B8.027 Prework 4: Clinical Issues of Menopause Flashcards
classic symptoms of menopause
change in menstrual cycle patterns
vasomotor symptoms
vulvovaginal symptoms, dyspareunia
other symptoms sometimes associated with menopause
cognitive concerns (memory, concentration) pscyhological symptoms (depression, anxiety, moodiness)
body changes seen in menopause
average weight gain of 5 lbs 30% decline in skin collagen within 5 years female pattern hair loss sleep changes urinary incontinence changes in sexual function
pattern of decline in fertility
wanes in mid 30s
by age 45, risk of spontaneous miscarriage 50%
risk of child with congenital anomaly increases dramatically
spontaneous pregnancy still possible until 1 year after FMP
menstrual bleeding changes in menopause
changes are common and usually normal: lighter bleeding heavier bleeding duration of bleeding cycle length skipped periods
definition of AUB
bleeding between periods bleeding after sex spotting anytime in cycle bleeding heavier or for more days than normal bleeding after menopause
categories of AUB
heavy
OR
intermenstrual
classes of causes of AUB
structural
OR
nonstructural
structural causes of AUB
polyp
adenomyosis
leiomyoma
malignancy and hyperplasia
nonstructural causes of AUB
coagulopathy ovulatory dysfunction endometrial iatrogenic not yet classified
diagnostic workup for AUB
h&p
blood tests: CBC, TSH
endometrial biopsy
vaginal US
US measurement of endometrial thickness in AUB
limited value in premenopausal women (changes w cycle in response to hormone changes)
endometrial biopsy in AUB
1st line in women with AUB after 45
use in younger women w a history of unopposed estrogen (obesity, PCOS), failed medical management, persistent AUB
results of endometrial biopsy
highly accurate is cancer occupies >50% of cavity
+ test more accurate for ruling in than a - test for ruling out (PPV > NPV)
causes of bleeding during postmenopaure
vulvar lesions urethral caruncles cervix (friable, polyps, neoplasia) vaginal (lesions, atrophy) uterine (fibroids, polyps, malignancy) anal/rectal sources HT
when should you evaluate for malignancy/ hyperplasia in HT with bleeding
if lasts > 6 months
stepwise analysis of endometrial tissue
- transvaginal US to measure thickness of endometrium or find other structural abnormalities
- if endometrium >4mm or not visualized, proceed with biopsy
- if abnormality identified, consider surgery
what are vasomotor symptoms
recurrent, transient episodes of flushing accompanied by a sensation of warmth to intense heat on the upper body and face/head
prevalence of hot flashed
75% of women get them within 2 years around menopause
primary reason for seeking medical treatment
25% remain symptomatic >5 years
mechanisms of vasomotor symptoms
not understood well
small fluctuations in core body temp superimposed on an extremely narrow thermoneutral zone
triggered when core body temp rises above upper (sweating) threshold or drops below lower (shivering) threshold
factors contributing to hot flashes
warm environment, hot drinks, spicy foods, stress, higher BMI, cigarette smoking, alcohol
drugs: SERMs, SSRIs, aromatase inhibitors
disease conditions
are serum E levels predictive of hot flash frequency?
nah
treatment of hot flashes
based on severity, risk factors, and personal preferences
- lifestyle mods
- nonhormonal therapies (SSRI, gabapentin, clonidine)
- HT
vulvovaginal changes of menopause
loss of E and inflammation and tissue changes in the vaginal microbiome increase vaginal pH from an acidic environment to an alkaline one
vaginal atrophy in menopause
loss of mature superficial cells in post menopausal vaginal epithelium
higher proportion of parabasal cells
less wavy
symptoms of vulvovaginal changes
dryness, irritation/itching, and dyspareunia experienced by 10-40%
can be progressive and unlikely to resolve on its own
treatments for vulvovaginal symptoms
regular sexual activity
lubricants and moisturizers
local vaginal estrogen
HT in vulvovaginal symptoms
E proven to restore vaginal blood flow, decrease vaginal pH, and improve the thickness ad elasticity of vulvovaginal tissue
can use low dose local E if vasomotor symptom relief or osteoporosis prevention is not required
HT effects on sexual function
doesnt really affect it unless its because its helping the dryness and stuff
STIs in menopause
women still at risk
vaginal atrophy increases the risk
