Chapter 4 — Postmenopausal Sonography

Question 1

These gradually become unresponsive to the gonadotropins as a women ages and stops producing progesterone estradiol and significant levels of estrogen. These also atrophy and decrease in size with disappearance of follicles over subsequent few years

Answer 1

Ovaries

Question 2

Menses become irregular and generally ceases between what year of age

Answer 2

45-55 years of age

Question 3

Postmenopausal bleeding may be due to what

Answer 3

Atrophic endometrium

Question 4

Normal anatomy sono findings
- uterine and cervical contours and proportions are maintained
- myometrium may have calcified arcuate arteries
- small amount of fluid in the endometrium cavity (hydrometric is considered normal in an asymptomatic patient this is often caused by cervical stenosis

Question 5

A normal endometrial stripe is less than _____ in asymptomatic patient

Answer 5

8mm
Asymptomatic = no vaginal bleeding

Question 6

Decreased estrogen levels = thinner or thicker endometrial stripe?

Answer 6

Thinner

Question 7

_____ mm is considered upper limits of normal, if there is a history of bleeding

Answer 7

4-5mm

Question 8

In patients receiving sequential estrogen/progesterone replacement, the endometrium resembles ____________ cyclic endometrium and measuring up to _____ mm

Answer 8

Pre-menopausal
8mm

Question 9

Administration of estrogen and progesterone may help alleviate some of the symptoms associated with menopause and can help prevent severe osteoporosis

Question 10

Unopposed estrogen is associated with increased risk of hyperplasia and endometrial carcinoma and typically not used without progesterone/progestins

Question 11

Women may take cycling (___________) doses of estrogen and progesterone which will cause the endometrium to ______ during the estrogen phase and ______ during the progesterone phase

Answer 11

Sequential
Thicken
Thin

Question 12

Some women are given continuous combination dowse of estrogen and progesterone; in those women the endometrium doesn’t cycle between thicker and thinner phases

Question 13

Sono findings with hormone replacement
- endo stripe up to 8mm of unopposed estrogen only
- endo stripe up to 10-12mm in estrogen phase decreases during progesterone phase ( us after progesterone withdrawal - after bleeding)
- cyclic hormones = menstrual type endo
- continuous combined hormones <8mm

Question 14

Bleeding from genitalia tract of an older women that occurs more than 12 months after LMP is considered

Answer 14

Postmenopausal bleeding

Question 15

Most common cause of postmenopausal bleeding is

Answer 15

Exogenous estrogen administration

Question 16

Most common cause of postmenopausal bleeding without
HRT (hormone replacement therapy) is

Answer 16

Endometrial atrophy

Question 17

More cause of postmenopausal bleeding
- endometrial carcinoma
- cervical carcinoma
- estrogen producing functional tumor of the ov (rare)

Question 18

This is a nonsteroidsl antiestrogen used as a chemotherapeutic agent on patients with certain types of breast cancer, it may cause changes in the endo increasing their risk for endometrial carcinoma

Answer 18

Tamoxifen