IC17eL & IC17 Flashcards
Definition of Amenorrhea
No menstrual bleeding for 90 days
Definition: Primary/ functional Amenorrhea
Absence of menses by age 15
in females who never menstruated
Secondary amenorrhea
Absence for 3 cycles in a previously menstruating female
Risk factors for Secondary amenorrhea
- < 25 yo with hx of menstrual irregularities
- Competitive athletics
- Massive weight loss
S/sx for dysmenorrhea
Crampy pelvic pain with or just before menses
Pathophysiology for primary dysmenorrhea
Release of prostaglandins & leukotrienes -> vasoconstriction -> cramp
Likely Pathophysiology for secondary dysmenorrhea
endometriosis
Pathophysiology for PCOS
Ovaries produce an abnormal amount of androgens -> Small cysts (fluid-filled sacs) form in the ovaries
Definition of Menopause
Permanent cessation of menses for at least 12 months following the loss of ovarian follicular activity
Continuous-cyclic: Is bleeding with progestin normal?
No, it is abnormal
Continuous-cyclic: Is bleeding with progestin normal?
No, it is abnormal
Dietary supplements recommended for non-pharm in menopausal women
Isoflavones & black cohosh
How long should HRT be used before seeing a vast improvement of menopausal symptoms?
2-3 months of use
Pharmacological, non-contraceptive options for heavy menses
- NSAIDs during menses
- Tranexamic acid during menses
- Cyclic progesterone
Non-pharm option for heavy menses
endometrial ablation / hysterectomy
Clinical presentation of menopause (big 4)
- Vasomotor symptoms (hot flushes & night sweat)
- Genitourinary symptoms/ atrophy
- Psychological/ cognitive
- Bone fragility
Estrogen dosage forms
- Oral tablets
- Topical (gel/ patch)
- Local vaginal (pessary/ cream)
Counselling for estrogen patch
Replaced twice a week -> lower back, abdomen, thigh or buttocks -> rotate sites
Counselling for estrogen gel
Ruler provided to measure dose of gel -> apply over arms or thigh daily -> let gel dry -> rotate sites
Counselling for estrogen tablet
Take same time everyday -> once finished with a pack, start a new one right away
Counselling for estrogen pessary
Inserted twice a week -> insert tablet just before bedtime to minimize movement
HRT: Which to give if u want/ dw period?
Want period: Continuous-cyclic
Dw period: Continuous-combined
HRT: How long does it take to show vast improvement in s/sx?
2-3 months
Monitoring after initiating HRT
- Annual mammography
- Endometrial surveillance for any abnormal symptoms
Why is progestin added to estrogen for HRT?
protect the endometrium from overgrowth (& risk of endometrium cancer)
Pharmacological option for vasomotor symptoms apart from HRT
- SNRI & SSRI
- Gabapentin
- Tibolone
Pharmacological option for vasomotor symptoms apart from HRT
- SNRI & SSRI
- Gabapentin
- Tibolone (improves mood & GMS symptoms also)
NOTE: Tibolone can only be used for post-menopausal women
Concern for tibolone use
- Breast CA recurrence
- Endometrial cancer
- Risk of stroke
