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GYN > menopause > Flashcards

menopause Flashcards

1
Q

menopause beings

A

no period for 12 months the first day after that year

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2
Q

average age of menopause

A

Menopause is the cessation of menstrual periods occurring at about 51.4 years in normal women

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3
Q

impacts of not having estrogen for 30 years

A 
cardiovascular
bone density
sexual function
memory 
dementia
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4
Q

late postmenopause takes place

A

about 5-6 years after menopause begins

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5
Q

Perimenopause is defined as

A

no period for 12 months

Defined as the 2-8 years preceding menopause

and up to 10 years
technically ends one year afte the least mentraul period

ovarian function waxes and wanes

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6
Q

what occurs during perimenopasue

A

less frequent or more frequent bleeding

might get normal ovulary cycles interspersed with regular cycles

irregular menses but still need to be on contraception

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7
Q

hormone cycles seen in perimenopause

A

Fluctuating FSH, estradiol, progesterone

FSH begins to rise, Inhibin B concentrations fall

Progesterone low in luteal phase

Estradiol low (more estrone)

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8
Q

CM of peri menopause (early)

A

changes in bleeding patterns- pretty common

vasomotor symptoms-hot flashes

sleep disturbances-1st complaint

sexual dysfunction

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9
Q

CM of peri menopause (late)

A

genitourinary sxs-later

Vaginal dryness/urogenital atrophy; dyspareunia

sexual dysfunction can also be a problem later

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10
Q

as estrogen declines we frequently see these mood changes

A

depression

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11
Q

what are vasomotor sxs associated with peri menopause

A

most common acute change

vasomotor sxs
75% of women experience hot flashes
sleep disturbance

fatigue irritability, depression and difficulty concentrating

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12
Q

Genitourinary symptoms associated with menopause

A

Vaginal dryness/urogenital atrophy

Due to estrogen deficiency causing thinning of the vaginal epithelium and vaginal atrophy

Atrophic Vaginitis, Atrophic Urethritis

Recurrent urinary tract infections

Dyspareunia

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13
Q

Sexual Dysfunction CM

A

Decreased vaginal lubrication

Decrease in blood flow to vagina/vulva

Vaginal atrophy, dryness and dyspareunia

Decrease in elasticity of the vaginal wall

? Decreased sensation in the clitoral and vulvar area

Shortening and narrowing of the vaginal vault

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14
Q

what predisposes pts to depression

A

Prior history of depression or PMS is strong predictor

Depression during the perimenopausal years

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15
Q

ddx of menopause

A

pregnancy

premature ovarian failure women <45

thyroid (always check TSH with fatigue or weight changes)

hyperprolactinemia

atypical hot flashes

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16
Q

bone pain
weight loss
early satiety with hot flashes or atypical hot flasshes

A

suspect malignancies

atypical hot flashes only at night and during the day)

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17
Q

labs for women under 45 with sxs of menopause

A

Blood work for HCG, prolactin, TSH, FSH
probably estradiol too (would be low if FSH up )

FSH of 8, 9, 10 = ovary shut down
over 25 probably peri menopause

increasing FSH in the presence of decreasing estradiol is indicative of menopause

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18
Q

what would you want to do in a pt over 45 with really heavy bleeding

A

endometrial biopsy

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19
Q

Post Menopausal Bleeding

A

Bleeding that occurs after 12 months of amenorrhea

never normal and always needs a work up (unless ot is on hormones)

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20
Q

HCT bleeding usually looks like

A

Prolonged (10-14 days) or heavy bleeding associated with hormone replacement

takes about 3 months for women to adjust

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21
Q

Unopposed oral estrogen is a bad idea because

A

Unopposed oral estrogen (without progesterone) in women with a uterus can cause hyperplasia and endometrial carcinoma

if there is a uterus need progesterone!!!!!

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22
Q

Major source of estrogen in menopausal women

A

is conversion of androstendione to estrone

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23
Q

Estrone compared to estrogen

A

Estrone is a less potent estrogen than estradiol

24
Q

what are the effects of estrone on the body

A

estrone because it is less potent will be accompanied by hot flashes and our typical menopausal symptoms

also can lead to cysts (adnexal mass or pain)

Functional cysts
Hemorrhagic cysts
Diagnosis may be achieved using ultrasound, laparoscopy or laparotomy

25
Q

lifestyle modifications for peri menopausal women

A

exercise regularly and sleep regularly

hydration for regulation of the hypothalamus

26
Q

pH change with menopause

A

between 3.8 and 4.5 is normal

during menopause
Vaginal pH 6.0 to 7.5

Increase in pH and vaginal atrophy may impair protection against vaginal and urinary tract infection

27
Q

Inhibin B concentrations fall due to

A

to a decline in follicle number

FSH levels begin to rise

28
Q

what labs would indicate menopause

A

High FSH and low estradiol values may be suggestive of menopause

29
Q

how topical estrogen is rx

A

every day for two weeks

to two to three times a week

30
Q

functional vs hemorrhagic cysts

A

functional cysts do not secrete anything

31
Q

anovulation is the result of

A

Due to progesterone deficiency

32
Q

other than EMB what else can be done to evaluate DUB in a post menopausal woman

A

TVS

To look at the endometrial stripe <5mm

33
Q

Vaginal dryness/urogenital atrophy

A

Due to estrogen deficiency causing thinning of the vaginal epithelium and vaginal atrophy

34
Q

sxs of atrophic vaginitis

A

Symptoms can include itching, irritation and dyspareunia (painful intercourse)

35
Q

long term complications

A

Osteoporosis

Cardiovascular disease

Dementia

36
Q

Osteoporosis is of significant risk in

A

more common in women with low estrogen levels

37
Q

cardiovascular disease is seen

A

seen as early as 2 years post menopause especially in women w/out hormone replacement

women at higher risk than men after menopause due to the loss of estrogen

38
Q

when would you need to do a workup for post menopausal tx

A

if there is any bleeding at all and the pt is not on HRT

hx of fibroids maybe do a TUS instead

If bleeding for >6 mos on HRT
(usually normal in first 3 months)

OR on HRT and bleeding Prolonged (10-14 days) or heavy bleeding associated with hormone replacement

maybe the fibroid was asleep before and now super heavy bleeding

OR on unopposed oral estrogen

39
Q

everyone with a uterus needs to be on this type of HRT

A

progesterone and estrogen

can lead to hyperplasia and endometrial carcinoma

40
Q

why do we workup a pt who is bleeding a lot on HRT

A

first thing we are worried about is endometrial cancer

41
Q

when can HRT not be considered

A

over the age of 60 or 10 years post menopause

can use vaginal estrogen

cardiovascular risk is too high

42
Q

indications for HRT

A

Osteoporosis prevention and treatment
(not first line)

Urogenital atrophy

Vasomotor symptoms

Symptomatic after oophorectomy

43
Q

what is the first line for osteoperosis

A

bisphosphinates

44
Q

probable benefits of estrogen

A 
Improves mood, libido
-Decreases skin aging
-Decreases incontinence
-Reduced osteoarthritis
-Prevents cataracts
-Prevents macular degeneration
Hormone replacement NO LONGER FOR PREVENTION of CAD (Coronary Artery Disease)
45
Q

known benefits of HRT

A 
Decreases hot flashes 
Improves bone mineral density (BMD)
-Decreases fracture risk
Improves sexual function
-Improves symptoms of vaginal atrophy 
-Decreases risk of colon cancer
Reduction of benign breast disease
Prevention of ovarian cancer and endometrial cancer
46
Q

IUD would not work for these sxs of menopause

A

hot flashes

just irregular bleeding

would want OCP (enough estrogen to decrease hotflasshes)

47
Q

CI to HRT

A 
	Hypertension
	Atypical breast lesions
	Diabetes mellitus
	Hx of gall bladder disease or stones
	Migraines
	Endometriosis
	Fibrocystic breast disease
	Uterine fibroids
	Obesity
	Seizures
	Past history of deep venous thrombosis or pulmonary embolism
48
Q

when can you use OCP as opposed to HRT

A

OCP until age 51 if no contraindications
then you can switch without testing

however if you have a woman coming in with sxs and w/out BC probably want to test FSH first if over 25= menopausal and switch to HRT

49
Q

can say with confidence hormone users who develop breast cancer have better outcomes then those not on hormones probably because

A

more regualr screening

50
Q

if you have a woman with a 10 year CVD rish of 4% when could you use HRT

A

anywhere from 5-10 years after menopause

51
Q

if you have a woman with a 10 year CVD risk of 6% when could you use HRT

A

Trandermal only

52
Q

when would you avoid HRT if worried about her cardiovascular risk

A

if greater than 10%

53
Q

CI to HRT

A

such as a history of breast cancer, coronary heart disease [CHD], a previous venous thromboembolic event or stroke, or active liver disease

54
Q

what type of progesterone should be used in pts interested in oral HRT

A

micronized progesterone

because it is effective for endometrial hyperplasia, is metabolically neutral, and does not appear to increase the risk of either breast cancer or CHD, although data are limited.

55
Q

HRT should be used for the length of time .

A

Suggest limiting to 5 years

but can be used for longer if time permits

GYN (13 decks)

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