Gynecology- Menopause

Question 1

Atrophic vaginitis

Answer 1

Reduced estrogen levels associated with menopause cause decreased blood flow and reduced collagen and glycogen content in vulvovaginal tissues.

Question 2

S&S genitourinary syndrome of menopause (atrophic vaginitis)

Answer 2

• Thin valvular skin with reduced elasticity
• Dryness (minimal dischage, pH >4.5)
• Volvovaginal irritation & pruritus
• Dyspareunia
• Vaginal bleeding
• Urinary incontinence
• Dysuria and Urinary frequency

Question 3

Tx atrophic vaginitis

Answer 3

First-line: vaginal moisturizers & lubricants

No improvement: Vaginal estrogen (increases blood flow and glycogen content to tissues)

Question 4

Ddx: “Dysuria and urinary frequency” UTI vs atrophic vaginitis

Answer 4

Normal urinalysis. Atrophic vaginitis can mimic UTI but has normal labs.

Question 5

S&S luchen sclerosus

Answer 5

Vulvar pruritus 
Dyspareunia
White skin that forms into plaques 
Perianal thickening with fissures 
Doesn't affect vagina

Question 6

Indication for hormone replacement therapy

Answer 6

Women age <60 who have undergone menopause within the past 10 years.

Indicated only to treat vasomotor symptoms that interfere with daily activities are cannot be managed with lifestyle modifications

Question 7

Contraindications to hormone replacement therapy

Answer 7

Personal history of: 
CAD
Thromboembolism 
TIA
Stroke 
Breast Cancer 
Endometrial cancer

Question 8

Estrogen only vs Estrogen progesterone replacement therapy

Answer 8

In patentees with a uterus a progestin component is required for endometrial protection (unopposed estrogen ↑endometrial proliferation)