5 Flashcards
4 common symptoms of menopause
Hot flashes
Vasomotor symptoms
Atrophic vaginitis
Dyspareunia
What is benefit in HT for menopausal woman?
Prevention of osteoporosis, relief of vasomotor symptoms and atrophic vaginitis
5 reasons not to use HT in menopausal women?
1Cmbined 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.
- HT for menopausal symptoms should use the lowest effective doses for the shortest possible times.
Can HT increased risk of CAD and stroke?
YES
If you want to start HT, how can you decrease risk of endometrial cancer?
combined HT, unopposed estrogen is dangerous for endometrial growth
What age range is mammogram testing recommended?
50-74, every two years (shared decision making if to begin at 40 based on family history, risk factors, patient preference)
Age range for colon screening
50-75
When to do co-test pap smears?
30-65; co-test is every 5 years, could opt for cytology alone every 3 years
When can a woman stop having paps?
> 65 years old with two previously negative pap smears
When to screen for osteoporosis?
> 65 or woman younger with risk of > 65 year old based on calculator
A post-menopausal woman comes in with vaginal bleeding. What is on your differential?
Endometrial hyperplasia or cancer, proliferative endometrium, cervical polyps, hormone producing ovarian tumors
What are the risk factors for endometrial cancer?
•unopposed estrogen therapy •tamoxifen (Nolvadex) - Often used in women with breast cancer and has an estrogenic effect on the female genital tract. •obesity •anovulatory cycles •estrogen-secreting neoplasms •early menarche (before age 12) •late menopause (after age 52) •menstrual cycle irregularities •nulliparity age hypertension history of breast, colon cancer diabetes
What should be included in workup of postmenopausal bleeding?
CBC
TSH
Transvaginal US
Endometrial biopsy
What is a reassuring endometrial thickness?
<4/5 mm
What is the calculator used for osteoporosis risk?
FRAX score; helps determine if a women under 65 should get DEXA scan. If FRAX score is > 10% then advise for screening.
What is recommended supplementation for prevention of osteoporosis?
Calcium 1200 mg and Vit D 800-1000 U
In which bones do osteoporosis fractures commonly happen?
vertebrae, the hip, distal radius and proximal humerus
What T score is associated with osteopenia?
-1 to -2.5
Is a T score less than -2.5 diagnostic of osteoporosis?
YES
What are the available treatments for osteoporosis?
Alandronate
Parathyroid
Calcitonin
Raloxifene
What type of drug is Raloxifene?
Selective Estrogen Receptor Modulator (SERM)
What medication is first-line in treatment of osteoporosis?
Bisphosphonates like Alendronate
What medications are available for treatment of menopausal hot flashes?
HRT SSRIs SNRIs Gabapentin Clonidine
What is primary dysmenorrhea?
onset of painful menses without pelvic pathology
What is metrorrhagia?
irregular frequent bleeding but it doesn’t have to be heavy
A woman has lower quadrant pain that is worse midcycle. What is the likely etiology?
Ovarian cysts
Differential diagnosis for dysmenorrhea?
Adenomyosis
Chronic pelvic inflammatory disease
Endometriosis
Uterine Leiomyomas
How does a uterus with adenomyosis feel on physical exam?
The uterus is typically enlarged and diffusely boggy, but symmetric and should still be mobile.
What symptom helps differentiate endometriosis from leiomyoma?
Dyspareunia, common in endometriosis
A woman’s uterus feels “nobby” on exam. What diagnosis do you suspect and what symptom does she likely have?
Leiomyoma/fibroid, commonly presents with menorrhagia and dysmenorrhea
What do you recommend to decrease flow in a patient with menorrhagia?
Progestin only or combined hormone methods
If a woman gets N/V with combined OCP, what options would you suggest?
Nuva Ring or patch, passes GI system
What are 3 medications that can be used for premenstrual disorder?
Danazol (androgen medication with progesterone effects)
SSRIs during menses (fluoxetine, sertraline, venlafaxine)
OCPs
What are the indication for progesterone IUD mirena?
long-term birth control, menorrhagia, and potentially shrinking uterine volume in women with fibroids
