Menopause/Pap smear - Widstrom Flashcards
What are the current pap smear screening guidelines?
No papsmears if age 65: Do not screen women who have evidence of adequate prior screening and no history of CIN 2+ within the past 20 years. Do not resume screening for any reason, even if a woman reports a new sexual partner. USPSTF = Do not screen women who have had adequate prior screening and who are not otherwise at high risk for cervical cancer.
What are the risks for cervical dysplasia?
HIV positive
Immunosuppressed
History of abnormal tests in prior 10 years
History of cervical cancer
History of CIN 2/3/CIS
History of in utero DES exposure
What is the physiology behind menopause?
Permanent cessation of menses after the cessation of ovarian function
Amenorrhea in the presence of signs of hypoestrogenemia and FSH > 40
Follicles decrease, inhibin falls, FSH rises, eventual estradiol level decline => endometrial development fails => absence of menses.
Progesterone production ceases, unopposed estrogen (initially higher), increased endometrial cancer in early menopause
Androgen production decreases from both ovaries and adrenals => ? Effect on libido
What are the common problems for women with menopause?
skin aging/discoloration
osteoporosis
mood changes
cardiovascular disease
hot flashes, cold intolerance
sexual function changes or dysfunction
vaginal atrophy
uterovaginal prolapse
incontinence
What does the evaluation of menopausal women involve?
Physical exam
TSH
Mammogram
DEXA (after age 65 if no risk factors)
Abnormal uterine bleeding => rule out pregnancy, physical exam, US, biopsy
What are some of the fundamentals of female hormone replacement therapy?
Indications: hot flashes, vaginal atrophy, osteoporosis/high risk, osteopenia
Contraindications: pregnancy, undx vaginal bleeding, active VTE, current GB dz, liver dz, unopposed estrogen with uterus, CVD
Relative contraindications: h/o breast Ca, h/o VTE
Side effects: vaginal bleeding, breast tenderness, mood changes, headaches
Oral, transdermal, parenteral, vaginal
Cyclic, continuous/combined, continuous
Estrogen + Progesterone (still have uterus), Estrogen + methyltestosterone (younger women), Estrogen only (if no uterus), Progesterone only (protects uterine lining)
What are the physiologic changes associated with menopause?
1) Body mass: weight and total body fat increase, increase in waist to hip ratio
2) Decreased collagen: Thinning of skin, Tooth loss
- Atrophic vaginitis, poor uterovaginal support => cystocele, rectocele, enterocele, uterine prolapse
- urinary => OAB, stress urinary incontinence, dysuria, frequency
3) Hot Flashes (>50%): directly correlated to estrogen levels, corresponds to GnRH pulses from hypothalamus (probably not the cause, but a marker for disturbance of thermoregulation)
Other symptoms: Depression, anxiety, irritability, fatigue, insomnia, Loss of libido, Sense of loss of youth, Headaches (most women with migraines premenopause will improve after menopause)
What are the current recommendations for HRT according to the Women’s Health Initiative?
Only use lowest possible dose that is effective for symptoms for as short of time as possible
