menopause Flashcards
when do you begin screening women for osteoporosis
healthy women by age 65
earlier if women smoke, drink, RA, hx of fractures, dz/meds that add to the risk, body weight less than 127
combo estrogen and progestin Hormone Therapy
increases risk of
but decreases risk of
increases risk of:
- thromboembolic events
- breast CA
- CVD
- stroke
decreases risk of
- fractures
- colon CA
what are some non-pharmacologic osteoporosis preventative measures that pts can take
exercise: weight bearing, resistance, walking, aerobics
nutrition:
increase Ca to 1200 mg/ day at age 50
increase Vit D to 800 at age 70
avoid:
smoking, ETOH
laboratory diagnosis of perimenopause
FSH > 25
what are the non-hormonal pharmacological treatments for the vasomotor sxs of perimenopause and menopause
SSRIs (esp. LD paroxetine)
SNRIs
centrally acting anti-epileptics (gabapentin, pregabalin, clonidine)
vaginal vault apical pelvic prolapse
enterocele
stage 1 pelvic organ prolapse
more than 1 cm from the hymenal ring (inside)
Hispanic women are more susceptible to ___
pelvic organ prolapse
stage 3 pelvic organ prolapse
beyond 1 cm past the hymenal ring but still in vagina
what type of hormone therapy do you give
to a woman who has
undergone a hysterectomy
estrogen only
posterior compartment pelvic prolapse
rectocele
why is progestin added to estrogen in Hormone Therapy for women with a uterus
to decrease the risk of endometrial hyperplasia and endometrial CA
what type of hormone therapy do you give
to a woman who
still has an intact uterus
combo estrogen and progestin
(b/c unopposed estrogen with a uterus can cause endometrial hyperplasia and increase the risk of endometrial CA)
what are the components of the genitourinary syndrome of menopause
vulvovaginal atrophy (dryness, itching, dyspareunia)
sexual dysfunction
urinary frequency
recurrent bladder infections
white women and menopausal side effects
more susceptible to ___
osteoporosis
DEXA T score’s:
normal
osteopenia
osteoporosis
normal = - 1 +
osteopenia = - 1 to - 2.5
osteoporosis = less than - 2.5
when treating a patient w/ systemic hormone therapy,
what should the dose be?
for how long should they take it?
lowest effective dose
for the shorterst duration needed
(generally not more than 5 years or beyond 60)
how do you treat the sexual dysfunction sxs of postmenopause
why would not give everyone this (side effects)?
testosterone
but
side effects: lipids, clitoromegaly, hirsutism, and acne
risk factors for pelvic organ prolapse
- vaginal deliveries
- advanced age/ menopause
- obesity
- CT disorder
- chronic dz (constipation/ COPD)
- Hispanic
stage 4 pelvic organ prolapse
beyond the vagina
asian women and menopausal side effects
more susceptible to ___
less susceptible to ___
more susceptible to osteoporosis
less susceptible to vasomotor sxs
how often do you monitor osteoporosis once you begin?
- normal BMD- Q 5 to 15 years
- osteopenia (-1.5 to -1.99)- Q 5 years
- osteopenia (-2 to -2.5)- yearly
- osteoporosis- after tx Q2 years
pelvic organ prolapse treatment
pessary
pelvic floor muscle exercises (kegels)
surgical tx (symptomatic/ refractory)
what are the non-pharmacological treatments for the vasomotor sxs of perimenopause and menopause
lifestyle mods (layering clothes, avoid ETOH and caffeine)
exercise
phytoestrogens (soy, red clover)
herbal remedies (black cohosh, ginseng, ginkgo
vitamin E
accupuncture
** limited data for all of this **
how do you pharmacologically treat the vasomotor sxs of menopause (and perimenopause)
Hormone Therapy
SSRIs and SNRIs
clonidine
gabapentin
pelvic prolapse where the uterus/ vaginal vault protrudes out of vagina
procidentia
disadvantages of pessaries
odor
discharge
vag ulcers
erosion into bladder
fistula formation
ureteral obstruction w/ urosepsis or uremia
small bowel prolapse and incarceration
stage 2 pelvic organ prolapse
from 1 cm before the hymenal ring to 1 cm beyond the hymenal ring
heaviness/ pressure/ pain/ irritation/ discomfort
urinary incontinence/ retention
defecation sxs
feels like something is bulging outside of vagina
pelvic organ prolapse
what are the 3 types of pelvic organ prolapse surgeries
fixation to the sacrospinous ligament
fixation to the uterosacral ligament
sacrocolpopexy (fixation to the anterior longitudinal ligament)
how do you determine risk for osteoporosis related fracture
FRAX score
10 year risk assessment
when do you enter menopause
after 12 months without menstruation, avg age 51.5, younger than 40 is abnormal
osteoporosis diagnosis
DEXA (use T score to diagnose osteoporosis in post-menopausal women)
or
having fragility fractures (fractures that occur from a fall of standing height or less)
laboratory diagnosis of postmenopause
FSH > 70
what are the routes of systemic Hormone Therapy
oral
transdermal- patch/ gel/ spray
who gets osteoporosis tx
T score less than - 2.5
osteopenia + high risk
postmenopausal + hx of hip/ vertebral fracture
black women and menopausal side effects
more susceptible to ___
less susceptible to ___
more susceptible to vasomotor sxs (hot flashes)
less risk of osteoporosis and pelvic organ prolapse
estrogen only Hormone Therapy increases risk of
thromboembolic events
transdermal > oral
osteoporosis pharmacologic tx
-
bisphosphonates- first line
- dronates
- Selective Estrogen Receptor Modulators- also reduces risk of breast CA
- raloxifene
- Recombinant PTH- severe
- teriparatide
- Calcitonin- short term acute pain relief
vulvovaginal atrophy treatment
water soluble moisturizers and lube
estrogen (topical > oral)
estrogen agonists and antagonists that selectively stimulate and inhibit different targe tissues (ospemifene)
how long does perimenopause last?
about 4 years til Final Menstrual Period (FMP)
anterior compartment pelvic prolapse
cystocele
contraindications for Hormone Therapy
breast CA
CVD
prior VTE/ stroke/ TIA
active liver dz
unexplained vag bleeding
high risk endometrial CA
