Exam 1 - Menopause Flashcards
Define menopause.
Permanent cessation of menses for 12 consecutive months
What are clinical manifestations of perimenopause?
- Irregular menses
- Vasomotor symptoms (hot flashes or night sweats)
- Mood symptoms (anxiety, depression)
- Vaginal dryness
- Changes in lipids and bone loss begin
What lab is suggestive of Perimenopause?
FSH > 25
At what age is menopause abnormal?
What is this due to?
Before 40 years of age
Primary ovarian insufficiency (premature ovarian failure)
What lab is suggestive of being post-menopausal?
FSH > 70
What are clinical manifestations of menopause?
- Irregular menses
- Vasomotor symptoms (if untreated, hot flashes stop within 4-5 years of onset)
- Mood symptoms
- Vaginal dryness
- Increased risk of osteoporosis, cardiovascular disease, and dementia
Describe vasomotor symptoms associated with menopause.
- Hot flush - sudden sensation of extreme heat in the upper body, particularly the face, neck, and chest lasting for several minutes
- Due to narrowing of thermoregulatory zone
What is the most effective therapy for vasomotor symptoms associated with menopause?
Systemic hormone therapy (HT)
How does HT therapy differ between in specific populations of women?
Estrogen only
- Women who have undergone hysterectomy
Combined estrogen with progestin
- Women with intact uterus
Why should women who still have a uterus not use estrogen alone without progestin?
- Can result in endometrial hyperplasia
- Increased risk of endometrial adenocarcinoma
For vasomotor symptoms, how long are women typically treated for with HT?
Shortest duration needed at lowest effective dose
Generally not more than five years or not beyond age 60 years
Compare the risks of using combined HT and estrogen only HT.
Combined HT:
- Slightly increased risk of breast cancer, CAD, stroke, and venous thromboembolic events
- Decreased risk of fractures and colon cancer
Estrogen Only HT:
- Increased risk of thromboembolic events
- No increased risk of cardiovascular events or breast cancer
What are some general risks of using HT for vasomotor symptoms?
Increase risk of thromboembolic disease and breast cancer
What are some contraindications of using hormone therapy?
- Breast cancer
- Coronary Heart Disease
- Previous venous thromboembolic event or stroke
- Active liver disease
- Unexplained vaginal bleeding
- High-risk endometrial cancer
- TIA
Why is progestin alone not considered a first-line therapy for the management of vasomotor symptoms?
Risk of breast cancer may be related to progestin use
What are the bioidentical hormones that are FDA regulated?
Micronized progesterone and estradiol
What are some non-hormonal medication options for the treatment of vasomotor symptoms?
- SSRIs (Paroxetine-FDA approved for hot flashes)
- SRNIs
- Antiepileptics/centrally-acting (Gabapentin, Lyrica, Clonidine)
What is Genitourinary Syndrome of Menopause?
All atrophic symptoms women may have in the vulvovaginal and bladder-urethral areas from loss of estrogen that occurs with menopause
What are some management options for vulvovaginal atrophy?
Water-soluble moisturizers and lubricants
Hormone Therapy
- Estrogen (local preferred)
- Estrogen Agonists and Estrogen Antagonists (Ospemifene)
What are some risk factors for osteoporosis?
- Advanced age
- Female sex
- Corticosteroid use (chronic)
- Low body weight
- Alcohol use
- Cigarette smoking
- FH of osteoporosis
- Vitamin D deficiency
What are some lifestyle measures for osteoporosis prevention?
- Weight bearing, resistance exercises, walking and aerobics
- Nutrition (Vitamin D and Calcium)
- Smoking cessation
- Avoid heavy alcohol use
What methods are used to diagnose osteoporosis?
Dual-energy X-ray absorptiometry (DXA)
- Measure bone density
- T-Score: of -2.5 or less
Fragility fracture at the spine, hip, wrist, humerus, rib, or pelvis (fractures occurring from a fall from standing height or less)
What T-scores are associated with normal, osteopenia, and osteoporosis?
Normal: -1.0 or greater
Osteopenia: Between -1.0 and -2.5
Osteoporosis: -2.5 or less
When should you start screening for osteoporosis in women?
Normal healthy women: Begin by age 65 years
Postmenopausal women with risk factors: Screen earlier
Which women are candidates for pharmacologic therapy for osteoporosis?
- Postmenopausal women with a history of hip or vertebral fracture
- Women with T score of -2.5 or less
- High-risk postmenopausal women with T scores between -1.0 and -2.5
What is the first-line pharmacologic therapy for osteoporosis?
Bisphosphonates (Fosamax, Actonel, Boniva, zoledronic acid)
What are some adverse effects of Bisphosphonates?
Upper GI tract, osteonecrosis of the jaw
Other than Bisphosphonates, what are some other pharmacological therapies for osteoporosis?
Selective Estrogen Receptor Modulators (SERMs)
- Inhibits bone resorption and decreases risk of vertebral fractures
- Reduces risk of breast cancer
Forteo
- Useful in severe cases, those who cannot take bisphosphonates, or refractory cases
Calcitonin
- Useful in short-term treatment of acute pain relief
- Less preferred
What are the different types of pelvic organ prolapse?
- Apical (uterovaginal, vaginal vault)
- Anterior compartment (cystocele)
- Posterior compartment (rectocele)
- Procidentia
What are some risk factors for pelvic organ prolapse?
- Parity (vaginal deliveries)
- Advancing age
- Obesity
- Connective tissue disorders
- Menopausal status
- Chronic disease (constipation, COPD)
What are the management options for pelvic organ prolapse?
- Expectant management
- Conservative management (pessary, pelvic floor muscle exercises)
- Surgical treatment (sacrocolpopexy, anterior anterior repair, posterio repair, obliterative)
When is surgical treatment for pelvic organ prolapse considered?
Symptomatic prolapse who failed or declined conservative management
Which POP surgery involves plication to vaginal tissue to the midline to reduce the bulging rectum?
Posterio Repair
Which POP surgery involves attachment of vagina or cervix to the anterior longitudinal ligament of the sacrum?
Sacrocolpopexy
Which POP surgery involves plication to vaginal tissue to the midline to reduce the bulging bladder?
Anterior repair
When is POP urgent/emergent?
Almost never
Exception is in the case of urinary retention or obstructive nephropathy
- Place indwelling catheter
- Urogyn consult with for either pessary or surgery
