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Women's Health Exam 1 (A,S,L) > Menopause And Pelvic Organ Prolapse 🍩(Lauren🌭) > Flashcards

Menopause And Pelvic Organ Prolapse 🍩(Lauren🌭) Flashcards

1
Q

What is the definition of Perimenopause or Menopausal Transition?

A

The preceding time period during the physiologic changes associated with menopause occur

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2
Q

What is THE definition of menopause?

A

Permanent cessation of menses for 12 consecutive months*

That means it is ONE point in time. You hit menopause for ONE MOMENT in your life and after that you are postmenopausal.

This is absolutely on the test do not get this wrong
🐝🐝🐝

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3
Q

What is the definition of postmenopause?

A

The time following menopause

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4
Q

How long does menopause last?

A

ONE SECOND

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5
Q

What happens to ovarian estrogen production during perimenopause?

A

Fluctuates unpredictably

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6
Q

When does perimenopause usually start?

A

About 4 years before the final menstrual period (FMP)

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7
Q

What are the clinical manifestations of perimenopause?

A

Irregular menses**⏳

Vasomotor symptoms (hot flashes and night sweats)***🥵

Mood sx (anxiety, depression)

Vaginal dryness

Changes in lipids and bone loss begin

FSH>25

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8
Q

Although you don’t need to do lab tests to diagnose peri menopause or menopause, what would FSH usually be in perimenopause and menopause?

A

Perimenopause: FSH>25

Menopause: FSH>70

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9
Q

What is the median age of menopause?

A

51.5

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10
Q

Menopause before age ____ is abnormal

A

40

Would suggest primary ovarian sufficency

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11
Q

What is this:

“permanent cessation of menses after 12 consecutive months”

A

Menopause

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12
Q

Do hot flashes last forever?

A

No, they will stop 4-5 yrs after onset

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13
Q

What is the name of the system that is used to classify if a woman is reproductive, perimenopausal, or postmenopausal?

A

Straw Staging System

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14
Q

What causes hot flashes?

A

Narrowing of the thermoregulatory zone

You can no longer tolerate small variations in ambient temp

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15
Q

How do you treat vasomotor symptoms (hot flashes)?

A

Lifestyle mods

Hormone therapy

SSRIs and SSNRIs

Clonidine

Gabapentin

Herbal shit

(This is usually the order they are recommended in)

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16
Q

What kinds of lifestyle mods are recommended to help with hot flashes?

A

“Common sense”- layering clothing, cold drinks, avoiding alcohol and caffeine, using fans/AC

Aerobic exercise may help

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17
Q

What is the MOST effective therapy for hot flashes?

A

Hormone therapy- 75% reduction in hot flash frequency

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18
Q

Women who have had a hysterectomy get what kind of hormone therapy?

A

Estrogen only

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19
Q

Women with an intact uterus should have what type of hormone therapy?

A

Estrogen AND Progestin
*******

Progetsin helps prevent hyperplasia

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20
Q

Women you still have a uterus should NOT use ________________

A

Unopposed estrogen

This is probably on the test

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21
Q

Why should you not take estrogen alone if you have an intact uterus?

A

Can cause endometrial hyperplasia and possibly endometrial cancer

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22
Q

How long should women be on hormone therapy?

A

LOWEST EFFECTIVE DOSE FOR THE SHORTEST DURATION THAT IS NEEDED TO RELIEVE VASOMOTOR SYMPTOMS

Generally not more than 5 years or beyond age 60

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23
Q

What are the side effects of hormone therapy?

A

Breast tenderness

Vagina bleeding

Bloating

Headaches

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24
Q

What treatments are NOT recommended for hot flashes?

A

Progestin only meds

Testosterone

Compounded bioidentical hormones

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25
Q

What are the risks of hormone therapy (Both combined and estrogen only)?

A

Thromboembolic disease

Breast cancer

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26
Q

Which has a lower risk of causing breast cancer and heart disease:

Combined HT or Estrogen Only HT

A

Estrogen Only

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27
Q

What are the contraindications to hormone therapy?

A

Breast cancer

Heart disease

Previous thromboembolic event or stroke

Active liver disease

Unexplained vaginal bleeding (must r/o endometrial cancer first)

High risk endometrial cancer

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28
Q

Why isn’t testosterone recommended for hot flashes?

A

Doesn’t work

Can cause hirsutism, acne, clitoromegaly, and increased lipids

(May improve sexual function but were not talking about this today)

29
Q

What is the deal with bioidentical hormones?

A

They are plant derived hormones vs the ones from horses 🐎

Some are FDA regulated (micronized progesterone and estradiol)

Compounded preparation are not FDA regulated. They are cheaper, and there are some concerns for purity, potency and quality.

Some people test their salivary hormone levels to customize their dosing for Bioidential hormones.

HE DOESNT RECOMMEND THEM

30
Q

What did Dr. Stone say about nonhormonal meds (SSRI’s, SRNIs, gabapentin, clonidine) for hot flashes

A

They work OK. Not as effective as hormones, but no side effects

31
Q

What kinds of herbal therapies are out there for hot flashes?

A

Phytoestrogens (soy)

Black cohosh/ginseng/st johns wort, ginkgo biloba

Vitamin E

Acupuncture

~~no clear evidence that any of these work~ i don’t even know why i made this card

32
Q

What is “Genitourinary Syndrome of Menopause”?

A

A term that encompasses all of the atrophic changes women may have in their vulva, vagina, and bladder/urethral areas that occur due to loss of estrogen

33
Q

What symptoms can come along with vulvovaginal atrophy?

A

Vaginal dryness, itching, painful sex

Urinary frequency

Recurrent UTIs

34
Q

What are the treatment options for Vulvovaginal atrophy?

A

Lubricants/moisturizers

Hormone therapy (local estrogen application so systemic absorption is low. Don’t even need progestin if they have a uterus)

Estrogen agonists/antagonists (SERMs)

35
Q

What is Ospemifene?

A

A SERM that stimulates estrogen receptors in vagina

36
Q

What happens to the bones of post menopausal women?

A

Decreased bone strength and increased risk of fracture

37
Q

What are the top two risk factors for osteoporosis

A

Advanced age

Female

38
Q

How much Vitamin D is recommended for females age 9-70?

A

600 IU/day

39
Q

How much Vitamin D is recommended for women 71+?

A

800 IU/day

40
Q

When you do a DXA scan to measure your bone mineral density, the results are expressed in _______

A

T scores

41
Q

What is a T score?

A

Number of standard deviations above or below the mean BMD for a normal 30 yr old woman

42
Q

How do you diagnose osteoporosis?

A

A T score of -2.5 of lower

Or

Fracture at spine, hip, wrist, humerus, rib or pelvis that occurred from a fall at standing height or less

43
Q

What is a normal T score?

A

-1.0 or higher

44
Q

What T score is considered “Low bone mass”?

A

Between -1.0 and -2.5

45
Q

What T score is considered Osteoporosis?

A
  • 2.5 or lower

* ****

46
Q

When should normal healthy women begin screening for osteoporosis?

A

Begin by age 65

****

47
Q

What are the lifestyle recommendations for osteoporosis?

A

Fall prevention

Weight-bearing exercise 🏋🏻‍♀️

diet

stop smoking

avoid heavy alcohol use

48
Q

Who is considered a candidate for therapy for osteoporosis?

A

Postmenopausal women who have had a hip or vertebral fracture

T score -2.5 or lower

T score -1 to -2.5 with a high risk of fracture in next 10 years (based on FRAX score)

49
Q

What is the First line pharmacologic therapy for osteoporosis?

A

Bisphosponates

50
Q

What are the adverse effects of bisphosphonates?

A

Upper GI stuff

Osteonecrosis of the jaw

51
Q

What are some examples of bisphosphonates in case you don’t remember

A

Alendronate

Risedronate

Zolendronate

52
Q

What are 3 other types of pharmacologic therapy for osteoporosis other than bisphosphonates?

A

SERMs- inhibit bone resorption, reduce risk of breast cancer

Teriparatide- parathyroid hormone

Calcitonin- PTH antagonist

53
Q

What is the definition of pelvic organ prolapse?

A

Descent of one or more aspects of the vagina or uterus

54
Q

What are the different types of Pelvic Orhan prolapse?

A

Apical- uterovaginal

Apical- vaginal vault (entrerocele)

Anterior compartment (cystocele)

Posterior compartment (rectocele)

Procidentia

55
Q

What is a uterovaginal prolapse?

A

Uterus falls down your hoohoo

56
Q

What is a vaginal vault prolapse?

A

It looks like your intestines fall through your taint (between vagina and butthole)

57
Q

What is an anterior compartment (cystocele) prolapse?

A

Bladder bulges into vaginal canal

58
Q

What is a posterior compartment (rectocele) prolapse?

A

Rectum bulges into vaginal canal

59
Q

What is procidentia

A

“Severe”

Looks like you’re giving birth to a balloon 🎈

60
Q

What are the symptoms of a prolapse?

A

Bulge/something falling outside of vagina

Heaviness

Pressure

Discomfort

Urinary (incontinence or retention)

Defecation symptoms

Splinting (having to place a finger in the vagina to hold in the bulge while you poop)

Pain

61
Q

What are the risk factors for pelvic organ prolapse?

A

Vaginal deliveries

Operative deliveries

Big babies

Advancing age

Obesity

Connective tissue disorder

Postmenopausal

Chronic disease- COPD or constipation

Prior prolapse surgery

Hispanic

62
Q

What should you ask your patient to do when doing a pelvic exam to check for a prolapse

A

Ask her to Valsalva or cough

63
Q

What are the advantages of pessaries?

A

Safe

Effective

(Good option for older gals who don’t want surgery)

64
Q

What are the disadvantages of pessaries?

A

Odor

Discharge

Vaginal ulceration

Must remove for coitus

Rare reports of erosion into bladder, fistula fornjlifhadsiufhdsuabf
‘
I’m done I’m not writing anymore

65
Q

Do all pelvic organ prolapse surgeries use mesh?

A

No sometimes he just sews it right to their sacrospinous ligament

66
Q

What is a sacrocolpopexy?

A

His favorite procedure!

“Attachment of vagina or cervix to anterior longitudinal ligament of the sacrum (using mesh)”

The over reaching goal is to correct all compartments with this procedure

67
Q

Pelvic organ prolapse is almost NEVER an emergency, but what are the 2 times it is?

A

Urinary retention

Obstructive nephropathy

68
Q

What should you do if your patient’s prolapse is causing urinary retention or obstructive nephropathy (aka having a prolapse emergency)

A

Place indwelling catheter

Call Dr. Stone for surgery consult or pessaries placement lol

Women's Health Exam 1 (A,S,L) (3 decks)

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