can be found early.
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