Menopause

Question 1

Physio of Menopause

Answer 1

Reduced #/quality of follicles –> dec inhibit –> loss of negative feedback to pituitary –> rise in FSH secretion –> more rapid follicular development/shorter follicular phase, dec intervals between pds –> eventually ovulation = intermittent –> cease

Question 2

The menopausal transition (perimenopausal)

Answer 2

• inc FSH
• intermittent ovulation
• variable cycle lengths
• ends w final menses

Question 3

menopause is defined

Answer 3

retrospectively (by 12 mo amenorrhea)

Question 4

perimenopause result in ___ FSH

Answer 4

inc

Question 5

perimenopause result in ___ inhibin

Answer 5

dec

Question 6

Which group of women are most affected by vasomotor sx due to menopause?

Answer 6

African American women also affected

Asian women least affected

Question 7

Most effective

Answer 7

systemic estrogen therapy

• OCPs (perimenopause only)
• low dose estrogens
• concomitant progesterone therapy needed if pt has uterus

Question 8

hormone replacement therapy risks

Answer 8

heart disease, stroke, breast cancer, VTE

Question 9

non hormonal pharm tx for vasomotor sx

Answer 9

• SSRIs
• Gavapentin
• Clonidine

Question 10

vulvovaginal atrophy results in which acid-base change

Answer 10

vaginal pH = more alkaline –> inc risk of vaginitis

Question 11

tx for vulvovaginal atrophy

Answer 11

• lubricants

- topical estrogen therapy (very low systemic absorption, minimal endometrial stimulation)

Question 12

urge incontinence

Answer 12

detrusor overactivity

involuntary leakage assoc w/ sudden strong need to void

Question 13

stress incontinence

Answer 13

involuntary leakage with effort

inc intra-abd P overcomes sphincter closure

Question 14

mixed incontinence

Answer 14

combo of stress and urge incontinence

too much tone and too much activity

Question 15

overflow incontinence

Answer 15

involuntary frequent voids of very small amounts of urine, just can’t hold anymore

assoc w/ loss of bladder m. contractile strength or bladder outlet obstruction

Question 16

Q tip test

Answer 16

measure urethral mobility

angle >30 = abnml

Question 17

Osinski reflex

Answer 17

assesses sacral reflex activity

Question 18

detrusor contraction

innervation

Answer 18

M3 cholinergic receptors

Question 19

overactive bladder pharm tx

Answer 19

1. anti-cholinergics to block ACh at muscarinic receptor sites
   (block detrusor contraction)
2. b3 agonists (stimulate detrusor relaxation)

Question 20

mirabegron

Answer 20

b3 agonist

• relaxes detrusor
• can INC amount of urine the bladder can hold

Question 21

botox

Answer 21

ACh antagonist

• paralyzes detrusor
• for non-responders to other tx

AE: infections (less contraction, more urine retained)

Question 22

imipramine

Answer 22

tricyclic antidepressant, alpha antagonist (blocks NE)

• detrusor relaxation AND smc at bladder neck contract
• treats mixed incontinence

Question 23

duloxetine

Answer 23

• serotonin and NE inhibitor, anti-depressant

- urethral sphincter relaxation

Question 24

is topical estrogen useful for urinary incontinence in female?

Answer 24

little evidence

Question 25

stress urinary incontinence tx

Answer 25

focus on improving bladder neck support

• surgery is best