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NM701 Gynecological Health > Menopause > Flashcards

Menopause Flashcards

1
Q 
Agents that reliabily improve \_\_\_\_\_\_\_\_\_\_\_:
estrogen
acupuncture
venlafaxine (Effexor)
placebo
A

hot flashes

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2
Q

the most reliable determinant of whether a woman has reached menopause

A

LMP 12 full months ago or longer

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3
Q

estrogen+progestin ___________ the risk of colorectal cancer

A

reduces

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4
Q

most effective therapy for hot flashes

A

estrogen

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5
Q

dyspareunia can often be resolved with:

A

vaginal estrogen

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6
Q

normal physiologic change in the HPO axis which causes the ovaries to stop functioning and periods to stop marking the end of reproductive years

A

menopause

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7
Q

usual age of menopause =

average age of menopause =

A

48-55

average 51

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8
Q

Diagnostics for ___________
Periods stop for 12 consecutive months w/o taking exogenous hormones (using LMP)
Age
Lab hormone testing (not recommended during perimenopause)

A

menopause

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9
Q

Hormone Changes during ____________:
Fewer ovarian follicles develop w/ each cycle →
those follicles less responsive to FSH
ovaries have less estradiol, progesterone, and androgens →
negative feedback loop is lost
anterior pituitary production of FSH and LH continues

A

Perimenopause

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10
Q

Eventually, ___________ stops which causes hormone levels to stop fluctuating making periods stop

A

follicle production

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11
Q

FSH during ____________:

follicles less responsive to FSH → eventually remains high

A

Perimenopause

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12
Q

FSH during ____________:
HIGH in response to decreased estrogen → ovarian stromal tissues to increase testosterone production
Increase to >/=30– likely indicates menopause (not required for dx)

A

Postmenopause

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13
Q

LH during ___________:

eventually remains HIGH

A

Perimenopause

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14
Q

LH during ___________:

HIGH in response to decreased estrogen → ovarian stromal tissues to increase testosterone production

A

Postmenopause

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15
Q

Estrogen during ___________:

Ovaries produce less estradiol, progesterone, and androgens so estrogen eventually remains LOW

A

Perimenopause

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16
Q

most potent form of estrogen, mainly in reproductive years, low in postmenopausal years following the peripheral conversion of androstenedione

A

Estradiol - E2

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17
Q

estrogen form secreted by the placenta, synthesized from fetal androgens during pregnancy
(Small amounts in nonpregnant women)
By-product of estradiol and estrone

A

Estriol - E3

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18
Q

weakest form of estrogen, mostly found in postmenopausal women, children, and men. Postmenopause produced by adipose conversion of androstenedione secrete by adrenals (95%) and ovaries (5%) also by the metabolism of estradiol

A

Estrone - E1

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19
Q

Ovaries no longer produce estrogen or functional follicles when?

A

after menopause

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20
Q

After menopause, coricostromal and hilar cells of stromal tissue are steroidogenic which leads to significant levels of ___________ and ____________ for many years

A

androstenedione and testosterone

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21
Q

Circulating levels of this hormone remain relatively constant in PRE and POST menopause partly due to presence of high FSH and LH that cause ovarian stromal tissues to increase production

A

testosterone

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22
Q

vasodilation that causes hot flashes is result of a surge of ______

A

LH

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23
Q

increased body temp followed by decreased core temp causes:

A

night sweats

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24
Q

night sweats along with normal aging lead to less time in sleep stage ___ and ___

A

3 and 4

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25
Q

causes vaginal dryness, dyspareunia, and UTI predisposition

A

Urogenital atrophy

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26
Q 
\_\_\_\_\_\_\_\_\_\_ of Menopause:
longer time to lubrication
less overall vag secretions and elasticity
petechiae and bleeding
fewer lactobacilli → more infections
tissue atrophy
A

Sexual Dysfunctions

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27
Q

___________ Symptoms of Menopause:
More common in obese
Begin in perimenopausal period
Peak in first 2 years after final LMP
Most symptomatic women will experience s/s on average of 5 yrs after menopuase
⅓ will experience s/s for 10 years or more

A

Vasomotor

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28
Q

Hormonal Treatment for __________:
Standard treatment if appropriate
ET or EPT
Micronized P 300 mg/night → less hot flashes/night sweats, increased sleep

A

Vasomotor Symptoms

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29
Q

Lifestyle Mods for ___________:
avoid hot drinks/spicy food/ETOH/caffeine/smoking; stress, anxiety management; increase water, breathable clothes, decrease room temp, fans, layers, paced respirations, cold drinks, exercise (start before menopause), chill towels & pillows, decrease stress, soy isoflavones

A

Vasomotor Symptoms

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30
Q 
Nonhormonal Medical Treatment for \_\_\_\_\_\_\_\_\_\_\_\_\_:
Vitamin E- up to 800 IU
Soy isoflavones - for 6 wks - 1 yr 
Black cohosh
St john’s - often w/ cohosh
Antidepressants
Anticonvulsants
Antihypertensives
A

Vasomotor Symptoms

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31
Q

CAM for ______________:
Acupuncture
Mindfulness
CBT

A

Vasomotor Symptoms

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32
Q 
Hormonal Therapy for \_\_\_\_\_\_\_\_\_\_:
Low-dose ET or EPT
Oral Progestin (mildly sedating)
A

Sleep Disturbances

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33
Q 
Lifestyle Mods for \_\_\_\_\_\_\_\_\_\_\_:
Regular exercise - especially yoga
Sleep hygiene
Avoid caffeine, ETOH, nicotine
Decrease stress
Mindfulness
Manage hot flashes
A

Sleep Disturbances

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34
Q

Nonhormonal Medical Treatment for _____________:

Valerian

A

Sleep Disturbances

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35
Q

CAM for ______________:
acupuncture
relaxation techniques

A

Sleep Disturbances

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36
Q 
Hormonal Treatment for \_\_\_\_\_\_\_\_\_\_:
Vaginal estrogen (consider cancer hx - topical preferred)
A

Vaginal Symptoms

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37
Q

Nonhormonal Medical Treatment for _____________:
Dyspareunia - Ospemifene & intravaginal DHEA
Lubes - water, silicone, oil
Unscented moisturizers to support normal pH - several times/week and between sex

A

Vaginal Symptoms

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38
Q

CAM for ______________:
Mindfulness
CBT

A

Vaginal Symptoms

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39
Q

Hormonal Treatment for __________:

ET- vaginal or transdermal

A

Urogenital Symptoms

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40
Q

CAM for ______________:
Pelvic floor training
Pessaries
Surgery

A

Urogenital Symptoms

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41
Q

Lifestyle Mods for ___________:
Exercise
Stress management
Relaxation techniques

A

Mood Symptoms

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42
Q 
Nonhormonal Medical Treatment for \_\_\_\_\_\_\_\_\_\_\_\_\_:
Valerian
Kava (anxiety, hepatotoxic)
Ginseng
St.John’s Wort
A

Mood Symptoms

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43
Q 
Lifestyle Mods for \_\_\_\_\_\_\_\_\_\_\_:
Social networking
Nind engagement
Stimulating work
Puzzles
Not smoking
ETOH moderation
Exercise
A

Mental Function

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44
Q

Nonhormonal Medical Treatment for _____________:

Omega-3 fatty acids

A

Mental Function

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45
Q

Lifestyle Mods for ___________:

Stop smoking

A

Osteoporosis

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46
Q

Nonhormonal Medical Treatment for _____________:
Calcium supplement
Vitamin D

A

Osteoporosis

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47
Q

___-___% of women experience s/s of vulvovaginal atrophy (VVA) due to decreased estrogen

A

20-50%

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48
Q

Moisturizers don’t replace ________ at time of sex

A

lubrication

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49
Q

Not recommended for __________:
Petroleum jelly products
Fragrances (including products with them)
Douching

A

Vaginal Dryness

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50
Q

For vaginal ___________, consider silicone based iso osmolar product or propylene glycol free product

A

irritation

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51
Q

unopposed estrogen hormal therapy given to those WITHOUT a uterus recommended when only vaginal symptoms are present

A

Estrogen therapy (estrogen only) (ET)

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52
Q

causes increased endometrial cancer due to proliferating endometrial lining if given to woman with a uterus

A

Estrogen therapy (estrogen only) (ET)

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53
Q

Transdermal and low-dose oral ET associated w/ lower risk for __________

A

VTE and stroke

54
Q

may be given oral, transdermal, topical, creams, or via vaginal tablets

A

Estrogen therapy (estrogen only) (ET)

55
Q

hormonal therapy for those WITH a uterus

BUT Limited to 3-5 years of use due to increased risk of breast cancer

A

Estrogen Plus Progestogen Therapy (EPT)

56
Q

only included in the hormonal therapy for endometrial protection for women w/ a uterus to decrease endometrial carcinoma risk

A

progestogen

57
Q

there is an option to place LNG IUD along with giving ET so woman is receiving:

A

progestogen

58
Q

progestogen added is not needed when ET is:

A

local (NOT systemic)

59
Q

hormone therapy is used during ___________ and ______________

A

perimenopause and postmenopause

60
Q

for premature or early menopause, used until median menopause age of 52

A

Menopause Hormone Therapy (MHT)

61
Q

CS-EPT – Estrogen daily + Progestofen cyclicly usually day 1-12 of cycle (will have a withdrawal bleed)

A

Sequential HT

62
Q

CC-EPT everyday to avoid withdrawal bleeding

A

Continuous HT

63
Q

Progestogen taken 2 days on then 1 day off (more breakthrough bleeding)

A

Pulsed HT

64
Q

Estrogen taken day 1-12 then Progestogen taken day 12-21 then nothing taken day 22-28 (withdrawal bleeding and menopause s/s rebound)

A

Cyclic HT

65
Q

cannot use _______ for progestogen therapy because they have more than needed

A

Depo or Nexplanon

66
Q

Forms of __________”
oral
gel
IUD

A

Progestogen

67
Q 
\_\_\_\_\_\_\_\_\_ forms of Estrogen:
oral
patch
creams
sprays
gels
Femring (only one)
A

Systemic

68
Q

___________ forms of Estrogen:
vaginal creams
vaginal tablets
rings (Estring lower dose than Femring)

A

Local

69
Q

Progestogen-only form of HT is a ______ because cream is not FDA approved

A

pill

70
Q

Systemic HT doses treat:

A

vasomotor symptoms

71
Q

Local HT doses treat:

A

genitourinary symptoms (atrophic vaginitis)

72
Q

EPT use should be limited to ___-___ years due to increased risk of breast cancer

A

3-5

73
Q

could be used longer than 3-5 years in the absence of adverse effects or known risk factors

A

ET (Estrogen-only Therapy)

74
Q

most effective treatment for vulvar and vaginal atrophy

A

ET (Estrogen-only Therapy)

75
Q

_______ ET is recommended when only vaginal sympotoms are present

A

Low-dose, Local

76
Q

data is lacking to support ET in women with history of:

A

breast cancer

77
Q

HT can be used in women who experience premature menopause until age:

A

52 (median age of menopause)

78
Q

transdermal and low-dose oral ET have been associated with lower risk of:

A

VTE and stroke

79
Q

all women with intact uterus receiving systemic ET should receive:
(decreases risk of endometrial cancer)

A

systemic progestogen or

LNG IUD placement

80
Q 
Contraindications of \_\_\_\_\_\_\_\_\_\_\_\_:
Hx breast cancer
Estrogen-dependent neoplasia
Hx uterine cancer
Hx ovarian cancer
Hx biliary tract disorder
Undiagnosed abnormal genital bleeding
Hx of or active thrombophlebitis/thromboembolic disorder
A

Estrogen Therapy

81
Q 
Contraindications of \_\_\_\_\_\_\_\_\_\_\_\_:
Active thrombophlebitis/thromboembolic disorder
Liver dysfunction/disease
Hx breast cancer
Undiagnosed abnormal vaginal bleeding
Pregnancy
A

Progestogen Therapy

82
Q 
Adverse Effects of \_\_\_\_\_\_\_\_\_\_:
Uterine bleeding
Breast tenderness
Nausea
Bloating
Fluid retention in extremities
HA
Dizziness
Hair loss
A

Estrogen Therapy

83
Q

Adverse Effects of __________:
Mood changes
Possible increased uterine bleeding (higher chance than if taking estrogen alone)

A

Progestogen Therapy

84
Q

Adverse Effects of ________:
All the same as ET & P-only
Plus Weight Gain

A

Hormone Therapy

85
Q 
Risks of \_\_\_\_\_\_\_\_\_\_:
breast cancer (if started age<60 or within 10 years of onset)
endometrial cancer (if E taken unnopposed)
VTE
biliary issues
MI
stroke
dementia
A

Hormone Therapy

86
Q

Do not start HT over ___ years after menopause

A

10

87
Q 
Management of \_\_\_\_\_\_\_\_\_\_ caused by HT:
take w/ meals
change estrogen
change to transdermal
lower dose
A

nausea

88
Q

Management of __________ caused by HT:
low dose transdermal E
lower dose or micronized P

A

bloating

89
Q 
Management of \_\_\_\_\_\_\_\_\_\_ caused by HT:
salt restriction
adequate water intake
exercise
herbal or Rx diuretic
A

fluid retention

90
Q 
Management of \_\_\_\_\_\_\_\_\_\_ caused by HT:
(P related)
lower P dose
CC-EPT
adequate water intake
restrict salt, caffeine, ETOH
A

mood changes

91
Q 
Management of \_\_\_\_\_\_\_\_\_\_ caused by HT:
transdermal E
CC-EPT
low dose E or P
adequate water
restrict salt, caffeine, ETOH
A

HA

92
Q

Management of __________ caused by HT:
lower E dose
change P dose
restrict salt, caffeine, ETOH, chocolate

A

breast tenderness

93
Q

symptomatic time leading up to menopause plus for about a year after last LMP

A

perimenopause

94
Q

Use continuous birth control method until age ____ then assume menopausal unless another period happens

A

55

95
Q

Fertility stops at typical age of ___ - so use backup and draw serial FSH labs over several months

A

51

96
Q

may be used in perimenopause (usually ages 45-55) for hot flashes and irregular bleeding

A

CHCs

97
Q

If woman cannot take CHCs for vasomotor symptoms/irregular bleeding due to smoking or other contraindications, give:

A

progestogen-only contraceptive + ET systemic

98
Q

OTC Non-hormonal ____________ :
Water-based: KY jelly, Astroglide liquid/gel, slippery stuff
Silicone: Astroglide X, KY intrigue, pink, ID, Millenium,
Oil: coconut oil, olive oil, vitamin E oil, etc

A

Lubricants

99
Q 
OTC Non-hormonal \_\_\_\_\_\_\_\_\_\_\_\_ :
Feminease
KY SILK-E
luvena
me again
replens
silken secret
vagisil
A

Moisturizers

100
Q

_________ for vaginal dryness:
Most effective
First line for s/s in those w/o contraindications
Femring

A

HT

101
Q

Femring also prevents:

A

bone loss/fracture

102
Q

systemic estrogen therapy for vaginal dryness consisting of estradiol over 3 months - only local tx for HF, has slightly more systemic absorption

A

Femring

103
Q

_________ treatments for vaginal dryness:
Vag preps of E creams - Estrace and Premarin
Tablets - vagifem
Rings - estring and femring
P products - gels, IUD

A

Local

104
Q

prescribed first for isolated GU symptoms of menopause

A

low-dose vaginal ET

105
Q

Local vaginal treatments do not help with:

A

vasomotor symptoms

106
Q

Bone density that is lower than normal peak density, but not low enough to be classified as osteoporosis
T-score -1.1 to -2.49

A

Osteopenia

107
Q

The most common human bone disease characterized by low bone mass, deterioration of the bone tissue, and disruption of bone architecture resulting in reduced bone strength that increases the risk for fracture
T-score -2.5 or less

A

Osteoporosis

108
Q

most common cause of morbidity among menopausal women

A

Osteoporosis

109
Q

Peak bone mass occurs in late ___ - mid ____ and then rates of bone resorption and formation become relatively stable

A

20s-30s

110
Q

type of osteoporosis associated with aging and affects women much more than men. After mid 30s, women’s bone resorption rate slowly begins to exceed formation; d/t loss of estrogen bone loss is especially rapid after menopause

A

primary

111
Q

type of osteoporosis due to medicaitons such as corticosteroids, anticonvulsants, or methotrexate or other dx such as hyperthyroidism, chronic liver disease or GI diseases like malabsorption

A

secondary

112
Q

type of osteoporosis where low bone density or fracture in young adults when no other cause is identified

A

idiopathic

113
Q

Prevention of ___________:
**Prevention starts at menarche
Weight bearing resistance exercise
Fall prevention
Avoid tobacco
Moderating ETOH intake - < 2 drinks/day for women
Screening
Identify risk factors and modify what you can
Use FRX to make decisions about medical treatment
Young & low BMI? Menstruating? If not, consider estrogen tx due to not laying down enough bone
Adequate calcium and vitamin D intake
–Vitamin D: 800-1000IU/day for adults >50
-Calcium: 1200mg/day in postmenopausal
–Dietary intake is best!! - supplementation not recommended for prevention

A

Osteoporosis

114
Q

bone mineral density test by dual-energy x-ray absorptiometry that looks at spine and hip - bone density and reports densities of posterior-anterior lumbar spine, total hip, and/or femoral neck **international criteria for dx of osteoporosis
**results reported in T-scores and z-scores

A

DXA scan

115
Q

osteoporosis diagnosed when T-score is < ___

A

-2.5

116
Q

T-scores are used for men > age ___ and __________ women

A

men > 50 and postmenopausal

117
Q

comparisons to the BMD of an age, sex, and ethnicity matched reference population – used for premenopausal women, children and men <50

A

Z-scores

118
Q

Z-score < _____ is “less than expected range” and should be evaluated for secondary cause of osteoporosis

A

-2.5

119
Q 
Labs to consider and rule out \_\_\_\_\_\_\_\_\_\_\_\_\_\_:
CBC
TSH
CMP
urine calcium
25-hydroxyvitamin
A

secondary osteoporosis

120
Q

computer generated model using clinical factors and BMD to calculate future fracture risk for individuals

  • -Provides 10-year probability for both hip and major osteoporotic fracture - spine, forearm, hip, or shoulder
  • -Aids in identifying those at increased fracture risk and would benefit from medical treatment
A

FRAX

121
Q

Osteopenia is T score ____-____

A

-1.0 – -2.5

122
Q

compares woman’s bone density to 28 yr old woman so score of 0 means equivalent

A

T score

123
Q

comparisons to the BMD of an age, sex, and ethnicity matched reference population

A

Z score

124
Q

First Line treatment for postmenopausal w/ osteoporosis that is an antiresorptive

A

Biophosphonates (alendronate, risedronate)

125
Q

medication best offered to postmenopausal women w/ osteoporosis at high risk for fracture
–Daily SQ injections for no more than 24 months

A

Teriparatide (PTH 1-34)

126
Q

most often considered treatment for postmenopausal women with low bone mass or younger postmenopausal women with osteoporosis

A

SERM (Raloxifine- estrogen agonist-antagonist)

127
Q

osteoporosis medication whose primary indication is to treat moderate to severe menopause symptoms (eg, vasomotor symptoms)

  • When symptoms are controlled or cease, continued treatment can still be considered for bone effects while weighing its benefits and risks against those of alternative therapies
  • May be a treatment option for a few years of early postmenopause
A

Systemic ET/EPT

128
Q 
Reasons for \_\_\_\_\_\_\_\_\_\_\_\_:
T-scores of -2.5 or less
women with hip or vertebral fractures 
T-scores in the low bone mass range (-1.0 to -2.5) +fractures or +high risk for fractures
immobilized
glucocorticoids use
high fall risk
FRAX >/= 3% OR any major osteoporotic fx >/= 20%
A

medication management of osteoporosis

129
Q

Lifestyle changes for ___________:
Eat a balanced diet
Adequate calcium and vitamin D
Appropriate exercise and activity - weight bearing to preserve bone mass, maintain muscle mass, and improve balance
Avoid smoking and excessive alcohol consumption
Fall prevention
Vision
Balance and mobility
Household hazards
**May be all that is needed for postmenopausal at low risk for fracture but all should be encouraged

A

osteoporosis

130
Q

Used to estimate risk and determine who to screen early and risk of fracture
Low scores = used to identify those who would have a cost-effective benefit from starting medication therapy

A

FRAX

131
Q

Once treatment for osteoporosis is initiated, how often do we check bone density?

A

q 2 years

NM701 Gynecological Health (5 decks)

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