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Women's Health Clin med > menopause > Flashcards

menopause Flashcards

1
Q

What is Menopause

A

Cessation of menses due to loss of ovarian activity

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2
Q

What is the average age of menopause

A

51

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3
Q

When are people generally post menopausal

A

12+ months after their final menses

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4
Q

What is perimenopause

A

4-6 years of cycle changes and other symptoms before total cessation of menses

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5
Q

What is premature menopause

A

ovarian failure before age 40

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6
Q

When is early menopause

A

40-50 y/o

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7
Q

What is surgical menopause

A

cessation of menses due to BSO

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8
Q

Which patients are at higher risk of going into menopause early

A

Smokers
people with malnutrition

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9
Q

What factors DO NOT impact menopause

A

race
ethnicity
age of menarche
weight

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10
Q

What causes symptoms to occur in perimenopause

A

erratic fluctuations of hormones

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11
Q

What is the mean age of onset for perimenopause

A

47

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12
Q

What are some perimenopause symptoms

A

Vasomotor (night sweats)
Psych (depression)
Cognitive
Sexual (decreased libido)
Other (weight change)

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13
Q

What are the different types of estrogen

A

Estrone (E1)
Estradiol (E2)
Estriol (E3)

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14
Q

What is the most common type of estrogen

A

estradiol

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15
Q

What is the main type of estrogen present in a pregnant persons bloodstream and what does it do

A

Estriol

Prepares for childbirth

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16
Q

What symptoms occur due to early estrogen loss

A

Hot flashes
insomnia
irritability

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17
Q

What physical changes occur with intermediate estrogen loss

A

vaginal atrophy
skin atrophy

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18
Q

What occurs during late estrogen loss

A

coronary heart disease
Osteoporosis

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19
Q

What is luteal insufficiency

A

ovarian follicles become less responsive to FSH leading to a heavier menses

*generally after age 40

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20
Q

What causes FSH levels to increase with luteal insufficiency

A

fewer oocytes are available in early follicular phase and a decrease in estradiol causes the FSH increase

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21
Q

What causes a heavier menses with luteal insufficiency

A

Corpus lute doesn’t function as well and progesterone secretion diminishes = estrogen becoming dominant

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22
Q

What occurs when the FSH level increase

A

Follicles mature faster and produce enough estradiol to trigger and LH surge

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23
Q

What is anovulation

A

accelerated decline in responsive follicles

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24
Q

What does anovulation cause

A

an increase in cycle length and variability

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25
Q

What are vasomotor symptoms that occur with menopause

A

Hot flashes
night sweats

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26
Q

What is a hot flash

A

Sudden sensation of heat centered in the face and chest that rapidly becomes generalized

*last 2-4 min

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27
Q

What causes a hot flash to occur

A

Skin temp rises because of peripheral vasodilation, followed by a drop in core temperature

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28
Q

What things are associated with hot flashes

A

chills
anxiety
heart palpitations

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29
Q

What is the most common reasons women seek medical care during menopause

A

Hot flashes

30
Q

What does menopause do to the bodies thermoregulatory zone

A

causes it to become narrowed and more sensitive to subtle changes in core body temperature

*naturally variable at night

31
Q

What can help widen thermoregulatory zone - leading to fewer symptoms

A

Exogenous estrogen

32
Q

What are some triggers for vasomotor symptoms in menopause

A

alcohol
coffee
exercise
emotional upset

33
Q

What is atrophic vulvovaginitis

A

Gradual thinning of genital mucosa

34
Q

What causes the gradual thinning of genital mucosa

A

loss of vaginal rugae
less flexible tissue
decreases transudate
pH becomes alkaline
Change in microbiome
increased pathogens to the bladder

35
Q

What is the cause of genitourinary syndrome of menopause

A

the increase ascension of pathogens to the bladder

36
Q

What are some sexual changes that occur with menopause

A

decreased lubrication
increased UTI/ yeast infections
decreased libido

37
Q

What are some treatments that can help with Dyspareunia

A

Personla lubricants and moisturizers and vaginal estradiol

38
Q

What needs to be checked with genitourinary syndrome of menopause

A

Vaginal / urethral prolapse
bladder emptying
possible stones

39
Q

What is the criteria for genitourinary syndrome of menopause

A

> 2 cultures confirmed UTIs in 6 months
or
3 in 12 months

40
Q

When does peak bone mass occur

A

30-35

41
Q

What is the rate of bone loss during menopause

A

~5% /year for the first 5 years
and 1% /year after that

42
Q

Where is the greatest loss of bone during menopause

A

trabecular

43
Q

What are the cardiovascular effects of estrogen changes during menopause

A

Increased HDL
decreased LDL

44
Q

How does menopause effect cognition

A

hormonal changes change the environment in the brain and affecting brain cells, glucose levels, and metabolic function

45
Q

What are ways to maintain brain health through menopause

A

physical activity
cognitive activity
social contact
adequate sleep

46
Q

What is the reason for skin and hair changes with menopause

A

decreased estrogen and unopposed testosterone
-temporal balding
-hirsutism (chin/mustache area)

47
Q

What generally causes premature menopause

A

ovarian dysfunction

48
Q

If someone has ovarian dysfunction, what can be supplemented to delay the onset of menopause

A

HRT

49
Q

What are some positive changes that occur with menopause

A

decreased issues with fibroids/ endometriosis

end of menstrual migraines

no more contraception

50
Q

What are some VMS treatment alternatives when estrogen/progesterone is contraindicated

A

SSRI/SNRI
alpha adrenergic agonist (Clonidine)
Gabapentin

51
Q

If someone has prolonged heavy or frequent vaginal bleeding in menopause, what steps do you take to treat

A

TVUS
+/- endometrial sampling

52
Q

What are some risks for heavy/prolonged bleeding perimenopause

A

Obesity
tamoxifen use

53
Q

If someone is symptomatic through menopause, how can you treat them

A

E/HRT
*smallest dose possible for shortest duration of time

54
Q

How can vaginal estrogen be delivered

A

cream (Estrace / Premarin)
Tablet (vagifem/imvexxy)
Estring

*symptomatic improvement for vaginal and urethral atrophy

55
Q

What is the greatest concern with vaginal bleeding after 1 year of amenorrhea

A

malignancy
endometrial polyps
endometrial hyperplasia

56
Q

What is the purpose of vaginal estradiol in postmenopausal women

A

manage recurrent UTIs

57
Q

How frequent do post menopausal women need to have Pap smears

A

3-5 years

58
Q

What makes up the connective tissue of the pelvis

A

uterine sensory ligaments
vaginal connective tissue
pelvic floor musculature

59
Q

What is the landmark for uterine prolapse

A

hymenal remnant

60
Q

What is a cystocele

A

anterior vaginal wall prolapse

61
Q

What is a rectocele

A

posterior vaginal wall prolapse

62
Q

What are the risk factors for pelvic organ prolapse

A

obesity
chronic constipation
operative delivery
multiparty
chronic cough
heavy lifting for work

63
Q

What are obstetrical risk factors for pelvic organ prolapse

A

episiotoomy
tears/extension
vacuum extraction
forces deliver
shoulder dystocia
breech extraction

64
Q

How does a pelvic organ prolapse present

A

pink bulging tissue at vaginal opening

can feel heavy and cause a DULL backache

**some manually reduce before presenting to clinic

65
Q

How / why do you evaluate a pelvic organ prolapse

A

need to evaluate what is descending and how far in comparison to hymenal remnants

66
Q

What is POPQ

A

pelvic organ prolapse quantification system

67
Q

How does the POPQ system work

A

Hymen is a fixed reference point and there are 6 other defined points with 3 main landmarks

68
Q

What is considered prolapse stage 2

A

Presenting part is within 1cm north or south go hymenal remnants

69
Q

If the presenting part is >2cm distal to the hymen but 2cm less than total vaginal length, what stage is the prolapse

A

stage 3

70
Q

What is a stage 4 prolapse

A

vagina is completely everted

71
Q

How do you treat a prolapse

A

watchful waiting if not bothersome

pelvic floor muscle exercises

surgical tissue repair

vaginal obliterative procedure in select patients

Women's Health Clin med (13 decks)

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