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Special Pops Exam 1 > Menopause -> > Flashcards

Menopause -> Flashcards

1
Q

What is perimenopause/menopausal transition (MT)?

A

Period leading up to & immediately following menopause

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2
Q

How can menopause be induced?

A

Surgically via bilateral oophorectomy

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3
Q

What is postmenopause?

A

Phase of life that comes after menopause

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4
Q

Premature menopause is menstrual cessation before what age?

A

40

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5
Q

Causes of premature menopause?

A

Genetic, autoimmune, induced

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6
Q

Duration of perimenopause/MT?

A

Variable
begins: avg. 4yrs before FMP
overlaps with: late reproductive stage

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7
Q

How long does perimenopause/MT extend?

A

To 12 months after menopause (last meses)

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8
Q

Ovulation becomes ______ during perimenopause/MT

A

Sporadic

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9
Q

What is perimenopause/MT characterized by?

A

Irregular menstrual cycles, endocrine changes, & hot flashes

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10
Q

Pathophys of perimenopause/MT?

A

Decline in quality/quantity of follicles, ovaries lose sensitivity to LH/FSH, dec. levels of estrogen and inhibin B (slight inc. in FSH/LH) —> anovulatory cycles, unpredictable menses, estrogen insensitivity, menopause, permanent amenorrhea

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11
Q

Clinical manifestations of perimenopause/MT?

A

Vasomotor sx (hot flashes), irregular menses, sx of dec estrogen (insomnia, vaginal dryness, depression), inc. androgen sx -> hirsutism

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12
Q

Most common sx w/ perimenopause/MT?

A

Hot flashes (seconds to 10 minutes, frequency of 1-2/hr - 1-2/wk), cause sleep disturbance/mood changes

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13
Q

Treatment of hot flashes?

A

Mild: lower room temp, fans, avoiding triggers (spicy food/stress), etc.
Moderate/severe: OCPs, estrogen, SSRI/SNRI, gabapentin, soy, black cohosh

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14
Q

Why is further workup required with irregular menses as a result of perimenopause/MT?

A

Organic disease can occur at the same time (fibroids, polyps, hyperplasia, cancer)

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15
Q

Ddx for vaginal dryness with perimenopause/MT?

A

Stress, meds (antihistamines), vulvar/vaginal lesions (whitening, thickening, cracking of vulvar tissue, raised/erosive lesions should be bx), menopause (atrophic vaginitis)

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16
Q

Tx for vaginal dryness from perimenopause/MT?

A

Lubricants (KY jelly, astroglide) prior to intercourse, moisturizers (longer term tx - Replens, Gyn-Moistrin), Vit E oil

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17
Q

What is menopause?

A

Cessation of menses > 1 yr d/t loss of ovarian function (leads to dec. estrogen/progesterone production)

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18
Q

When if menopause officially diagnosed?

A

after 12 mos of amenorrhea in absence of other causes (test HCG, prolactin, TSH)

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19
Q

What age is considered premature menopause?

A

<40

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20
Q

Average age of onset for menopause?

A

50-52 (may occur 45-55)

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21
Q

What is the only risk factor associated w/ early menopause?

A

Smoking

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22
Q

Hormonal level changes w/ menopause?

A

Decreased progesterone & estradiol (estradiol <20pg/mL)
Increased LH/FSH (>100mU/mL)
*FSH>LH

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23
Q

S/Sx of estrogen deficiency w/ menopause?

A

Menstrual cycle alterations, hot flashes (vasomotor), sleep disturbances, mood changes, skin/nail/hair changes, inc. cardiovascular events, HLD, osteoporosis, vaginal atrophy, dyspareunia

24
Q

PE for menopause?

A

Dec. bone density, dry/thin skin w/ dec. elasticity, vaginal atrophy: thin mucosa that is pale/smooth, small uterus/cervix, dec. breast size

25
Q

Physical changes of the reproductive tract w/ menopause?

A

Atrophy of labia majora, vaginal epithelium
Vaginal wall smooth/loses rugation
Increase in vaginal pH >/=5
Canal/cervix dec in size, dec secretions
Fibroids if present: shrink
Endometriosis/adenomyosis resolve if present
Minimal trauma w/ exams or sex
Ovaries dec in size/no longer palpable
Loss of pelvic muscle tone/prolapse of organs

26
Q

What is atrophic vaginitis?

A

Atrophy of epitheliu w/ dec blood supply: thin/shiny/pale surface that is more susceptible to trauma and infection

27
Q

Sx of atrophic vaginitis?

A

Dryness, spotting, vaginal pain/burning, dyspareunia, possible urinary sx

28
Q

How to dx atrophic vaginitis?

A

Clinical (H&P)

29
Q

Tx options for atrophic vaginitis?

A

1st line: mositurizers, lubes, Vit. E oil
2nd line: Estrogen vaginal creams or ring (cream nightly x 2wks followed by twice wkly, ring left in for 3 mos)

30
Q

Physical changes of the urinary tract w/ menopause?

A

Atrophic changes of epithelial lining of bladder/urethra (can lead to atrophic cystitis: urgency, frequency, dysuria, incont) –> can lead to frequent UTIs and loss of urethral tone

31
Q

Mammary gland changes w/ menopause?

A

Dec in breast size, dense tissue replaced w/ adipose tissue

32
Q

Skin/hair changes w/ menopause?

A

Thinning of skin, dec elasticity
Loss of pubic/axillary hair
Inc. coarse hair on upper lip/chin

33
Q

Psychological changes w/ menopause?

A

Depression, dec libido, memory loss

34
Q

Bone changed w/ menopause?

A

Bone mineral density dec –> osteoporosis

35
Q

Increased chance for what w/ menopasue?

A

Coronary artery disease

36
Q

Diagnostics for menopause?

A

12 mos of amenorrhea w/o other cause
Serum HCG, prolactin, TSH (FSH often measured but not required for dx)
*inc serum FSH >25, inc LH, dec estrogen

37
Q

The “big three” of management of menopause?

A

Symptoms (hot flashes, vaginal dryness), osteoporosis, CVD

38
Q

Women lose how much bone mass in the first 5-7 years after menopause?

A

20%

39
Q

Diagnostics for osteoporosis?

A

DEXA scan (T scores), monitor height changes

40
Q

Tx for osteoporosis from menopause?

A

Wt bearing exercise, calc/Vit D, bisphosphonates, HRT, SERMS (Raloxifene), Calcitonin, PTH

41
Q

After menopause, the risk of coronary heart disease increases how much compared to premenopausal women of the same age?

A

2-3x (estrogen deficiency thought to be partially responsible)

42
Q

Is HRT recommended for disease prevention?

A

No, found to be more harmful than helpful (but can be beneficial for some women depending on risk factors –> Menopausal hormone therapy/MHT)

43
Q

Proven benefits of HRT?

A

Estrogen/progestin combo: lowers risk of colorectal CA, fractures and improves vasomotor/GU sx

Estrogen alone (women w/o uterus): lowers risk of fractures, improves vasomotor/GU sx

44
Q

Complications of HRT?

A

Estrogen/progestin combo: inc. risk of breast CA, stroke, MI, blood clots, gallbladder dz

Estrogen alone: inc risk of stroke, blood clots, gallbladder dz, endometrial CA

45
Q

Recommendations when using HRT?

A

Use lowest dose possible for shortest time (<5yrs), not indicated for cardioprotection, women w/ intact uterus must take progestine w/ estrogen to prevent endometrial hyperplasia/uterine cancer

46
Q

Current indications for HRT?

A

Tx of: vasomotor sx, vulvovaginal atrophy/atrophic vaginitis
Prevention of: osteoporosis (reserved for women already on estrogen for menopausal sx and cannot tolerate antiresorptive drugs)

47
Q

Formulations of HRT?

A

Systemic (oral and transdermal patch/gel), Local topical (little systemic abs -> endometrial proliferation rare w/ minimal doses)

48
Q

Possible S/E of HRT?

A

Nausea, bloating, wt gain, fluid retention, mood swings, breakthrough bleeding, breast tenderness

49
Q

C/I for HRT?

A

Undiagnosed abnormal vaginal bleeding, known/suspected breast CA or estrogen dependent neoplasia, active or hx of DVT/PE, thromboembolic dz (Factor V Leiden), TIA/stroke, liver dysfunction/dz, endometrial CA or high risk for it

50
Q

Alternatives to HRT for hot flashes?

A

SSRIs (Paxil, Zoloft effective), soy products, herbal therapies, avoid spicy food/caffeine

51
Q

Alternatives to HRT for osteoporosis?

A

Calcium/Vit. D dialy, bisphosphonates, wt bearing exercise, avoid RF (smoking, excess alcohol, steroids)

52
Q

Alternatives to HRT for CVD?

A

Maintain normal cholesterol, treat HTN, exercise, weight control

53
Q

When does HRT take effect in increasing the risk of breast CA?

A

After 5 years of continuous therapy

54
Q

Estrogen alone in women w/ an intact uterus increases the risk of what?

A

Endometrial cancer

55
Q

HRT increases the risk of what?

A

Thromboembolism

56
Q

Treatment for HRT is always what?

A

Individualized

Special Pops Exam 1 (8 decks)

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