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women's health > Menopause and pelvic organ prolapse > Flashcards

Menopause and pelvic organ prolapse Flashcards

1
Q

define menopause

A

permanent cessation of menses after 12 consecutive months with no menstrual bleeding

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2
Q

climacteric

A

time period during which the changes of menopause occurs

  • woman transitions from reproductive to nonreproductive stage
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3
Q

What are the hallmark signs of Perimenopause (menopausal transition)

A
  • ovarian estrogen fluctuates unpredictably
  • menstrual cycle irregular
  • sx:
    • hot flashes
    • mood symptoms
    • vaginal dryness
    • bone loss
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4
Q

with advancing reproductive age, remaining oocytes become increasingly resistant to

A

FSH -> leads to higher levels of FSH during menopause

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5
Q

What are the typical clinical manifestations of menopause

A
  • hot flashes
  • insomnia
  • irritability
  • depression
  • cognitive changes
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6
Q

what is atrophic vaginitis

A
  • vaginal atrophy common in menopause
    • -> vaginal dryness, itching, dyspareunia
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7
Q

are the urogenital symptoms associated with menopause

A
  • atrophic vaginitis
  • urinary stress incontinence
  • urinary frequency, dysuria
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8
Q

hormone therapy for women who have undergone hysterectomy

A

estrogen

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9
Q

hormone therapy for women with intact uterus

A

combined estrogen and progestin

  • progestin needed to prevent endometrial hyperplasia
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10
Q

what are some nonhormonal treatment of menopause symptoms

A
  • SSRI
  • SNRI
  • antiepileptics -> gabapentin
  • cantrally-acting drugs
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11
Q

What are short term alternative options for tx of vasomotor symptoms (night sweats, hot flashes) associated with menopause

A
  • soy isoflavones
  • black cohosh
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12
Q

What is a short term alternative option for tx of mild-mod depression and hot flashes associated with menopause

A

st johns wort

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13
Q

managment of atrophic vaginitis

A
  • water-soluble moisturizers and lubricants
  • systemic or topical vaginal estrogens
    • topical preferred if therapy is to solely tx vaginal atrophy
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14
Q

What SERM (selective estrogen receptor modulator) is FDA approved for moderate to severe dyspareunia caused by atrophic vaginitis

A

Ospemifene

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15
Q

combination of estrogen + progestin HRT long term results in inc risk of

A
  • MI
  • CVA
  • thromboembolic disease
  • breast CA
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16
Q

HRT treatment should be prescribed as

A
  • lowest effective dose for the shortest period of time
  • < or = 5 years
17
Q

menopause leads to what bone strength

A
  • decreased bone strength
  • increase risk of fx
18
Q

what type of fx is most common in osteoporosis

A
  • vertebral
    • hip close second
19
Q

What does a DEXA scan assess?? results are expressed as

A
  • bone mineral density
  • T scores
20
Q

what T score is diagnostic for osteoporosis

A

< or = -2.5

21
Q

who should be screened for osteoporosis

A
  • women > 65
  • younger women in menopausal transition with risk factors
22
Q

what women with osteoporosis are candidates for pharmacologic therapy

A
  • postmenopausal women with a h/o hip or vertebral fx or with T score < or = -2.5
23
Q

MOA of bisphosphonates? all drugs end in what

A
  • incorporates into bone and inhibits bone resorption and turnover
  • “dronate” + zoledronic acid
24
Q

MOA of SERM in tx of osteoporosis

A
  • e.g Raloxifene
  • inhibits bone resorption and decrease risk of vertebral fx
  • reduce risk of breast cancer
25
Q

What drug class is Forteo (Teriparatide) in? use in osteoporosis?

A

recombinant parathyroid hormone

  • intermittent administration produces bone growth -> anabolic
  • useful in severe osteoporosis, those who can’t take bisphosphonates
26
Q

calcitonin (miacalcin) use in tx of osteoporosis

A
  • PTH antagonist -> decreases bone resportion of Ca2+
  • usefull in short term tx of acute pain relief (vertebral fx)
    • decreases bone pain and loss
27
Q

what drug class is Denosumab (Prolia)

A
  • RANKL inhibitor
    • inhibits osteoclast formation
    • reduces bone resorption and turnover
28
Q

how often should osteoporosis monitoring be repeated

A
  • DEXA scan q 1-2 yrs after initiating therapy and then 2 years thereafter
29
Q

define pelvic organ prolapse

A

herniation of pelvic organs to or beyond the vaginal walls

30
Q

list risk factors for pelvic organ prolapse

A
  • advanging age
  • vaginal birth
  • prior pelvic sx, hysterectomy
  • obesity
  • chronic constipation
31
Q

physical exam to asses for pelvic organ prolapse

A
  • visual inspection relaxed and with straining
    • cough or valsalva
    • may have to examine standing
32
Q

presentation

  • anterior vaginal wall prolapse
  • stress urinary incontinence
A

cystocele

33
Q

presentation

  • posterior vaginal wall prolapse
A

rectocele

34
Q

What is apical compartment prolapse

A
  • decent of apex of vagina into lower vagina, to the hymen or beyond the vaginal introitus
    • includes
      • uterine prolapse
      • vaginal vault prolapse
    • often associated with enterocele
35
Q

enterocele

A

hernia of intestines to or through vaginal wall

36
Q

management of pelvic organ prolapse

A
  • vaginal pessary
  • kegel exercise
  • sx

women's health (5 decks)

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