318 Obstetrics and Gynecology Board Review •••
❍ Although the ovary produces increased testosterone in menopause, why is the total amount of testosterone
not increased?
Androstenedione is reduced, adrenal testosterone is reduced, and sex hormone binding globulin (SHBG) levels
are reduced.
❍ Does serum testosterone change over the menopausal transition?
No.
❍ What is the cause of mild hirsutism in menopause?
Increased free androgen to estrogen ratio as a result of decreased SHBG and estrogen.
❍ What increases aromatization of androgens to estrogens?
Age and weight. Aromatase activity increases twofold in the perimenopausal period and adipose tissue is a rich
source of aromatase.
❍ In which tissues has aromatase been identified?
Liver, fat, muscle, and certain hypothalamic nuclei.
CARDIOVASCULAR DISEASE
❍ What is the leading cause of death for women?
Heart disease, followed by malignancies, cerebrovascular disease, and motor vehicle accidents.
❍ How many deaths are attributed to cardiovascular disease in women over 50?
50%.
❍ What is the risk of heart disease after menopause compared with premenopause?
Twice the risk.
❍ What are the risk factors for cardiovascular disease?
Hypertension, smoking, diabetes, hypercholesterolemia, obesity, and family history.
❍ Does the onset of heart disease occur at the same age in men as it does in women?
No. Typically the onset of heart disease occurs 10 years later in women. Similarly, myocardial infarction and
sudden death typically occur 20 years later in women than in men.
❍ What cholesterol fraction is associated with atherosclerosis in women?
High-density lipoprotein (HDL) is more closely associated than low-density lipoprotein (LDL).
❍ How important are triglycerides in predicting coronary risk?
Triglycerides are uniquely predictive in older women, especially at levels above 400 mg/dL.