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RDS Test 1 > B8-027 CBCL Menopause > Flashcards

B8-027 CBCL Menopause Flashcards

1
Q

menopause is confirmed after […] of no menstrual bleeding

A

1 year

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2
Q

premature menopause occurs before age […]

A

40

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3
Q

perimenopause begins with variation in cycle greater than […] days associated with increased […]

A

seven
FSH

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4
Q

which phase of menopause is the most symptomatic for women?

A

perimenopause

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5
Q

average age of onset of menopause

A

51

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6
Q

FSH consistently elevated over […] is considered diagnostic for menopause

A

30

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7
Q

menopause before age 40 suggests

A

primary ovarian failure

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8
Q

cause early induction of menopause

A

radiation
chemotherapy
bilateral oophorectomy

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9
Q

source of estrogen after menopause

A

peripheral conversion of androgens

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10
Q

what would you expect to see for FSH, LH, GnRH, and estrogen in a menopausal female?

A

FSH very high
LH high (no surge)
estrogen low
GnRH high

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11
Q

symptoms of menopause

A

Hot flashes
Atrophy of
Vagina
Osteoporosis
Coronary artery disease
Sleep disturbances

causes HAVOCS

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12
Q

how can early menopause result in shorter cycles?

A

as follicles decrease –> decreased inhibin –> less negative feedback on hypothalamus –> more FSH released

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13
Q

when the cycle length shortens, it is called

A

LOOP: luteal out of phase

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14
Q

what leads to the loss of LH surge in menopause?

A

GnRH pulses slow, but more GnRH is released
alterations of GnRH pulse cause this

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15
Q

is AMH useful in predicting when menopause will occur?

A

no

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16
Q

in premenopause […] is the dominate estrogen type
however, in post menopause it is […]

A

estradiol
estrone (formed via peripheral metabolism)

(ratio reverses after menopause)

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17
Q

most common cause of AUB

A

bleeding due to anovulation

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18
Q

in the workup of AUB endometrial biopsy is important to rule out [2]

A

endometrial hyperplasia
malignancy

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19
Q

most common symptom of menopause

A

sudomotor symptoms (hot flashes)

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20
Q

physiologic mechanism of hot flashes

A

estrogen narrows the thermoneutral zone

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21
Q

serum estrogen levels [are/are not] predictive of hot flash frequency

A

are not

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22
Q

treatment of hot flashes

A

lifestyle modifications
SSRI, gabapentin, clonidine

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23
Q

the sudomotor symptoms of menopause tend to […] over time, while the vulvo-vaginal symptoms […]

A

get better
progressively worsen

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24
Q

people with surgical menopause [are/are not] considered to have POI

A

are not

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25
Q

diagnosis of POI requires a minimum of […] bleeding abnormally and at least […] FSH levels drawn at least 1 months apart

A

4 months
2

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26
Q

why should patients with POI not desiring pregnancy still be on contraception?

A

ovary can occasionally ovulate

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27
Q

HT used to protect women with a uterus from endometrial cancer

A

estrogen-progesterone therapy

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28
Q

HT consisting of hormones chemically identical or very similar to those made in the body

A

bioidentical hormone therapy

(generally not recommended by ACOG unless dosing is not commercially available or there is an allergy)

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29
Q

HT useful for perimenopausal transition to treat symptoms and prevent bleeding and pregnancy

A

hormone contraception

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30
Q

primary estrogen during reproductive years

A

estradiol

31
Q

primary estrogen circulating after menopause

A

estrone

32
Q

estrogen produced primarily by the placenta during pregnancy

A

estriol

33
Q

estrogen that comes from granulosa cells in dominant follicles

A

estradiol

34
Q

estrogen that comes from aromatization in body fat

A

estrone

35
Q

estrogen found in estrogen containing contraceptives

A

ethinyl estradiol

36
Q

used to prevent endometrial cancer in women on estrogen therapy

A

progesterone

37
Q

hormonal contraception is contraindicated in women over […] who smoke

A

35

38
Q

menopausal EPT will not suppress ovulation in perimenopausal women and can result in […]

A

unpredictable bleeding

39
Q

factors to consider in duration of HT use

A

severity of symptoms
effectiveness of other treatments
risk of osteoporosis
risk of CAD
risk of cerebrovascular event
risk of DVT
risk of breast cancer

40
Q

does EPT or ET have a higher risk of breast cancer?

A

EPT

41
Q

effect of oral estrogen on liver

A

increases fibrinogen, factors VII and X, triglycerides, and platelet aggregation

decreases: antithrombin III

42
Q

there is less risk of thromboembolism with […] estrogen delivery

A

non-oral

(transdermal)

43
Q

women who initiate HT older than […] are at a higher risk of cardiac event

A

60

44
Q

there is some evidence that ET has antidepressant effects in what phase of menopause?

A

perimenopausal

45
Q

mood changes are a side effect of […] therapy that can worsen in patients with PMS or PMDD

A

progestin

46
Q

in women with POI, it is recommended to continue HT until

A

average age of menopause

47
Q

system of nomenclature for reproductive aging

A

STRAW staging system

48
Q

evaluation of AUB after age 45 should include [3]

A

endometrial biopsy
transvaginal US
pregnancy test

49
Q

3 major hormones synthesized in the ovary

A

estrogen
progesterone
testosterone

50
Q

adverse effects of exogenous estrogen [4]

A

DVT
stroke
endometrial cancer
postmenopausal bleeding

51
Q

absolute contraindications for estrogen therapy

A

breast cancer
thromboembolic event
CVD

52
Q

vasomotor symptoms typically occurs in […] menopause

A

early

53
Q

urogenital atrophy typically occurs in […] menopause

A

late-post menopause

54
Q

term used to describe menopausal transition and 12 months after FMP

A

perimenopause

55
Q

menopause that occurs before age 40

A

premature menopause

56
Q

does an ovarian sparing hysterectomy carry the risk of early menopause?

A

yes, hastens menopause by 2-3 years

57
Q

major hormones secreted by the ovary during the follicular phase

A

estradiol
inhibin B

58
Q

predominant hormone secreted by the ovary in the luteal phase

A

progesterone

59
Q

what can early follicular phase FSH tell you about a patient’s ovarian reserve?

A

an ovary with a decreasing number of follicles will release lower levels of inhibin, so early follicular phase FSH will be elevated

60
Q

risk factors of endometrial cancer [4]

A

age
obesity
infertility
unopposed estrogen

61
Q

risk factors for increased vasomotor symptoms [3]

A

obesity
smoking
decreased physical activity

62
Q

caffeine, smoking, and spicy foods can worsen […] symptoms

A

vasomotor

63
Q

what would you expect to see on histologic examination of the vaginal epithelium during menopause?

A

loss of mature epithelial cells
increase in parabasal cells

64
Q

first line treatment for women with genitourinary syndrome

A

lubricants/moisturizers

(then low dose estrogen if those don’t work)

65
Q

second line treatment for women with genitourinary syndrome

A

vaginal estrogen cream

66
Q

levonorgestrel-releasing intrauterine system (Mirena) is FDA approved for contraception and […]

A

abnormal uterine bleeding

67
Q

often used in peri-menopause to regulate menses and help with vasomotor symptoms while providing contraception

A

oral contraceptive pills

68
Q

[…] estrogen therapy is associated with a higher risk of DVT

A

oral

69
Q

risk of DVT with estrogen therapy [is/is not] dose dependent

A

is

70
Q

paroxetine is FDA approved to treat […] symptoms without risk of thromboemolic event

A

vasomotor

71
Q

unopposed estrogen increases risk for

A

endometrial cancer

72
Q

if a patient has both vasomotor symptoms and GSM, what is the best treatment option?

A

systemic non-oral ET (patch) and progestin

73
Q

start […] estrogen therapy for GSM only symptoms

A

local

(cream or vaginal ring)

RDS Test 1 (23 decks)

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