Menopause and pelvic organ prolapse Flashcards
define menopause
permanent cessation of menses after 12 consecutive months with no menstrual bleeding
climacteric
time period during which the changes of menopause occurs
- woman transitions from reproductive to nonreproductive stage
What are the hallmark signs of Perimenopause (menopausal transition)
- ovarian estrogen fluctuates unpredictably
- menstrual cycle irregular
- sx:
- hot flashes
- mood symptoms
- vaginal dryness
- bone loss
with advancing reproductive age, remaining oocytes become increasingly resistant to
FSH -> leads to higher levels of FSH during menopause
What are the typical clinical manifestations of menopause
- hot flashes
- insomnia
- irritability
- depression
- cognitive changes
what is atrophic vaginitis
- vaginal atrophy common in menopause
- -> vaginal dryness, itching, dyspareunia
are the urogenital symptoms associated with menopause
- atrophic vaginitis
- urinary stress incontinence
- urinary frequency, dysuria
hormone therapy for women who have undergone hysterectomy
estrogen
hormone therapy for women with intact uterus
combined estrogen and progestin
- progestin needed to prevent endometrial hyperplasia
what are some nonhormonal treatment of menopause symptoms
- SSRI
- SNRI
- antiepileptics -> gabapentin
- cantrally-acting drugs
What are short term alternative options for tx of vasomotor symptoms (night sweats, hot flashes) associated with menopause
- soy isoflavones
- black cohosh
What is a short term alternative option for tx of mild-mod depression and hot flashes associated with menopause
st johns wort
managment of atrophic vaginitis
- water-soluble moisturizers and lubricants
- systemic or topical vaginal estrogens
- topical preferred if therapy is to solely tx vaginal atrophy
What SERM (selective estrogen receptor modulator) is FDA approved for moderate to severe dyspareunia caused by atrophic vaginitis
Ospemifene
combination of estrogen + progestin HRT long term results in inc risk of
- MI
- CVA
- thromboembolic disease
- breast CA
HRT treatment should be prescribed as
- lowest effective dose for the shortest period of time
- < or = 5 years
menopause leads to what bone strength
- decreased bone strength
- increase risk of fx
what type of fx is most common in osteoporosis
- vertebral
- hip close second
What does a DEXA scan assess?? results are expressed as
- bone mineral density
- T scores
what T score is diagnostic for osteoporosis
< or = -2.5
who should be screened for osteoporosis
- women > 65
- younger women in menopausal transition with risk factors
what women with osteoporosis are candidates for pharmacologic therapy
- postmenopausal women with a h/o hip or vertebral fx or with T score < or = -2.5
MOA of bisphosphonates? all drugs end in what
- incorporates into bone and inhibits bone resorption and turnover
- “dronate” + zoledronic acid
MOA of SERM in tx of osteoporosis
- e.g Raloxifene
- inhibits bone resorption and decrease risk of vertebral fx
- reduce risk of breast cancer
