Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

OB/Gyn > Menopause > Flashcards

Menopause Flashcards

1
Q

The transition to menopause and typically 5-10 yrs before actual menopause?

A

Perimenopause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What happens during the perimenopause phase?

A
  1. Waxing and Waning of ovarian function.
  2. Signs/Sx of estrogen deficiency begin.
  3. FSH levels increase; the body makes more to try and stimulate ovulation.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Name some common symptoms of estrogen deficiency?

A

Hot flashes (50-80%), sleep disturbance (due to night sweats from hot flashes), urinary continence (50%).

Mood swings, breast tenderness, cognitive (brain fog, memory), vaginal dryness leading to dyspareunia, weight gain, decreased libido, irregular or absent menses.

HA, decr. bone mineral density, joint pain, Incr. total cholesterol/LDL, decr. HDL, depression.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define the criteria to diagnose Menopause?

A
  1. Dx after 12 months consecutive amenorrhea.
  2. Further increase of FSH; typically >40.
  3. Age – range of 40-58 w/median of 52 yrs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the cessation of menses for at least 12 months called?

A

Menopause.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is menopause at < 40 years of age called?

A

Premature Ovarian Failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define “surgical” menopause?

A

Occurs when ovaries are removed in pre-menopausal women – oophorectomy.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Sudden onset of warmth with chest and face becoming flushed?

A

Hot flashes – typically last < 3 mins, sudden resolution and often feeling of cold.

  • May have associated sleep disturbances.
  • Resolve spontaneously in many women over 2-3 yrs.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the gold standard for treating menopausal symptoms?

A

HRT – Hormone Replacement Therapy.

**HRT is an individual risk/benefit decision!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Who can receive HRT with estrogen alone?

A

Pt’s who have had a hysterectomy; everyone else should receive both estrogen and progesterone.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name some NON-pharmacologic therapy (8) to treat menopause?

A
  1. Smoking cessation.
  2. Limit alcohol and caffeine.
  3. Limt hot beverages.
  4. Limit spicy foods.
  5. Keep cool and dress in layers.
  6. Stress reduction – meditation/relaxation exercises.
  7. Increase exercise.
  8. Pace respiration.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the benefits for HRT?

A
  1. Control of disruptive vasomotor symptoms:
    - -Hot flashes, helps restore normal sleep cycle, diminish mood swings, improve lipid profile.
  2. Improvement in vulvovaginal atrophy:
    - -Improve vaginal dryness.
  3. Preservation of bone mineral density.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the risks with HRT, estrogen +/- progestin?

A

Thromboembolism, Breast CA, MI, CVA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the contraindications for HRT?

A
  1. Thromboembolic disease.
  2. Breast CA.
  3. Estrogen-dependent neoplasms.
  4. Pregnancy.
  5. Liver disease.
  6. Undiagnosed abnormal vaginal bleeding.
  7. Uncontrolled HTN, confirmed CVD.
  8. Migraine w/Aura.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indications for Estrogen?

A
  1. Tx of moderate to severe VASOMOTOR Symptoms & VULVOVAGINAL ATROPHY associated with menopause.
  2. Prevention of POST-Menopausal Osteoporosis (2nd line).

**DOSE at lowest effective dose for relief of Sx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Treating primary vaginal atrophy?

A

Topical estrogen products – creams, tablets, rings, etc.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the most prominent and active form of endogenous estrogen?

A

Estradiol

There is also synthetic estrogens, equine estrogens (from pregnant mares), micronized estrogens (smaller particle size).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Name two PO Estrogen medications?

A
  1. Oral conjugated Equine Estrogen (Premarin).
  2. Micronized Estradiol tablets (Estrace).
  3. Synthetic conjugated estrogens (Enjuvia, Cenestin).
  4. Estradiol Acetate (Femtrace).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the advantage of Transdermal Estrogen (Estraderm, Climara)?

A

Steady rate of estrogen absorption for more uniform symptom control and avoids 1st pass and less GI Sx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Other NON-PO forms of Estrogen?

A
  1. Transdermal (Estraderm, Climara).
  2. Percutaneous gel or cream (Evamist).
  3. Estradiol pellets.
  4. Vaginal creams, Tablets, Rings (Femring, Premarin Vaginal Cream).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Women with an intact uterus must also be prescribed what with estrogen therapy to prevent what?

A

Rx Progestin along with Estrogen to prevent the increased risk of endometrial hyperplasia/cancer.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Progestins should be used for at least how long during the cycle?

A

12-14 days; but can be used continuously.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Why is both estrogen and progestin used daily?

A

To avoid cyclic withdrawal bleeding especially during menopause.

*Medroxyprogesterone Acetate (Provera), 2.5 mg daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Indication for continuous estrogen with cyclic progestin?

A

Cyclic withdrawal bleeding for continued menstrual cycles.

*Medroxyprogesterone Acetate (Provera), 5-10 mg for 12-14 days each cycle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Combination Estrogen and Progestin meds?

A
  1. Prempro – 0.625 mg estrogen, 2.5 mg medroxyprogesterone acetate.
  2. Premphase – 2 pack of 14 tabs (28 days).
    - -1st pack: 0.625 mg conjugated estrogen.
    - -2nd pack: 0.625 mg conj. estrogen and 5 mg medroxyprogesterone acetate.
  3. Combipatch – estradiol and levonorgestrel.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

HRT adverse effects, specifically estrogen?

A

Glucose intolerance, Lipid abnormalities, Na/Water retention (edema, incr. BP), Nausea, Breast tenderness, Melasma, Thromboembolism/DVT.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

HRT adverse effects, specifically progestin?

A

Incr. Sebum (Oily Skin), Incr. facial/body hair, Gallbladder dysfunction, HA, Fatigue, Breast tenderness, Mood changes, Incr. appetite/weight gain, Lipid abnormalities.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Use of Androgens in women?

A

Testosterone

  • -Controversial.
  • -Alleviates Sx of decr. Libido, energy and sense of well-being.
  • -Addition to estrogen may improve bone mineral density (BMD).
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Androgen medications?

A

Methyltestosterone and Esterified Estrogen (Estratest and Estratest HS).

  • -1.25/0.625 mg.
  • -2.5/1.25 mg.
30
Q

Adverse effects associated with Androgen therapy?

A

Incr. appetite/weight gain, Oily skin/Acne, Hirsutism, Incr. LDL and Decr. HDL, Fluid retention.

31
Q

Process for discontinuation of HRT?

A

Treatment SHOULD BE TAPERED!

2 general tapering mechanisms:
–Dose taper: decrease dose of estrogen over weeks to months and monitor for return of symptoms.

–Day taper: decrease the days per week of HRT from 7 days to 5 days a slowly from there.

32
Q

Antidepressant use in menopause?

A

NON-hormonal treatment to decrease frequency of hot flashes and help alleviate associated depression and anxiety.

  • SSRIs – Citalopram (Celexa), Paroxetine (Paxil), Sertraline (Zoloft), Fluoxetine (Prozac).
  • SNRI – Venlafaxine (Effexor).
33
Q

What NON-hormonal treatment has been considered safe for short-term treatement of hot flashes?

A

Gabapentin.

34
Q

Good option as NON-Hormonal treatment in pt’s with frequent hot flashes and hypertension?

A

Clonidine (Catapress).

35
Q

Used for postmenopausal women with dyspareunia?

A

Ospemifene (Osphena) – SERM; agonist activity on vaginal tissue only.

36
Q

AE of Ospemifene (Osphena)?

A

Worsen hot flashes and increased risk of thromboembolism.

37
Q

Treatment for vasomotor Sx and prevents Osteoporosis?

A

Conjugated Estrogen + Bazedoxifene (Duavee) – Estrogen + SERM.

38
Q

When does perimenopause typically occur?

A

In the 40s.

39
Q

What is the hallmark presentation of Perimenopause?

A

Irregular periods.

40
Q

Other common symptoms of perimenopause?

A
  1. Hot flashes and sleep problems.
  2. Mood changes.
  3. Vaginal or Bladder problems.
  4. Decreasing fertility – as ovulation becomes irregular.
  5. Changes in libido.
  6. Loss of bone.
  7. Change in cholesterol levels.
41
Q

What is the patho behind vaginal or bladder problems during peri/menopause?

A
  1. Estrogen levels diminish, vaginal tissues lose lubrication and elasticity, making intercouse painful.
  2. Low estrogen may also cause an increase in urinary or vaginal infections and urinary incontinence.
42
Q

Why does your cholesterol change during peri/menopause?

A

Declining estrogen levels may lead to an increase in low-density lipoprotein (LDL) cholesterol, which contributes to an increased risk of heart disease.

43
Q

Risk factors of perimenopause?

A
  1. Smoking.
  2. Family History.
  3. Cancer treatment – chemo and pelvic radiation.
  4. Hysterectomy – partial, intact ovaries may cause menopause to occur earlier than average.
44
Q

What about perimenopause can cause endometrial hyperplasia and cancer?

A

The continuous estrogen exposure without sufficient progesterone levels.

45
Q

What would you consider in women over 40 y/o with abnormal bleeding? And why?

A

An endometrial Bx, due to the continuous exposure to estrogen w/o sufficient progesterone levels.

46
Q

What may regulate bleeding and reduce the risk of endometrial cancer?

A

Low dose OCPs or progesterone therapy (Oral or IUD).

47
Q

Diagnosis of perimenopause?

A

Perimenopause is a gradual process; no one test or sign is enough to determine perimenopause.

  • -Factors such as age, menstrual history, Sx or body changes can be used.
  • -Thyroid function, which effects hormone levels, should be checked to r/o other possibilities.
  • -Other hormone testing is rarely necessary or useful to eval perimenopause.
48
Q

Treatment of perimenopause?

A
  1. HRT – estrogen in lowest effective dose; most effective treatment.
  2. Vaginal estrogen – relieve vaginal dryness.
  3. Antidepressants – SSRI’s to reduce hot flashes.
  4. Gabapentin (Neurontin) – reduce hot flashes.
49
Q

Non-pharm treatment of perimenopause?

A
  1. Ease vaginal discomfort with OTC products.
  2. Eat healthy.
  3. Exercise.
  4. Get enough sleep.
  5. Stress reduction techniques.
50
Q

When the ovaries stop functioning normally and do not produce normal amounts of estrogen and do not ovulate correctly, before age 40?

A

Premature Ovarian Failure, aka Primary Ovarian Insufficiency.

51
Q

What is the difference between perimenopause and premature ovarian failure?

A
  • Women with Primary Ovarian Insufficiency can have irregular or occasional periods for years and might even get pregnant.
  • Women with perimenopause stop having periods and can’t become pregnant.
52
Q

Signs and Sx of Primary Ovarian Insufficiency?

A
  • Irregular or skipped periods.
  • Hot flashes and/or night sweats.
  • Vaginal dryness.
  • Irritability/difficulty concentration.
  • Decreased libido.
53
Q

Causes of Primary Ovarian Insufficiency?

A
  1. Idiopathic.
  2. Toxins - chemo, radiation.
  3. Immune response to ovarian tissue.
  4. Chromosomal defects.
54
Q

Risk factors for Primary Ovarian Insufficiency?

A
  1. Age – risk increases b/t ages 35-40.
  2. Family History.
  3. Ovarian surgery.
55
Q

Complications of Primary Ovarian Insufficiency?

A
  1. Infertility.
  2. Osteoporosis – low estrogen linked to weak/brittle bones.
  3. Depression or anxiety.
  4. Heart disease – early loss of estrogen incr. risk.
56
Q

What is Primary Ovarian Insufficiency also known as?

A

Premature Ovarian Failure.

57
Q

What is the treatment of Primary Ovarian Insufficiency?

A
  1. Estrogen therapy
    - -Help prevent Osteoporosis.
    - -Relieve hot flashes and other Sx of estrogen deficiency.
    - -Estrogen w/progesterone if uterus intact.
58
Q

How is adding progesterone to estrogen beneficial in a pt. with Primary Ovarian Insufficiency and an intact uterus?

A

It protects the endometrium from precancerous changes that may be caused by taking estrogen alone.

59
Q

Disorder of a symptomatic menopausal state that may include Sx such as flushing, headache, insomnia/sleeplessness, lack of focus/concentration, neurosis and psychoneurosis?

A

Climactic state.

Neurosis – mild mental illness not caused by organic disease, involving symptoms of stress (depression, anxiety, obsessive behaviour, hypochondria) but not a radical loss of touch with reality.

60
Q

What does Climacteric refer to?

A

The gradual changes of ovarian function that starts before menopause and continue after for awhile.

**It is not menopause.

61
Q

What is oocyte atresia?

A

The degenerative process where the fate of the vast majority of oocytes die or arrest.

  • 20 wks gestation – 7 million oocytes.
  • Birth – 1-2 million.
  • Puberty – 3-500,000 and only 400-500 actually ovulate.
  • Menopause – 1,000, which eventually all atrese.
62
Q

What are the major changes to the menstrual cycle during menopause?

A
  1. Follicular phase shortens; Luteal phase the same.
  2. Cycles irregular – short and normal cycles; more like anovulatory.
  3. FSH levels higher.
  4. Early follicular phase FSH above 10 IU/L.
  5. AMH = anti mullerian hormone; is non-detectable 5 yrs before menopause.
63
Q

What does Anti-mullerian Hormone do?

A

Produced by granulosa cells of pre-antral and small ovarian follicles and reflects the transition of resting primordial follicles to growing follicles.

64
Q

What are the 3 phases to the transition to menopause?

A
  1. Perimenopause begins the transition.
  2. Menopause; 12 consecutive months w/o a menstrual period.
  3. Postmenopausal; 24-36 months after last period and symptoms begin to subside.
65
Q

Hormone changes during menopause?

A
  1. Elevated FSH/LH (10-15 fold).
  2. Reductions in ESTRADIOL.
  3. Ratio of estradiol/estrone reverses making the ESTRONE the predominant circulating estrogen.
  4. Low progesterone.
  5. Testosterone declines with aging.
  6. Surgical menopause = lower testosterone levels; 40-50% less than women with intact ovaries.
  7. Cortisol levels reported to rise in late menopause transition, then stabilize.
66
Q

What is the most important aspect of treating menopause with HRT?

A

Must give progesterone if woman has an intact uterus.

67
Q

Why is CV risk greater in women undergoing menopause?

A
  1. CV protection is lost after menopause due to loss of estrogen.
  2. Young women who has a bilateral oophorectomy w/o hormone replacements, have a 2.2x greater risk of heart disease.
  3. Estrogen raised LDL and lowers HDL.
68
Q

Why are memory complaints common during perimenopause/menopause?

A

Estrogen affects dopamine (incr. w/estrogen); dopamine is a chemical essential for nerve cell communication.

**Cognitive impairment during menopause is caused by a reduction in estrogen.

69
Q

Depression in menopause…

A
  1. The risk of depressive d/o increases during and after the menopause transition.
  2. Women w/depression history prior to midlife are at greatest risk for MDD during and after the menopausal transition.
  3. HRT should NOT be used to treat MDD.
70
Q

Is HRT approved for treatment of Osteoporosis?

A

No, only prevention – HRT is an inhibitor of bone resorption.

**Fx risk is reduced.

71
Q

What is Genitourinary Syndrome of Menopause (GSM)?

A

Formerly Vulvovaginal Atrophy.

  • Affects 50% of postmenopausal women.
  • Vaginal walls become thinner.
  • pH changes to >5; changing the bacterial flora.
72
Q

What are the effects of estrogen on GSM?

A
  1. Lowers vaginal pH.
  2. Thickens epithelium.
  3. Incr. sub-epithelial capillary growth.
  4. Alleviates vaginal Sx: dryness, soreness, irritation, pruritus, dyspareunia.

OB/Gyn (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions