Gyneatrics Flashcards
1
Q
Define perimenopause and menopause
A
Perimenopause is the phase prior to menopause, also known as the menopausal transition or climacteric period. Menopause is defined as the cessation of menses.
2
Q
What is the average age of menopause in the U.S.?
A
51.4 years-old
3
Q
What is the term for natural menopause before age 40?
A
Premature Ovarian Insufficiency (POI)
4
Q
What are common symptoms associated with menopause?
A
- Hot Flashes
- Atrophy of the Vagina
- Osteoporosis
- Coronary Artery Disease
- Sleep Disturbance
5
Q
What hormonal changes occur during menopause?
A
Decrease in estrogen levels results in increased gonadotrophin levels (FSH and LH)
6
Q
What are the typical lab findings during menopause?
A
- Elevated FSH
- Elevated LH
- Decreased estradiol
- Decreased progesterone
7
Q
What is the most common symptom of menopause?
A
Hot flushes
8
Q
What psychological changes may occur during menopause?
A
- Depression
- Mood swings
- Libido changes
- Concentration difficulties
- Insomnia
9
Q
What lifestyle modifications are recommended for menopausal patients?
A
- Increase regular exercise
- Adequate diet (calcium and vitamin D)
- Smoking cessation
- Decrease alcohol intake
- Stress reduction techniques
10
Q
What is the first-line treatment for menopausal symptoms?
A
Lifestyle modifications
11
Q
What is the role of Hormone Therapy (HT) in treating menopausal symptoms?
A
HT reduces vasomotor symptoms, improves vaginal mucosa, and stabilizes bone loss in osteoporosis
12
Q
What are the long-term effects of estrogen loss?
A
- Cardiovascular disease
- Osteoporosis
- Increased colon cancer risk
- Impaired cognition
13
Q
What are the types of osteoporosis?
A
- Type 1: Mostly affects trabecular bone
- Type 2: Affects both trabecular and cortical bone
14
Q
What is the impact of smoking on menopause?
A
Smoking results in experiencing menopause on average 2 years earlier.
15
Q
What is the significance of post-menopausal bleeding?
A
Any vaginal bleeding that occurs after menses has ceased for 12 months is considered abnormal until proven otherwise.
16
Q
What are the common causes of post-menopausal bleeding?
A
- Exogenous estrogens (30%)
- Atrophic endometritis/vaginitis (30%)
- Endometrial cancer (5-10%)
- Endometrial/endocervical polyps (10%)
17
Q
What is the gold standard for endometrial sampling?
A
Dilation and curettage
18
Q
What is the role of selective estrogen receptor modulators (SERMs) in menopause treatment?
A
SERMs like Raloxifene and tamoxifen do NOT prevent osteoporosis but do still exhibit estrogen-like effects for osteoporosis management.
19
Q
What dietary recommendations are given for osteoporosis treatment?
A
Daily calcium intake of 1000 mg/day and Vitamin D supplement of 400-2000 IU/day.
20
Q
What is the most common cause of death in women related to menopause?
A
Cardiovascular disease
21
Q
What are the potential risks associated with Hormone Therapy?
A
Increased risk of breast cancer, DVTs, stroke, and dementia.
22
Q
What is the average duration of hot flushes during menopause?
A
1-7 years on average
23
Q
What factors may influence the variability of menopausal symptoms?
A
- Racial and/or ethnic differences
- Physiological differences
- Diet
- Socioeconomic status
- Smoking
24
Q
What is the gold standard for endometrial sampling?
A
Dilation and curettage (D&C)
D&C is a surgical procedure to remove tissue from the inside of the uterus.
25
What is the significance of an endometrial stripe greater than 4mm?
Warrants endometrial biopsy or sampling
## Footnote
A thicker endometrial stripe may indicate abnormal growth or pathology.
26
What are the supported treatments for night sweats and hot flashes according to the North American Menopause Society?
CBT, Hypnosis, SSRIs
## Footnote
Cognitive Behavioral Therapy, hypnosis, and selective serotonin reuptake inhibitors have shown effectiveness.
27
Which lifestyle control for vasomotor symptoms is not supported?
Lifestyle control
## Footnote
Evidence does not support general lifestyle changes for managing vasomotor symptoms.
28
What herbal supplements are mentioned for menopause treatment?
* Soy supplements
* Glucosamine
* Flax seed oil
* Ginkgo biloba
* Black cohosh
* Ginseng
## Footnote
These supplements may provide varying benefits during menopause.
29
What FDA-approved non-hormonal treatments are available for hot flushes?
* Fezolinetant (Veozah)
* Paroxetine (Paxil)
* Venlafaxine (Effexor)
* Clonidine (Catapres patch)
## Footnote
These medications are alternatives to hormone therapy for managing hot flushes.
30
What is the definition of menopause?
12 months without menses
## Footnote
Menopause marks the end of a woman's reproductive years.
31
What characterizes perimenopause?
Irregular menstrual cycles and other symptoms due to hormonal fluctuations
## Footnote
Perimenopause can begin several years before menopause.
32
What are common symptoms experienced during menopause?
* Vasomotor symptoms
* Sleep disturbance
* Psychological changes
* Libido disruption
## Footnote
These symptoms can significantly affect quality of life.
33
What is the purpose of the discussion between provider and patient regarding menopause management?
To give the best quality of life
## Footnote
Addressing physiologic, physical, and psychological changes is crucial for effective management.
34
What is the STRAW Criteria?
Stages of Reproductive Aging Workshop
## Footnote
STRAW provides a framework for understanding reproductive aging.
35
Fill in the blank: The link for the Estrogen and Progesterone resources is _______.
https://brick-portal.scholarrx.com/annotation/estrogen-and-progesterone
36
What is a recommended moisturizer for vaginal dryness?
Astroglide, KY Jelly
## Footnote
These products help alleviate vaginal dryness during menopause.
37
What medications are used for mood stability during menopause?
SSRIs (Celexa vs. Effexor)
## Footnote
Selective serotonin reuptake inhibitors can assist with mood stabilization.
38
What are the office hours for in-person or virtual office hours?
Every Friday 11a-12p CST / 12-1p EST
## Footnote
These hours provide opportunities for student engagement with faculty.
39
True or False: Weight loss is proven to be helpful for vasomotor symptoms.
False
## Footnote
Evidence does not support weight loss as a definitive treatment for vasomotor symptoms.
40
describe perimenopause-induced AUB
prolonged excessive bleeding and irregular anovulatory cycles
41
what are the most common causes of premature ovarian insufficiency?
trauma injuries
infections
radiation chemotherapy
autoimmune conditions
42
POI before age 30 is assoc. with what?
genetic anomalies
especially mosaic karyotypes
43
what urogenital changes occur during menopause?
increase in urgency & frequency often resulting in nocturnal enuresis
crusty vaginas
dysparenuia
decreased cervix diameter
shrinkage of ovaries and uterus
retreat of the SC junction
44
how does menopause affect the breast?
decrease in size & tone
45
how does menopause affect the skin?
decreased collagen content decreases skin thickness; subsequent loss of elasticity increases wrinkling
46
loss of tissue tone of the pelvic floor muscles can result in what?
uterine and vaginal prolapse
47
what are the long-term effects of estrogen loss?
decreased bone structure
decreased tooth structure
increased LDL and decreased HDL
increased colon cancer risk
impaired cognition
48
T or F: estrogen loss results in decreased osteoblast activity
false
estrogen loss increases osteoclastic activity
osteoblastic activity is unaffected
49
what are the most common fractures in postmenopausal women?
vertebral crush fractures
hip fractures
2nd metacarpal bone
50
what are risk factors for type 1 osteoporosis?
estrogen deprivation
smoking
alcohol
poor nutrition
inadequate weight bearing
51
what are risk factors for type 2 osteoporosis?
endocrine abnormalities
anorexia
malabsorption
medications
52
T or F: women who live at high altitudes tend to have early onset of menopause
true
53
list the factors assoc. w/ the absolute risk for VTE
age dependent
HT route of admin.
obesity
mobility
fractures
54
T or F: HT is first line for osteoporosis treatment and prevention.
false
bisphosphonates are 1st line
55
list the bispphosphonates you need to know.
the NATEs
alendro
risedro
ibandro
also zoledronic acid
56
what drug can be used to decrease back pain in females w/ vertebral fractures
calcitonin
57
what is the MOA of denosumab?
RANK ligand inhibitor that treats osteoporosis and hypercalcemia and bone malignancies
58
what is teriparatide used for?
PtH synthetic that is considered for high risk pt. w/ existing fractures
59
what systemic disease can increase the risk of endometrial carcinoma in menopausal pts.?
DM
chronic HTN
obesity
60
list factors in a pt. reproductive history that increase the risk of endometrial carcinoma
nullparity
late menopause
chronic unopposed estrogen
61
What is the primary goal of Hormone Replacement Therapy (HRT) in menopausal women?
To relieve symptoms associated with menopause and replace hormones that decline during this period
## Footnote
HRT aims to alleviate symptoms such as hot flashes, vaginal dryness, and mood swings.
62
What percentage of postmenopausal women in the US reported taking HRT at some point?
Approximately 50%
## Footnote
This statistic highlights the prevalence of HRT usage among this demographic.
63
What are the most common forms of HRT?
Oral forms
## Footnote
Oral medications are the most frequently used method for administering HRT.
64
Which demographic is more likely to be administered HRT?
Women who had a 'surgical' menopause
## Footnote
Surgical menopause typically leads to a more immediate need for hormone replacement.
65
What factors influence the likelihood of HRT usage among women?
* Race (Non-Hispanic White women are more likely to use HRT)
* Education level (more than high school education)
* Household income (above poverty level)
## Footnote
These socio-economic factors play a significant role in HRT adoption.
66
What is the definition of Hormone Replacement Therapy (HRT)?
Estrogen with or without progesterone administered to replace the natural decline that occurs at menopause
## Footnote
HRT is a prescribed treatment intended to alleviate menopause-related symptoms.
67
What are the main symptoms associated with menopause?
* Vasomotor: hot flashes, sweating, palpitations
* Gynecologic: vaginal dryness, discomfort, urinary issues
* Psychological: mood swings, insomnia, depression
## Footnote
These symptoms can significantly impact a woman's quality of life during menopause.
68
What initial tests are part of the HRT work-up?
* FSH level
* Estradiol level
* CBC
* UA/UCG
* Lipid Panel
* Comprehensive Metabolic Panel
* Pap test
* Pelvic Ultrasound
* Mammogram
* EKG
## Footnote
These tests help assess a woman's health status before starting HRT.
69
What are the lifestyle modifications recommended as first-line treatment for menopausal symptoms?
* Weight and nutrition management
* Regular exercise
* Adequate diet (calcium and vitamin D)
* Smoking cessation
* Decrease alcohol intake
* Stress reduction techniques (meditation, yoga)
## Footnote
Lifestyle changes can significantly improve menopausal symptoms without medication.
70
What is the recommended approach for HRT treatment?
Treat at the lowest effective dose for the shortest duration of time
## Footnote
This approach minimizes potential risks associated with long-term HRT use.
71
What are the common routes of HRT administration?
* Oral tablets
* Transdermal patches
* Gels
* Creams
* Implants/injections
* Sprays
* Vaginal creams
* Pessaries
* Rings
## Footnote
Each route has different benefits and may be chosen based on patient preference and medical history.
72
What are some common side effects of HRT?
* Breast tenderness
* Uterine bleeding
* Nausea
* Abdominal bloating
* Fluid retention
* Hair loss
* Headache
* Dizziness
## Footnote
Patients should be informed about these potential side effects before starting treatment.
73
What are absolute contraindications for HRT?
* Breast cancer
* Endometrial cancer
* Undiagnosed vaginal bleeding
* Active thromboembolic disease
* Severe active liver disease
* History of malignant melanoma
## Footnote
These conditions pose significant risks when considering HRT.
74
What are some definite risks associated with HRT?
* Endometrial cancer
* Pulmonary embolism
* Deep vein thrombosis
* Breast cancer (long-term use)
* Gallbladder disease
## Footnote
Understanding these risks is crucial for informed decision-making regarding HRT.
75
What is a probable risk of HRT in older women?
Coronary heart disease
## Footnote
The risk may vary based on the age of the woman and the timing of menopause.
76
What are some alternatives to HRT for managing menopausal symptoms?
* Non-hormonal medications (SSRIs, SNRIs)
* Herbal supplements (soy, black cohosh, ginseng)
* Lifestyle modifications
## Footnote
Non-hormonal approaches are often considered first-line choices for symptom management.
77
What is the recommendation for discontinuing HRT?
Discontinuation may result in a return of symptoms in ~50% of women
## Footnote
The decision to taper or stop HRT should be made collaboratively between the patient and provider.
78
What is Flax seed oil commonly used for?
Flax seed oil is used as a dietary supplement and is known for its omega-3 fatty acids.
79
What is Ginkgo biloba often used to support?
Ginkgo biloba is often used to support cognitive function and memory.
80
What is Black cohosh primarily used for?
Black cohosh is primarily used for alleviating menopausal symptoms.
81
What are the uses of Ginseng?
Ginseng is used for boosting energy, reducing stress, and enhancing cognitive function.
82
What should be considered before starting HRT?
Be aware of medical history and medications.
83
What percentage of women may experience a return of symptoms after discontinuation of HRT?
~50% of women may experience a return of symptoms.
84
Is there sufficient evidence on whether to taper or abruptly stop HRT?
There is insufficient evidence to show whether HRT should be tapered or abruptly stopped.
85
Who should make the decision regarding HRT discontinuation?
The decision should be made between the patient and provider.
86
What are some medication options for HRT?
Medication options include:
* Estrogen alone
* Combined estrogen and progesterone
* Progestin alone
* Testosterone
* Compounded bioidentical hormones
* Selective estrogen receptor modulator (SERM)
87
What are the formulations for HRT?
Formulations include:
* Systemic
* Oral tablets
* Transdermal
* Patches
* Gels
* Creams
* Implants
* Local
* Vaginal creams
* Pessaries
* Rings
88
What is the recommended approach for starting HRT?
Treatment should start at the lowest effective dose and used for the shortest period of time.
89
What must be discussed prior to starting HRT?
Indications, risks, benefits, and alternatives of HRT must be discussed.
90
True or False: HRT is a widely prescribed option for women with menopausal symptoms.
True
91
What is the purpose of HRT in relation to women's health?
HRT is used for quality of life and prevention of morbidity.
92
What resource discusses Menopause and Postmenopausal Hormone Therapy?
Manson, JE, Bassuk SS. Menopause and Postmenopausal Hormone Therapy in Harrison’s Principles of Internal Medicine.
93
Fill in the blank: HRT should be decided between the patient and provider keeping in mind _______.
[contraindications and side effects]
94
What is the source for the HRT clinical practice guideline?
C. Stuenkel et al. 'Treatment of Symptoms of the Menopause: An Endocrine Society Clinical Practice Guideline.'
95
estrogen replacement alone can be used in women w/ a h/o what?
hysterectomy
96
what are relative CIs for HRT?
hypertriglyceridemia
previous DVT
chronic liver diseases
gallbladder diseases
endometriosis
porphyria
fibroids
97
medication induced hepatitis mostly concerns HRT via what admin.?
oral formulations due to first pass metabolism
98
how does HRT alter the bio physiology of atherosclerosis in a bad way?
decreased ER expression
decreased vasodilation
increased inflammatory activation
increased plaque instability
increased MMP activity
increased neovascularization
99
what are the beneficial effects of HRT for AS?
decreased lesion progression via the following:
increased nitric oxide production
decreased LDL oxidation
decreased platelet activation
decreased VSMC proliferation
100
no matter the CVD risk, HRT should be avoided in menopausal pts. who had their last period how many yrs. ago?
>10
101
under what circumstances should HRT be avoided?
high CHD risk (>20%) no matter the number of yrs. since last period
102
transdermal HRT may be implicated for these pts?
moderate CHD risk (10-20%) for women whom have had a period within the past 10 yrs.
low CHD risk (5-10%) for women whom have had their last period b/t 6-10 yrs. ago
103
what effects does testosterone HRT have on the menopausal pt.?
improves sexual function and satisfying sedual episodes
provides no benefit for vasomotor symptoms
104
what medications have been FDA-approved for hot flashes
fezolinetant
paroxetine
105
what other medications can be used for hot flushes?
gabapentin (for night sweats)
venlafexine
SSRIs
clonidine
