Dunn OB/GYN XI Flashcards
50yo F LMP 3 weeks ago
- bleeding everyday since last period - 1 pad/day
- irregular periods last year
- hot flashes, fatigue, cranky
- 20 pack years smoker
labs - CBC, TSH, FSH, preg test, pap, endometrial bx
menopausal**
tx of menopause
HRT
perimenopause
time leading up to menopause
ovarian function and hormone production declining but not stopped
menopause
permanent cessation of menstrual cycle
not having period 12 months
post menopause
time in womens life after last period
premature menopause
before age 40
median age perimenopause
47
average age reach menopause
51
menopause changes
vasomotor sx sleep quality mood change urogenital symptoms sexual disinterest skin changes
hot flashes
may continue years after menopause
with decreased estrogen at menopause
bone loss/osteoporosis - HRT tx (estrogen)
more CV disease
decreased progesterone
irregular periods
PMS
decreased androgens at menopause
mood energy libido muscle weak osteopenia
HRT
does not increase cardiovascular disease if started within 5 years of menopause
risks of HRT
VTE -very low
greatest risk of venous thrombolic events - 1st year of use of HRTs
associated with menopause
coronary heart disease
osteoporosis
breast ca, colon ca, dementia
coronary artery disease
HRT reduced risk of death
age of initiation of HRT
important in determining cardiovascular risk
dementia
estrogen taken early in menopause is protective**
breast cancer
HRT no different risk - E/P
estrogen only hormone therapy
different risk for breast ca
protect against breast ca
unopposed estrogen
route of admin
transdermal vs. oral
less VTE - patch use
no CV disease risk difference with two routes of admin
mild vasomotor symptoms
lifestyle changs
isoflavones
black cohosh
vit E
moderate to severe vasomotor symptoms
HRT - gold standard**
SSRIs and gabapentin
progesterone
clonidine
no estrogen
osteoporosis
24yo F G0 LMP 3 months ago
- CC irregular periods
- denies pain with menses
- very heavy period
- obese
- fam hx DM II
- acne and virilization
- acanthosis nigricans
amenorrhea with irregular menses
hCG - pregnancy test first
TSH, LH, FSH, PRL
US
androgen levels
string of pearls on US and high testosterone levels
acne and virilization with acanthosis nigricans
high androgens
string of pearls
PCOS
US finding
diagnosis of PCOS
rotterdam criteria - need 2 of 3
oligoovulation/anovulation
excess androgen activity
polycystic ovaries on US
PCOS
don’t need an US
-can diagnose clinically
PCOS pathology
high levels of testosterone
and estrogen
don’t ovulate - so make estrogen - lots of estrone - increase LH production (positive feedback)
FSH not depressed - follicular growth stimulated
follicules last several month
feedback - LH high and FSH low - no surge
causes of PCOS
dont know
maybe insulin
maybe inflammation
maybe genetics
maybe fetal androgen exposure
complications of PCOS
abnormal bleeding infertility risk endometrial cancer incrased CRP metabolic syndrome DM II, HTN, HLD,
tx of PCOS
patient - contraception - give contraception
patient - bleeding - progesterone daily to cause endometrial shedding
patient - hirsutism - oral contraceptive suppress ovarian and adrenal production
