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Summer FDTN Exam 3 > menopause > Flashcards

menopause Flashcards

1
Q

What is climacteric

A

Phase characterized by gradual decline in ovarian function, leading to decreases sex steroid production

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2
Q

What are the aspects of climacteric

A

Menopausal transition: cycle length changes, increased FSH, ends with final period
Perimenopause: up to 12 months after FMP
Menopause: 12 months of amenorrhea in 45+y/o, w/o other cause
Post-Menopause: early is first 5 years, last is from 5 years after FMP to death

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3
Q

What factors affect the age of menopause onset

A

genetics
smoking
hysterectomy
(typical 50-55, mean 51.5)

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4
Q

What makes menopause occur

A

All oocytes have been ovulated or become atretic, ovaries begin to fail
lower levels of hormones= physical, physiological, and sexual changes

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5
Q

Signs of impending ovarian failure (perimenopause) include

A 
Menstrual cycle changes 
mood/emotional changes (irritable)
hot flashes 
night sweats 
breast changes (tender)
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6
Q

Hormone changes in menopause include

A

Decreased estrogen
Decreased androgens (facial hair growth, decreased breast size)
Decreased progesterone (irregular vaginal bleeding)
Increased LH, FSH

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7
Q

Physical changes that occur with menopause include

A

Urogenital atrophy (vag canal shrinks in diameter)
Urinary stress incontinence (bladder elasticity decreases)
skin collagen loss

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8
Q

Diseases that occur in conjunction with menopause include

A

Osteoporosis
CVD
Dementia

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9
Q

Hot flashes may present along with

A

dizziness, palpitations, sweating, night time wakening

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10
Q

Other Sx of menopause are

A 
Confusion, memory loss 
mild depression 
skin changes 
loss of libido
fatigue, insomnia
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11
Q

Differential for menopause diagnosis should include

A

Hyperthyroid (irregular menses, sweats, mood)
Pregnancy, hyperPRL, thyroid (irregular menses)
meds, Pheo, malignancy (hot flash, night sweats)

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12
Q

How do you manage menopausal atrophic vaginal changes

A

non-hormonal vaginal moisturizers and lubricants
vaginal estrogen therapy
Ospemifene
Vaginal prasterone

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13
Q

What is Ospemifene

A

selective estrogen receptor modulator (SERM)
used to Tx mod-severe dyspareunia 2/2 vulvovaginal atrophy
does not affect endometrium or breast

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14
Q

What is vaginal prasterone

A

DHEA; converts testosterone to estrone and estradiol

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15
Q

How do you manage systemic menopausal symptoms

A

menopause hormone therapy: unopposed estrogen/ estrogen&progesterone
Take lowest effective dose for shortest period of time possible
no unopposed estrogen if you have a uterus

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16
Q

Contraindications to menopause hormone therapy include

A 
Hx breast cancer 
CHD 
Hx DVT/VTE/CVA
liver disease 
unexplained vaginal bleeding 
high risk endometrial cancer 
TIA
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17
Q

GOLD standard for relieving vasomotor Sx of menopause

A

Estrogen therapy

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18
Q

ADE of medical hormone therapy include

A

Estrogen: breast tenderness
Progesterone: bloating, mood Sx

19
Q

How do you manage vaginal bleeding

A

Prempro, Prefest, Climapro (E&P)
Estratest (E&testosterone)
Premarin, Femtrace, Climara (E)
Duavee (bazedoxifen&E)

20
Q

WHO says not to use MHT long term because

A

A study on postmenopausal women 50-79 was d/c early 2/2 increased risks of CHD, stroke, VTE, and breast cancer in women taking estrogen alone, and estrogen/progesterone

21
Q

Why is WHO data not that impressive

A

It is mostly from women 60+, and most women with Sx of menopause are 40-50
So, the data is based on low quality evidence

22
Q

Bottom line with the WHO study is

A

Treat SYMPTOMATIC women only
If <60, only treat no benefit > risk
benefit > risk if <10 years form menopause
Do NOT use MHT to prevent chronic diseases, like osteoporosis

23
Q

MHT should be use for how long

A

5 years or less

24
Q

Alternative non-hormonal treatments for vasomotor Sx include

A 
Venlafaxine 
Paroxetine 
Gabapentin 
Acupuncture 
Soy &amp; Isoflavones (short term, 2 yrs) 
St. John's Wort (8 wks) 
Black Cohosh (6 months) 
Bioidentical hormonea, plant hormones
25
Q

St John’s wort can be used to treat

A

mild-moderate depression, for 2 years

hot flashes, for 8 weeks

26
Q

What are the types of pelvic organ prolapse

A 
Anterior: bladder 
Posterior: rectal 
Apical: apex of vagina 
Procidentia: all 3 compartments
Enterocele: intestines
27
Q

What is a cystocele

A

downward displacement of bladder into vagina
associated w/ childbirth (large or multiple babies, prolonged labor), age, obesity, chronic constipation
Associated w/ urethrocele (sagging of urethra)

28
Q

How does a cystocele present usually

A 
Pelvic pressure 
low back pain 
sensation of "sitting on something" 
worse with valsalva 
better when supine 
Dyspareunia, urinary incontinence, difficulty urinating
29
Q

On PE with a cystocele, you will see

A

When in the lithotomy position, a thin walled, smooth bulging mass in the vaginal vault
(have patient cough/bear down)

30
Q

DDx for a cystocele include

A

urethral or bladder diverticulum

enterocele

31
Q

How do you diagnose a cystocele

A

Clinically!
IVP (allows you to assess urinary structure)
US (info about bladder, urethra, etc.
MRI (eval pelvic floor muscles)

32
Q

How do you manage a cystocele

A

Exercise (kegels)
pessary
vaginal weights

33
Q

Surgical intervention of choice for a cystocele is

A

anterior colporrhaphy +/- bladder sling for stress incontinence
-rarely indicated for cystocele alone!

34
Q

Educate patient with a cystocele on

A

weight loss
future pregnancy (cant again)
bowel health
occupational concerns

35
Q

What is a rectocele

A

rectovaginal herniation between rectum and vagina

36
Q

How does a rectocele present

A

rectal fullness, straining at stool, vaginal “bulging”, low back pain

37
Q

You should evaluate a patient with suspected rectocele for

A 
Rectovaginal fistula 
(do PE just as cystocele)
38
Q

How do you diagnose a rectocele

A

Clinically!
dynamic cystoproctography helps tell rectocele vs enterocele vs sigmoidocele
-not popular bc you take an XR while peeing/pooping

39
Q

How do you manage a rectocele

A

stool softeners
Kegels
Pessary
-Tx if pt wants more kids, and if ASx

40
Q

What surgery is indicated for a rectocele

A

Colpoperineorraphy w/ sutures placed in levator ani muscles

-rarely required for rectocele alone

41
Q

What is vaginal prolapse

A

downward displacement of the vaginal apex 2/2 loss of muscle and ligament support
common s/p hysterectomy

42
Q

How does vaginal prolapse present

A

pelvic pressure, sensation of bearing down, dyspareunia, low back pain
concomitant cystocele

43
Q

How do you manage vaginal prolapse

A

Not sexually active: Colpectomy and Colpocleisis
Sexually active: vaginal suspension
Surgery is usually indicated

44
Q

What are the types of pessaries

A

Incontinence ring
Donut
Gellhorn
Gehrung

Summer FDTN Exam 3 (25 decks)

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