Menopause - anne Flashcards
what is the definition of menopause
cessation of menses due to loss of ovarian activity, average age 51 in US
what is postmenopausal
12+ months after final menses
what is premature menopause
ovarian failure before age 40
what is considered early menopause
age 40-45
what is surgical menopause
cessation of menses due to BSO
what is perimenopause/transition
4-6 years of cycle changes and other symptoms before total cessation of menses
what are vasomotor perimenopause symptoms
hot flashes, night sweats, insomnia
What are psych preimenopasual symptoms
depression, irritability, mood swings
What are cognitive perimenopausal symptoms
concentration/memory issues
What are sexual perimenopausal symptoms
dryness/dyspareunia, decreased libido
what are other perimenopausal symptoms
other: urinary incontinence, dry itchy skin, weight gain
Menstrual changes: shorter or longer cycles, irregular bleeding
What can effect the onset of menopause
smoking and malnutrition can make it earlier
what re the hormone changes with menopause
decreased ovarian synthesis of estrogens and progesterone
GnRH released at maximal frequency and amplitude (increase FSH by 4-fold)
what is androstenedione converted to
peripherally converted in fat and muscle to estrone
what are the types of estrogen
E1 (estrone)
E2 (estradiol)
E3 (estriol)
what is Estrone
E1 - made after menopause
what is Estradiol
E2 - most common type of estrogen
most potent and abundant during reproductive years
what is Estriol
E3 - main type of estrogen in a pregnant persons bloodstream, prepares for childbirth
weakest and used for HRT, lower risk of serious side effects
What are early symptoms of estrogen loss
hot flashes
insomnia
irritability
what are the physical changes with estrogen loss
vaginal atrophy
skin atrophy
what are the disease with estrogen loss
osteoporosis
coronary heart diesease
what is luteal insufficiency
occurs after age 40, ovarian follicles become less responsive to FSH
-less inhibin and estradiol
-FSH levels increase further
-results in heavier menses
what is the shorted cycle stage of menstraul changes
luteal phase remains the same, follicular phase is shorter - overall cycle is shorted
higher FSH levels cause follicles to mautre faster and produce enough estradiol to trigger an LH surge
what is anovulation
accelerated declined in responsive follicles
anovulation more common and cycle length and variability increase
bleeding occurs because of fluctuations of estrogen levels
bleeding episodes spread out and then stop
why does skin temperature rise with menopause
peripheral vasodilation followed by a drop in core temperature
what is the most common reason that women seek medical care during menopause
vasomotor symptoms, skin temperature, chills, anxiety, heart palpitations
what widens thermo-regulatory zone which decreases symptoms
exogenous estrogen
what can increase someones vasomotor symptoms with menopause
induced menopause
AA
obesity
smoking
depression
triggers: alcohol, coffee, exercise, emotional upset
what can decrease someones vasomotor symptoms with menopause
exercise
asian
avoidance of triggers
acupunctures?
pharmacotherapy
what is atrophic vulvovaginitis
gradual thinning of genital mucosa
loss of vaginal rugae (folds)
decrease pliancy of tissue, less flexible
decreased transudate (drier)
pH becomes alkaline
changes in microbiome
increase ascension of pathogens to bladder
what are the results of atrophic vulvovaginitis
genitouritary syndrome of menopause
UTI, Yeast infections, dryness
what is dyspareunia
pain with sexual activity (less comfortable with stretching and friction)
what is the treatment of dyspareunia
personal lubricants and moisturizers, vaginal estradiol
what are recurrent UTI associated with genitourinary syndrome
> 2 culture confirmed UTI’s in 6 months or > 3 in 12 months
check for vaginal or urethral prolapse, check bladder emptying, consider possible stone as nidus for infection
what are modifiable risk factors for osteoporosis
ETOH use, smoking, low body weight, sedentary lifestyle
low Ca, Vit D and prolonged systemic corticosteroid use
what are non-modifiable risk factors for osteoporosis
advanced age
caucasian or asian race
AFAB
what are the cardiovascular health effects of estrogen
decreases vascular resistance and increases blood flow
decreases production of endothelin
increased HDL cholesterol, decreased LDL cholesterol
what does the loss of estrogen increase a womens risk of
cardiovascular risk
what are the skin and hair changes with menopause
hirsutism and temporal balding and/or alopecia
thinning skin, wrinkles, pigmentation changes (face, hands)
what is early/premature menopause due to
ovarian dyfunction
what are positive menopausal changes
decrease issues with fibroids/endometriosis
end of menstrual migraines and PMS
no more menses
no more contraception
what are the treatment options for menopausal symtpoms
reassurance
comfort measures: lubricants, natural products
medication
what are VMS alternatives when estrogen/progesterone is not desired/contraindicated
SSRIs, SNRIs
alpha adrengergic agonists - clonidine
gabapentin
BRAND NEW: Veozah
what is Veozah
PO med for moderate to severe hot flashes
neuokinin 3 receptor antagonist - first in its class
not hormonal
what should be assessed with prolonged, heavy or frequent vaginal bleeding with peri-menopause
TVUS +/- endometrial sampling to exclude hyperplasia/neoplasia
what is the treatment for perimenopausal VMS
lifestyle modification
non-hormonal rx
systemic HRT
what is the treatment for perimenopausal GU symtpoms
low dose vaginal estradio
personal lubricants
what provides symptomatic improvement for both vaginal and urethral atrophy
vaginal estrogen
what can be used for recurrent UTI in postmenopausal women
vaginal estradiol 2x/week
this gradually improves health of urogenital epithelium, pH and microbiome
what is postmenopausal care/screenings
pap every 3-5 years
mammogram
obesity
HTN
cardiovascular risk
osteoporosis risk
colon cancer risk
urinary incontinence
interpersonal violence
exercise, diet, calcium, vitamin D, fall prevention
what are the connective tissues of the pelvis
uterine suspensory ligaments
vaginal connective tissue
pelvic floor musculature
what are the 4 functions of pelvic floor muscles
core control and breathing
sex/orgasms
not peeing your pants
labor and delivery
what is the landmark for prolapse of the pelvic floor
hymenal remnant tissue
what are the types of pelvic organ prolapse
anterior vaginal wall (cystocele)
posterior vaginal wall (rectocele)
uterus
can also have urethral prolapse
what are risk factors for pelvic organ prolapse
obesity
chronic constipation
operative delivery
multi-parity
chronic cough
heavy lifting for work
what are obstetrical risk factors
episiotomy
tears/extension
vacuum extraction
forceps delivery
shoulder dystocia
breech extraction
what is the clinical presentation of pelvic organ prolapse
smooth/striated appearing, pink bulging tissue at vaginal opening
bowl/bladder impairments
what is the evaluation for pelvic organ prolapse
exam to quantify what is descending and how far relative to hymenal remnant at intoitus
staging/quantification systems
POPQ
what is POPQ
pelvic organ prolapse quantification system : limited adoption
what is stage 2 of pelvic organ prolapse
presenting part is within 1cm north or south of hymenal remnant
what is stage 3 of pelvic organ prolapse
presenting part is > 2cm distal to hymen but at least 2cm less than total vaginal length
what is stage 4 of pelvic organ prolapse
vagina is completely everted
what is the treatment of pelvic organ prolapse
watchful waiting with reassurance if not bothersome
pelvic floor PT
pessary
surgical repair
vaginal obliterative procedure in select patients
what is cystocele
anterior vaginal wall
what is rectocele
posterior vaginal wall
