menopause and endometriosis Flashcards
perimenopause
time leading up to menopause
when ovarian function and hormone production are declining, but have not yet stopped
menopause
permanent cessation of menstrual cycle
premature menopause
menopause occurring before 40
changes that occur with menopause
vasomotor symptoms sleep quality mood changes urogenital symptoms sexual well being skin changes
decreased E
vasomotor symptoms UG disorders CHD risk factor (lipids) skin changes associated with CV disease, bone loss/osteoporosis
decreased P
irregular periods
PMS
decreased androgen
decrease in mood diminished energy impaired sexuality mm weakness osteopenia
what happens when HT is initiated within 5 years of onset of menopause?
does NOT increase CHD risk
what happens if HT is initiated years after menopause?
HT does not prevent and may actual increase risk of CHD
risks of HT
VTE- rare
greatest risk within first year of use
diseases associated with menopause
CHD osteoporosis breast CA colon CA dementia
transdermal administration of HT
seems to not have an increased risk of VTE
treating moderate-severe vasomotor symptoms
HT gold standard
SSRIs and Gabapentin
Progestogens (need large dose)
clonidine
what if pt cannot take E
bisphosphonates or SERMs
Vit D, Ca
Dx endometriosis
laparoscopy +/- Bx
triad of endometriosis
dysmenorrhoea
dyspareunia
infertility
other symptoms of endometriosis
pre menstrual staining pain with defaecation during menses intermenstual pain disordered cycles FHx
Ddx for endometriosis
primary dysmenorrhoea IBS ovulation pain PID psychosexual problems
predisposing factors for endometriosis
FHx disordered immunity environmental toxins recurrent ovulation infertile partner obstructed menstrual flow
Tx of endometriosis
pain- Rx
infertility- Surgery
no symptoms- no treatment
medical therapy options
progestins (COC, provera, mirena)
danazol and gestrinone
GnRH agonists +/- therapy
infertility
inability to conceive after 12 months of sex w/o contraception
age of woman major factor
principle causes of infertility
ovulation problems sperm problem tubal problem cervical factor endometriosis
how to test ovulation
BBT (P- raises temp .3-.5 C)
serum progesterone
LH surge in urine (false + occurs)
endometrial Bx
tests of tubal patency
hysterosalpingogram
laparoscopy with dye
testing of cervical factor
requires careful cycle timing
must be done when cervical mucous is recptive
day 12,13
sample of mucous 4-20 hours after sex
good back up for men who don’t want to give a sperm sample
semen analysis
48-72hrs of abstinence must collect whole semen sample must be examined w/in 1-2 hrs count >20million/ml motility >50% morphology >15% should be completely normal if abnormal repeat
