B8.027 Prework 4: Clinical Issues of Menopause

Question 1

classic symptoms of menopause

Answer 1

change in menstrual cycle patterns
vasomotor symptoms
vulvovaginal symptoms, dyspareunia

Question 2

other symptoms sometimes associated with menopause

Answer 2

cognitive concerns (memory, concentration)
pscyhological symptoms (depression, anxiety, moodiness)

Question 3

body changes seen in menopause

Answer 3

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

Question 4

pattern of decline in fertility

Answer 4

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

Question 5

menstrual bleeding changes in menopause

Answer 5

changes are common and usually normal:
lighter bleeding
heavier bleeding
duration of bleeding
cycle length
skipped periods

Question 6

definition of AUB

Answer 6

bleeding between periods
bleeding after sex
spotting anytime in cycle
bleeding heavier or for more days than normal
bleeding after menopause

Question 7

categories of AUB

Answer 7

heavy
OR
intermenstrual

Question 8

classes of causes of AUB

Answer 8

structural
OR
nonstructural

Question 9

structural causes of AUB

Answer 9

polyp
adenomyosis
leiomyoma
malignancy and hyperplasia

Question 10

nonstructural causes of AUB

Answer 10

coagulopathy
ovulatory dysfunction
endometrial
iatrogenic
not yet classified

Question 11

diagnostic workup for AUB

Answer 11

h&p
blood tests: CBC, TSH
endometrial biopsy
vaginal US

Question 12

US measurement of endometrial thickness in AUB

Answer 12

limited value in premenopausal women (changes w cycle in response to hormone changes)

Question 13

endometrial biopsy in AUB

Answer 13

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

Question 14

results of endometrial biopsy

Answer 14

highly accurate is cancer occupies >50% of cavity

+ test more accurate for ruling in than a - test for ruling out (PPV > NPV)

Question 15

causes of bleeding during postmenopaure

Answer 15

vulvar lesions
urethral caruncles
cervix (friable, polyps, neoplasia)
vaginal (lesions, atrophy)
uterine (fibroids, polyps, malignancy)
anal/rectal sources
HT

Question 16

when should you evaluate for malignancy/ hyperplasia in HT with bleeding

Answer 16

if lasts > 6 months

Question 17

stepwise analysis of endometrial tissue

Answer 17

1. transvaginal US to measure thickness of endometrium or find other structural abnormalities
2. if endometrium >4mm or not visualized, proceed with biopsy
3. if abnormality identified, consider surgery

Question 18

what are vasomotor symptoms

Answer 18

recurrent, transient episodes of flushing accompanied by a sensation of warmth to intense heat on the upper body and face/head

Question 19

prevalence of hot flashed

Answer 19

75% of women get them within 2 years around menopause
primary reason for seeking medical treatment
25% remain symptomatic >5 years

Question 20

mechanisms of vasomotor symptoms

Answer 20

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

Question 21

factors contributing to hot flashes

Answer 21

warm environment, hot drinks, spicy foods, stress, higher BMI, cigarette smoking, alcohol
drugs: SERMs, SSRIs, aromatase inhibitors
disease conditions

Question 22

are serum E levels predictive of hot flash frequency?

Answer 22

nah

Question 23

treatment of hot flashes

Answer 23

based on severity, risk factors, and personal preferences

1. lifestyle mods
2. nonhormonal therapies (SSRI, gabapentin, clonidine)
3. HT

Question 24

vulvovaginal changes of menopause

Answer 24

loss of E and inflammation and tissue changes in the vaginal microbiome increase vaginal pH from an acidic environment to an alkaline one

Question 25

vaginal atrophy in menopause

Answer 25

loss of mature superficial cells in post menopausal vaginal epithelium
higher proportion of parabasal cells
less wavy

Question 26

symptoms of vulvovaginal changes

Answer 26

dryness, irritation/itching, and dyspareunia experienced by 10-40%
can be progressive and unlikely to resolve on its own

Question 27

treatments for vulvovaginal symptoms

Answer 27

regular sexual activity
lubricants and moisturizers
local vaginal estrogen

Question 28

HT in vulvovaginal symptoms

Answer 28

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

Question 29

HT effects on sexual function

Answer 29

doesnt really affect it unless its because its helping the dryness and stuff

Question 30

STIs in menopause

Answer 30

women still at risk

vaginal atrophy increases the risk