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Endo/Repro Block2 > Menopause/Cervical Screening > Flashcards

Menopause/Cervical Screening Flashcards

1
Q

What is Perimenopause?

A

time b4, during & after menopause aka menopausal transition

  • uneventful or can have major Sx’s
    • 90% have irregular menses for about 4 yrs
    • 10% abrupt cessation of menses
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2
Q

What is menopause?

what is premature menopause?

A

permanent cessation of menses after cessation of ovarian fxn

  • amenorrhea in the presence of signs of hypoestrogenemia & FSH >40
  • climacteric
  • median age 51
  • premature menopause= before age 40 [1%]
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3
Q

What is postmenopausal period?!

What are some of the concerns associated with it?

A

more than 1/3 of a woman’s life!!!

CONCERNS: HRT, osteoporosis, CVD, sexual fxn, uterovag prolapse, skin, mood, hot flashes, vag atophy, incontinence

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4
Q

What hormonal changes are associated with menopause?

E?

FSH?

P?

androgens?

A
  • follicles decrease [exhausted]–>inhibin decreases–>FSH rises–>eventual estradiol decline–>endometrial development fails–>absence of menses
  • E from aromatization of androgens [in muscle & adipose]
    • obesity–>^^endometrial cancer
    • thin–> osteoporosis, hot flashes
  • **P ** prodxn ceases due to unopposed E [initially higher] & ^^endometrial cancer in early menoP
  • androgens prdxn decreases [both from ovaries & adrenals]–> effect libido?
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5
Q

What happens to body mass in menopausal yrs?

A
  • weight & total body fat ^^
  • ^^ in waist:hip
    • above 2 contribute to CVD risk
  • HRT [E replacement] DOES NOT contribute to weight gain
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6
Q

What happens to collagen in menopausal women?

A

Collagen Decreases:

  • thinning skin
  • tooth loss
  • atrophic vaginitis
  • poor uterovag support–>cystocele, rectocele, enterocele, uterine prolapse
  • urinary –> OAB, SUI, dysuria, ^^frequency
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7
Q

What is the cause of hot flashes?

A

pathognomonic Sx of menopause!!!! aka hot flush

  • recurrent transient periods of flushing, sweating, heat sensation, often w/ palpitations, anxiety & chills [usually 2-3 yrs]
    • up to 30/day for 1-5 min [avg = 5-10/day]
    • >50% of women in natural menopause, even more w/ surgical menopause
  • directly correlated to E levels–> correspond to GnRH pulses from hypothalamus [probably not the cause, but a marker for disturbance of thermoreg]
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8
Q

Wht are other common Sx’s of menopause?

A
  • depression, anxiety, irritability, fatigue, insomnia
  • loss of libido
  • sense of loss of youth
  • HAs [most women with migraines premenopause, have improved migraines after menopause]
  • amenorrhea
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9
Q

What is abnormal uterine bleeding? AUB

What do we need to rule out?

Other possible causes?

A

menstrual irregularity

  • >50% of women
  • irregular, heavy, prolonged
  • usually anovulatory
  • RULE OUT PREGNANCY
  • endometrial cancer [postmenopausal & AUB risk is 10%]
  • EM hyperplasia, polyps, cervical cancer, fibroids, adenomyosis also possible
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10
Q

What are the Tx’s for AUB?

A
  • meds: cyclic HRT, CCHRT, OCPs
  • hysteroscopy/EM ablation/D & C
  • hysterectomy
  • none
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11
Q

How does menopause cause/contribute to osteoporosis?

What do we use to screen for osteoporosis?

how do we tx?

A
  • post-menoP; BMD decreases by 1-2% per yr [whites & asians]
    • 60yo= 25% have spinal compression fracture
    • 80yo= 20% hip fracture, 15% die 6 mo later
  • Screening: DEXA
  • Tx: HRT, bisphosphates, calcitonin, SERMs, Ca++, VitD
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12
Q

What are risk factors for osteoporosis?

A
  • white/asian
  • low w8/height
  • early menopausefamily Hx
  • low Ca+ & vitD intake
  • high caffeine, protein, & alcohol intake
  • cigarette smoking
  • DM
  • hyperT
  • Cushings
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13
Q

What is HRT?

who should/shoudl not use HRT?

SE’s?

A

Hormone Replacement Therapy [E+/-P, P with many types of admin]

  • indicated if: hot flashes, vaginal atrophy, osteoporosis/high risk, osteopenia
  • contraindicated: pregnancy, unDx’d vag bleeding, active VTE, current GB dz, liver dz, unopposed ERT w/ uterus, CVD
    • relative contraindications: hx of breast cancer, hx of VTE
  • SE’s: vag bleeding, breast tenderness, mood changes
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14
Q

What is the WIH?

What should we conclude from this data?

A

Women’s Health Initiative–> study of HRT effects

  • women with uterus:
    • increased: breast cancer, new CVD, embolic stroke, VTE
    • decreased: colon cancer, & hip fracture
    • NO increased mortality from all causes
  • women WITHOUT uterus:
    • increased: embolic stroke, VTE
    • no change: new CVD, colon cancer, hip fracture, breast cancer
    • NO increased mortality from all causes

HRT has less side effects/comorbidities in women w/o uterus

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15
Q

What % of annual cervical cancer screening failures [i.e. new cervical cancer] is a false negative Pap responsible for?

A

30%!!!! or 3,651 women

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16
Q

What does ASC-US stand for?

LSIL

HSIL

ASC-H

AGS-NOS

AGS

AIS

A
  • *ASC-US** - Atypical Squamous Cells of Undetermined Significance
  • *LSIL** - Low grade Squamous intra-epithelial neoplasia
  • *HSIL** - High grade Squamous intra-epithelial neoplasia
  • *ASC-H** - Atypical Squamous Cells of Undetermined Significance can’t exclude high grade
  • *AGS-NOS** - Atypical Glandular cells-NOS [not of significance?]
  • *AGS** – favor neoplasia
  • *AIS** - Adenocarcinoma in-situ
17
Q

What do these cells show?

A

ASC-US: atypical squamous cells of undetermined signifcance

18
Q

What do these cells show?

A

LSIL- low grade squamous intra-epithelial neoplasia

19
Q

What do these cells show?

A

HSIL- high grade squamous cell intraepithelial neoplasia

20
Q

What does CIN 1, 2, & 3 stand for?

CIS?

AIS?

A
  • *CIN 1, 2, 3** - Cervical intra-epithelial neoplasia (mild, moderate, severe dysplasia)
  • *CIS**- Carcinoma in situ
  • *AIS** – Adenocarcinoma in situ
21
Q

How do CIN 1-3 compare to/are part of LSIL & HSIL?

A
22
Q

What type of cervical neoplasia is this?

how would it look on gross exam?

A

CIN-2

23
Q

what type of cervical neoplasia is this?

A

CIN-3

24
Q

What is one of the biggest contributors/risk factors to Cervical cancer?

A

HPV!!!

  • identified in 99.7% of cervical cancers
    • serotypes 16 & 18 are oncogenic and cause 70% of cervical cancers
      • others do too but not as significant
  • STD/I
  • most HPV infections regress
25
Q

What are other cervical cancer risk factors?

A
  • HIV +
  • Immunosuppressed
  • Hx of abn tests in past 10 yrs
  • Hx of cervical cancer
  • Hx of CIN 2/3/CIS
  • Hx of in utero DES exposure
26
Q

What does a gynecologist think is a reasonable pattern of cervical cancer screening?

A

yearly Pap & pelvic

27
Q

When [age] should we begin cervical screening tests?

Why do we wait until then to screen?

A

AFTER/AT 21 yo!!!

Wait til age 21 due to:

  • HPV prevalence is high [25-505]
    • 90% of cases of HPV infxn resolve w/in 24 mos
  • dysplasia [CIN] is common [also regress spontaneously]
  • Anxiety, Expense, maybe preterm labor
  • cancer is rare
    • .01% < 21 yo
28
Q

What kind of screening should ages 21-29 yo’s get?

A

Screen w/ cervical cytology every 3 years

  • DO NOT do HPV testing unless ASC-US present
    • HPV test will help triage these pts
    • OR if immunosuppressed, HIV+, DES exposed
29
Q

What type of screening should females aged 30-65yo get?

who do we screen annually in this age grp?

A

USPSTF: screen w/ cytology alone every 3 yrs or w/ combo cytology & HPV testing every five

ALL other ORGANIZATIONS: screen w/ combo of cytology & HPV testing every 5 yrs [preferred]

  • or cytology alone every 3 yrs

Annual screen: HIV+, immunosuppressed, Hx of DES exposure, maybe for Hx of CIN 1-3

30
Q

What type of screening should we do on women greater than 65 yo?

A

USPSTF: DO NOT screen women who have had adequate prior screening & otherwise not @ high risk for cervical cancer

Everyone ELSE: DO NOT screen women who have adequate prior screening & no Hx of CIN2+ w/in past 20yrs

  • DO NOT resume screening for any reason, even if woman has new sexual partner
31
Q

WHat is adequate prior screening?

A

3 ocnsecutive (-) cytology screenings [at 3 yr intervals] w/in past 10 yrs

OR

2 consecutive (-) cotests [cytology & HPV] w/in past 10 yrs

32
Q

How long/often do we screen HIV pts?

A

screen every 6mos until 2 pap tests are negative

THEN annual screening

33
Q

How do we screen women who have had a total hysterectomy [uterus + cervix removed]?

A

USPSTF: DO NOT screen women who have undergone removal of cervix & have no Hx of CIN2+ or cervical cancer

Everyone ELSE: DO NOT screen for vaginal cancer in women who have hysterectomy and w/o Hx of CIN2+

  • DO NOT resume screening for any reason
  • CONTINUE SCREENING if Hx of CIN2/3/CIS/AIS/or cancer
34
Q

When is HPV testing appropriate?

A
  • triage >/= 21yo w/ ASC-US
  • postmenoP omen w/ LSIL
  • 1’ screen > 30 as an adjunct to cytology
  • follow up after Tx of CIN2 or 3
  • follow up after CIN-1 or (-) findings on colposcopy w/ prior Pap ASCUS, ASCH, LSIL, or AGS

NOT IN WOMEN <21 YO

35
Q

How do we screen women who have been vaccinated for HPV?

What does Gardasil vaccinate against?

A

Screen the same as those unvaccinated

GARDASIL: HPV 16, 18, 6, & 11

  • ages 9-26: 3 injxns given @ 0, 2, and 6 months [post initial vaccination]
36
Q

What happens if Co-test results are discordant?

A

cytology (-) & HPV (+), 2 options:

  1. ​repeat cotesting in 1 year
    • if HPV(-) & cyto is norm or ASCUS–> repeat cotesting in 5 yrs
    • anything else–> do colposcopy
  2. immediate genotype specific testing for HPV 16 or 16/18
    • HPV (+) = colposcopy
    • HPV (-) = repeat cotest in 1 yr
      • if after 1 yr is (-) & norm/ASCUS: repeat in 5 yrs
      • anything else= do colposcopy
37
Q

If a woman has previously had CIN 2 or higher, how long/often do we screen?

A

after regression: continue routine screening for @ least 20 yrs–> even if that means past age 65

Endo/Repro Block2 (11 decks)

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