Menopause + MS Flashcards
Dx of menopause in pt with hysterectomy
High FSH and low estradiol
Dx of menopause generally, when it is premature + when it is early
12mo after final period
Premature if <40
Early if <45
Sx menopause
Sx:
Hot flashes
Libido change
Vaginal dryness
Dysuria
Incontinence
Sleep disturbance
Thinning skin + hair
Depression
Forgetfulness
Headache
Wt gain
RF for early menopause
smoking, surgery, chemo, RT
Lifestyle management of menopause
Diet (fruit, veg, grains, calcium)
Maintain healthy weight
Exercise
Stop smoking
BP control
Reduce alcohol
HRT - when to give, CI, what to give if uterus vs no uterus
Recommended if <60, <10 yrs past menopause
CI: abn vaginal bleeding, breast/ ovarian/ endometrial cancer, CAD, CVA, VTE, liver disease
If uterus intact, progestin + estrogen
If uterus absent, only estrogen
Oral vs transdermal HRT names
Oral:
Estrogen only: premarin or estrace
Progestin only: micronized progesterone, provera
Combined: activelle or angelique
Tissue selective estrogen complex + tibolone = progesterone free options for vasomotor sx
Transdermal (lower risk of VTE):
Estrogen only: Climara or Estradot patch or Estrogel
Combined: Estalis
Rx For breast cancer pts
venlafaxine, gabapentin, clonidine, CBT
Rx for Genitourinary sx
ospemifene (estrogen)
prasterone (steroid)
both topical
Rx for Hyposexual desire
Flibanserin or transdermal testosterone
Rx for hot flashes
Black Cohosh, Primrose Oil, SSRI/SNRIs (Venlafaxine), Clonidine, Gabapentin, Hormone Replacement Therapy
Sx of MS
loss of vision in one eye
painful eye movements
diplopia
ascending sensory disturbance
weakness
imbalance
altered sensation down back
bladder + bowel dysfunction
sexual dysfunction
patterns of MS
Relapsing remitting (periods of remission followed by exacerbations)
Secondary progressive (gradual accumulation of disability)
Primary progressive (sx gradually worsen over time)
Progressive relapsing (progressive w/ occasional attacks)
What dx criteria to use for MS + what Ix to order
Dx:
McDonald criteria
Ix:
MRI
CBC, LFTs, Cr, lutes, Calcium, glucose, TSH, B12
Management of MS: non-pharm
Education
MDT approach (neurologist, MS nurse, PT, OT, SLP, psychologist, RD)
Lifestyle
Exercise
Smoking cessation