menopause and endometriosis

Question 1

perimenopause

Answer 1

time leading up to menopause

when ovarian function and hormone production are declining, but have not yet stopped

Question 2

menopause

Answer 2

permanent cessation of menstrual cycle

Question 3

premature menopause

Answer 3

menopause occurring before 40

Question 4

changes that occur with menopause

Answer 4

vasomotor symptoms
sleep quality
mood changes
urogenital symptoms
sexual well being
skin changes

Question 5

decreased E

Answer 5

vasomotor symptoms
UG disorders
CHD risk factor (lipids)
skin changes
associated with CV disease, bone loss/osteoporosis

Question 6

decreased P

Answer 6

irregular periods

PMS

Question 7

decreased androgen

Answer 7

decrease in mood
diminished energy
impaired sexuality
mm weakness
osteopenia

Question 8

what happens when HT is initiated within 5 years of onset of menopause?

Answer 8

does NOT increase CHD risk

Question 9

what happens if HT is initiated years after menopause?

Answer 9

HT does not prevent and may actual increase risk of CHD

Question 10

risks of HT

Answer 10

VTE- rare

greatest risk within first year of use

Question 11

diseases associated with menopause

Answer 11

CHD
osteoporosis
breast CA
colon CA
dementia

Question 12

transdermal administration of HT

Answer 12

seems to not have an increased risk of VTE

Question 13

treating moderate-severe vasomotor symptoms

Answer 13

HT gold standard
SSRIs and Gabapentin
Progestogens (need large dose)
clonidine

Question 14

what if pt cannot take E

Answer 14

bisphosphonates or SERMs

Vit D, Ca

Question 15

Dx endometriosis

Answer 15

laparoscopy +/- Bx

Question 16

triad of endometriosis

Answer 16

dysmenorrhoea
dyspareunia
infertility

Question 17

other symptoms of endometriosis

Answer 17

pre menstrual staining
pain with defaecation during menses
intermenstual pain
disordered cycles
FHx

Question 18

Ddx for endometriosis

Answer 18

primary dysmenorrhoea
IBS
ovulation pain
PID
psychosexual problems

Question 19

predisposing factors for endometriosis

Answer 19

FHx
disordered immunity
environmental toxins
recurrent ovulation
infertile partner
obstructed menstrual flow

Question 20

Tx of endometriosis

Answer 20

pain- Rx
infertility- Surgery
no symptoms- no treatment

Question 21

medical therapy options

Answer 21

progestins (COC, provera, mirena)
danazol and gestrinone
GnRH agonists +/- therapy

Question 22

infertility

Answer 22

inability to conceive after 12 months of sex w/o contraception
age of woman major factor

Question 23

principle causes of infertility

Answer 23

ovulation problems
sperm problem
tubal problem
cervical factor
endometriosis

Question 24

how to test ovulation

Answer 24

BBT (P- raises temp .3-.5 C)
serum progesterone
LH surge in urine (false + occurs)
endometrial Bx

Question 25

tests of tubal patency

Answer 25

hysterosalpingogram

laparoscopy with dye

Question 26

testing of cervical factor

Answer 26

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

Question 27

semen analysis

Answer 27

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