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Women's Health > Exam 1 - Menopause > Flashcards

Exam 1 - Menopause Flashcards

1
Q

Define menopause.

A

Permanent cessation of menses for 12 consecutive months

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2
Q

What are clinical manifestations of perimenopause?

A
  • Irregular menses
  • Vasomotor symptoms (hot flashes or night sweats)
  • Mood symptoms (anxiety, depression)
  • Vaginal dryness
  • Changes in lipids and bone loss begin
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3
Q

What lab is suggestive of Perimenopause?

A

FSH > 25

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4
Q

At what age is menopause abnormal?

What is this due to?

A

Before 40 years of age

Primary ovarian insufficiency (premature ovarian failure)

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5
Q

What lab is suggestive of being post-menopausal?

A

FSH > 70

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6
Q

What are clinical manifestations of menopause?

A
  • 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
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7
Q

Describe vasomotor symptoms associated with menopause.

A
  • 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
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8
Q

What is the most effective therapy for vasomotor symptoms associated with menopause?

A

Systemic hormone therapy (HT)

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9
Q

How does HT therapy differ between in specific populations of women?

A

Estrogen only
- Women who have undergone hysterectomy

Combined estrogen with progestin
- Women with intact uterus

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10
Q

Why should women who still have a uterus not use estrogen alone without progestin?

A
  • Can result in endometrial hyperplasia

- Increased risk of endometrial adenocarcinoma

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11
Q

For vasomotor symptoms, how long are women typically treated for with HT?

A

Shortest duration needed at lowest effective dose

Generally not more than five years or not beyond age 60 years

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12
Q

Compare the risks of using combined HT and estrogen only HT.

A

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
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13
Q

What are some general risks of using HT for vasomotor symptoms?

A

Increase risk of thromboembolic disease and breast cancer

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14
Q

What are some contraindications of using hormone therapy?

A
  • Breast cancer
  • Coronary Heart Disease
  • Previous venous thromboembolic event or stroke
  • Active liver disease
  • Unexplained vaginal bleeding
  • High-risk endometrial cancer
  • TIA
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15
Q

Why is progestin alone not considered a first-line therapy for the management of vasomotor symptoms?

A

Risk of breast cancer may be related to progestin use

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16
Q

What are the bioidentical hormones that are FDA regulated?

A

Micronized progesterone and estradiol

17
Q

What are some non-hormonal medication options for the treatment of vasomotor symptoms?

A
  • SSRIs (Paroxetine-FDA approved for hot flashes)
  • SRNIs
  • Antiepileptics/centrally-acting (Gabapentin, Lyrica, Clonidine)
18
Q

What is Genitourinary Syndrome of Menopause?

A

All atrophic symptoms women may have in the vulvovaginal and bladder-urethral areas from loss of estrogen that occurs with menopause

19
Q

What are some management options for vulvovaginal atrophy?

A

Water-soluble moisturizers and lubricants

Hormone Therapy

  • Estrogen (local preferred)
  • Estrogen Agonists and Estrogen Antagonists (Ospemifene)
20
Q

What are some risk factors for osteoporosis?

A
  • Advanced age
  • Female sex
  • Corticosteroid use (chronic)
  • Low body weight
  • Alcohol use
  • Cigarette smoking
  • FH of osteoporosis
  • Vitamin D deficiency
21
Q

What are some lifestyle measures for osteoporosis prevention?

A
  • Weight bearing, resistance exercises, walking and aerobics
  • Nutrition (Vitamin D and Calcium)
  • Smoking cessation
  • Avoid heavy alcohol use
22
Q

What methods are used to diagnose osteoporosis?

A

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)

23
Q

What T-scores are associated with normal, osteopenia, and osteoporosis?

A

Normal: -1.0 or greater

Osteopenia: Between -1.0 and -2.5

Osteoporosis: -2.5 or less

24
Q

When should you start screening for osteoporosis in women?

A

Normal healthy women: Begin by age 65 years

Postmenopausal women with risk factors: Screen earlier

25
Q

Which women are candidates for pharmacologic therapy for osteoporosis?

A
  • 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
26
Q

What is the first-line pharmacologic therapy for osteoporosis?

A

Bisphosphonates (Fosamax, Actonel, Boniva, zoledronic acid)

27
Q

What are some adverse effects of Bisphosphonates?

A

Upper GI tract, osteonecrosis of the jaw

28
Q

Other than Bisphosphonates, what are some other pharmacological therapies for osteoporosis?

A

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
29
Q

What are the different types of pelvic organ prolapse?

A
  • Apical (uterovaginal, vaginal vault)
  • Anterior compartment (cystocele)
  • Posterior compartment (rectocele)
  • Procidentia
30
Q

What are some risk factors for pelvic organ prolapse?

A
  • Parity (vaginal deliveries)
  • Advancing age
  • Obesity
  • Connective tissue disorders
  • Menopausal status
  • Chronic disease (constipation, COPD)
31
Q

What are the management options for pelvic organ prolapse?

A
  • Expectant management
  • Conservative management (pessary, pelvic floor muscle exercises)
  • Surgical treatment (sacrocolpopexy, anterior anterior repair, posterio repair, obliterative)
32
Q

When is surgical treatment for pelvic organ prolapse considered?

A

Symptomatic prolapse who failed or declined conservative management

33
Q

Which POP surgery involves plication to vaginal tissue to the midline to reduce the bulging rectum?

A

Posterio Repair

34
Q

Which POP surgery involves attachment of vagina or cervix to the anterior longitudinal ligament of the sacrum?

A

Sacrocolpopexy

35
Q

Which POP surgery involves plication to vaginal tissue to the midline to reduce the bulging bladder?

A

Anterior repair

36
Q

When is POP urgent/emergent?

A

Almost never

Exception is in the case of urinary retention or obstructive nephropathy

  • Place indwelling catheter
  • Urogyn consult with for either pessary or surgery

Women's Health (5 decks)

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