17- post-menopausal bleeding

Question 1

benefits of HRT

Answer 1

decrease hot flashes
improve atrophic vaginitis
prevent osteroporosis

Question 2

risks of HRT

Answer 2

Combined estrogen and progestogen use beyond three years increases the risk of breast cancer.

Use of unopposed systemic estrogen in women with a uterus increases endometrial cancer risk.

Beginning HT after age 60 increases the risk of coronary artery disease.

HT increases the risk of stroke at least for the first one to two years of use.

Question 3

best practice of HRT

Answer 3

HT for menopausal symptoms should use the lowest effective doses for the shortest possible times.

individualize each scenario

Question 4

what is most common in postpartum and perimenopausal women to cause AUB?

Answer 4

cervical polyps

Question 5

do ovarian cancers cause post-men bleeding

Answer 5

rarely

Question 6

Other possible symptoms of ovarian cancer include

Answer 6

pelvic or abdominal pain, increase in abdominal size or bloating, and difficulty eating or feeling full.

Question 7

Other possible causes of abnormal uterine bleeding (non-endometrial/cervical)

Answer 7

medications (including anticoagulants, selective serotonin reuptake inhibitors, antipsychotics, corticosteroids, and hormonal medications)

disorders involving the thyroid, hematologic, hepatic, adrenal, pituitary, and hypothalamic systems.

Question 8

Physical Examination for Abnormal Uterine Bleeding

Answer 8

Pelvic Exam: Look for vulvar or vaginal lesions, signs of trauma, and cervical polyps or dysplasia. On bimanual examination, assess the size and mobility of her uterus, as a firm, fixed uterus would be concerning for uterine cancer.

Neck Exam: Thyroid exam to look for goiter or nodules, as thyroid disease is one of several systemic diseases that can cause dysfunctional uterine bleeding.

Skin Exam: Look for evidence of bleeding disorders, like bruises. Also, jaundice on skin exam and hepatomegaly on abdominal exam might signify an underlying acquired coagulopathy via liver disease.

Question 9

Symptoms & Findings of Atrophic Vaginitis

Answer 9

Symptoms: Vaginal dryness, dyspareunia, urinary symptoms ( urge incontinence and recurrent urinary tract infections) and vaginal pruritis

Physical exam findings: Smoother vaginal mucosa and cervix, related to postmenopausal changes from decreased estrogen levels.

Question 10

treat atrophic vaginitis

Answer 10

topical estrogen- helps all the symptoms

Question 11

risk factors- endometrial cancer

Answer 11

unopposed estrogen therapy
tamoxifen 
obesity, HTN
anovulatory cycles
estrogen-secreting neoplasms
early menarche (before age 12)
late menopause (after age 52)
menstrual cycle irregularities
nulliparity

Question 12

Evaluation of Postmenopausal Abnormal Bleeding in Women

Answer 12

B. Transvaginal ultrasound- thickness of the endometrium. , fibroids

C. Endometrial biopsy- gold standard

D. Complete blood count- anemia, thrombocytopenia

E. Thyroid-stimulating hormone (TSH) level- thyroid disorders can cause AUB

Question 13

what endometrium thickness is reassuring

Answer 13

<4mm

Question 14

traetments for osteoporosis

Answer 14

**bisphosphonates

Parathyroid Hormone (Forteo)- costly

Raloxiphen- SERM-when bisphosphonates not tolerated

Calcitonin- vertebral fractures only

Question 15

Management of Hot Flashes

Answer 15

hormone therapy (if minimal risk)

SSRIS, SNRIS

clonidine, gabapentin

no naturapthic shit :(

Question 16

what are alternative remedies that have been found to be at least possibly effective for treatment of hot flashes.

Answer 16

Soy, black cohosh, flaxseed, and St. John’s Wart

Question 17

what is used as an alternative remedy for depression/anxiety, erectile dysfunction, and vertigo.

Answer 17

Ginkgo biloba

Question 18

Use of combined estrogen and progesterone beyond how many years increases the risk of breast cancer.

Answer 18

3 years

Question 19

Beginning HRT after what age increases the risk of coronary artery disease.

Answer 19

60