Menopause Flashcards
Climacteric
Phase in a woman’s reproductive life when a gradual decline ovarian fxn results in decreased sex steroid production, and the associate sequelae
Menopause transition
change in length
increase FSH
leading to FMP
Perimenopause
change in length
increase FSH
12 months after FMP
Menopause
12 months of amenorrhea after FMP in a woman >45 yo in absence of other biological/physiological causes
Postmenopause
early stage is first 5 yrs after FMP, late stage is 5 yrs after FMP to death
Nl age of menopause and contributing factors to age of onset
50-55, avg 51.5
-genetics, smoking, hysterectomy
Sx of perimenopause
- changes in menstrual cycles
- mood and emotional changes
- hot flashes or flushes and night sweats
- breast changes
What happens to estrogen, androgens, progesterone, LH, and FSH levels in menopause?
- decreased estrogen
- decreased androgens (facial hair growth, decreased breast size)
- decreased progesterone (irregular vaginal bleeding)
-Increased LH and FSH
General sx of menopause
- hot flushes
- insomnia
- irritability
- mood disturbances
physical changes of menopause
- urogenital atrophy
- urinary stress incontinence
- skin collagen loss
disease a/w menopause
- osteoporosis
- CV disease
- dementia
Describe sx of “genitourinary syndrome of menopause”
- vaginal atrophy
- vaginal canal shrinks in diameter
- elastic capacity of the bladder is decreased
What are 1st and 2nd line tx options for menopause?
1ST line= non-hormonal vaginal moisturizers and lubricants
2nd= vaginal estrogen therapy
What is the gold standard tx for patients for relief of vasomotor sx?
Estrogen therapy
Who should NOT have unopposed estrogen?
women w/ a uterus
also: breast CA, CHD, prior stroke, high risk endometrial CA
When prescribing Menopause Hormone Therapy (MHT), what dosage/time do you do?
lowest effective dose for the shortest period of time (<5 yrs)
What are adverse effects of long-term, high dose Menopause Hormone Therapy?
Increased risk of CHD, stroke, VTE, breast CA
True or false: MHT should be used for prevention of chronic diseases (CHD, osteoporosis)
NAHHHHH
Alternative tx:
Soy & isoflavones can be used for?
short term tx for vasomotor sx (2 yrs)
Alternative tx:
St. John’s wort can be used for?
short term tx of mild-mod depression (2yrs)
short term tx of hot flashes (8 wks)
Alternative tx:
Black cohosh can be used for?
short term tx of vasomotor sx (6 mo)
What is a cystocele & what is it a/w (higher risk)?
downward displacement of bladder into the vagina
a/w childbirth
Common sx of a cystocele?
- pelvic pressure
- low back pain
- sensation of “sitting on something”
Aggravating and Alleviating factors of cystocele
aggravating= vallava, cough, sneeze
alleviating= lying supine
How do you dx a cystocele?
Clinically
you’ll see it coming out of the vagina…
Non surgical options for cystocele
- exercises- kegels
- pessary use
- vaginal weights
Surgical intervention of choice for cystocele?
anterior colporrhaphy
bladder is pushed back into place &support tissue is tightened/reinforced
What is a rectocele?
rectovaginal herniation between the rectum and the vagina
Possible sx of rectocele?
- rectal fullness
- straining at stool
- vaginal “bulging”
- low back pain
What type of patients would you use non-surgical management of a rectocele for?
what are the options
- pts w/ want more kids
- asymptomatic pts
- stool softeners
- kegel exercises
- pessary
What is the surgical management done for rectocele?
colpoperineorraphy
sutures placed in levator ani muscles
Vaginal prolapse typically is seen after what?
hysterectomy
Sx of vaginal prolapse
- pelvic pressure
- sensation of bearing down
- dyspareunia
- low back pain
If pt is not longer sexually active, what are the surgical interventions done for vaginal prolapse? (2)
colpectomy and colpocleisis
closing the vagina off
If pt desires sexual activity, what surgical option is done for vaginal prolapse?
vaginal suspension
