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Women's Health Exam 1 > Menopause & POP > Flashcards

Menopause & POP Flashcards

1
Q

perimenopause (menopausal transition)

A

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

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2
Q

Menopause

A

permanent cessation of menses for 12 consecutive months

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3
Q

Postmenopause

A

The period following menopause

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4
Q

age of perimenopause

A

4 years before final menstrual period (FMP)

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5
Q

manifestations of perimenopause

A 
estrogen fluctuates unpredictably
IRREGULAR MENSES
vasomotor sx (hot flashes/night sweats)
Mood sx (anxiety/depression)
vaginal dryness
change in lipids and bone loss begin
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6
Q

Labs for perimenopause

A

FSH >25 suggestive

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7
Q

Median age of menopause

A

51.5 YO

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8
Q

Abnormal menopause

A

before 40 YO (primary ovarian insufficiency/premature ovarian failure)

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9
Q

Labs for menopause

A

FSH >70 (post-meno women)

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10
Q

Sx of postmenopause

A

vasomotor- untreated, hot flashes stop spontaneously 4-5 years of onset
vaginal dryness
increased risk of osteoporosis, CVD, dementia
Mood sx (anxiety/depression)

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11
Q

Women with worst hot flashes

A

african american

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12
Q

women w/ fewest vasomotor sx

A

Asian

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13
Q

Length of hot flash

A

1-5 minutes

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14
Q

Tx for vasomotor sx

A
  • Lifestyle modification
  • Hormone Therapy (Estrogen vs Estrogen/Progestin)
  • SSRIs and SSNRIs
  • Clonidine
  • Gabapentin
  • Complementary Botanicals and Natural Products (Phytoestrogens, Herbal Remedies, Vitamins, Accupuncture)

• Not recommended: progestin‐only medications, testosterone, or compounded bioidentical hormones

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15
Q

Most effective therapy for menopause

A

Systemic hormone therapy (HT)

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16
Q

Cause of hotflashes

A

narrowing of thermoregulatory zones

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17
Q

Types of HT

A

estrogen only- women who have undergone hysterectomy

estrogen + progestin: intact uterus

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18
Q

Adverse effect of unopposed estrogen in woman w/ uterus

A

endometrial hyperplasia

increased risk of endometrial adenocarcinoma

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19
Q

SE of HT

A

breast tenderness
vaginal bleeding
bloating
h/a

low-dose estrogen has less SE but not as effective – treat w/ lowest effective dose for shortest duration to relieve vasomotor symtpoms (no more than 5 years or beyond age 50)

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20
Q

When to stop HT

A

5 years after start or beyond age 60

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21
Q

Risks of HT

A

thromboembolic disease
Breast CA

Combined HT: Breast CA, CHD, stroke, venous thromboembolic events; decreased fx and colon Ca

Estrogen only: only increased risk of thromboembolic (no CVD or breast CA)

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22
Q

Benefit of transdermal estrogen

A

lower risk of venous thromboembolism compared to oral

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23
Q

Contraindications of HT

A 
hx of:
• Breast cancer
• Coronary Heart Disease
• Previous venous thromboembolic event or stroke 
• Active liver disease
• unexplained vaginal bleeding
• high‐risk endometrial cancer
• transient ischemic attack
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24
Q

No risk of CVD or breast CA

A

estrogen only

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25
Q

Role of progestin

A

prevent endometrial hyperplasia and endometrial CA

may improve vasomotor sx somewhat

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26
Q

Why is progestin not used alone?

A

Risk of breast CA

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27
Q

Why is T not used?

A 
no benefit for vasomotor sx
clitoromegaly
hirsuitism
acne
lipid effects
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28
Q

T good for

A

improves sexual function

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29
Q

what are bioidentical hormones?

A

Plant‐derived hormones that are similar to those produced by the body (micronized progesterone and estradiol)

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30
Q

Types of bioidentical hormones

A

micronized progesterone and estradiol

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31
Q

dosing for bioidentical hormones

A

salivary hormone level testing to customize dosing – expensive and useless (hormones vary)

32
Q

Nonhormonal meds for hot flashes

A

SSRI’s
SNRI’s
Antiepileptic/central-acting

33
Q

SSRI’s

A

Low-dose paroxetine
Paroxetine (FDA)
CItalopram
Escitalopram

34
Q

SNRI’s

A

Venlaxafine

Desvenlafaxine

35
Q

Antiepileptics/central-acting

A

Gabapentin
Pregabalin
Clonidine

36
Q

Alternative therapies

A

Phytoestrogens (soy based, red clover)
herbal (black cohosh, ginseng, St. john’s worst, ginkgo biloba)
Vit E
Accupuncture

37
Q

GU syndrome of menopause sx

A

vulvovaginal atrophy (dryness, itching, dyspareunia, sexual dysfunction)
Urinary frequency
Recurrent bladder infections

38
Q

Tx for vulvovaginal atropy

A

water-soluble moisturizers/lubes
HT
- local estrogen (cream, ring, tablet)
- estrogen agonists and antagonists (SERMs): stimulate or inhibit estrogen receptors (Ospemifene)

39
Q

Caution w/ local estrogen for atrophy

A

h/o breast cancer (can still consider it)

40
Q

Ospemifene

A

SERM: stimulate estrogen receptors in the vagina; unknown effect elsewhere

41
Q

Osteoporosis risk factors

A 
(ACCESS)
alcohol
corticosteroid
calcium low
estrogen low
smoking
sedentary lifestyle
42
Q

Risk factors for osteoporosis

A 
• Advanced age
• Cigarette smoking
• FH of osteoporosis
• Vitamin D deficiency
• Female sex
• White or Asian ethnicity
• Secondary osteoporosis 
- Endocrinologic disorders 
-  Hormonal factors
- Medical disorders (RA)
• Long‐term glucocorticoid therapy 
• Low body weight
• Excess alcohol intake
43
Q

Ethnicity w/ lowest rate of osteoporosis

A

african american

44
Q

Preventing osteoporosis

A

weight-bearing, resistance exercises
walking and aerobics
Vit D
Calcium

45
Q

Calcium levels recommended

A

9-18: 1300
19-50: 1000
51-70: 1200
>71: 1200

46
Q

Vit D level recommended

A

9-70: 600

>71: 800

47
Q

Dx of osteoporosis

A

DXA (T-score and Z-score
T- score used in post-menopausal women

Fragility fx: spine, hip, wrist, humerus, rib and pelvis (fall or standing height or less)

48
Q

T-score

A

BMD in sex-matched young normal controls

49
Q

Z-score

A

BMD in same age

50
Q

T-score values

A

normal: > -1.0
Osteopenia: -1 - -2.5
Osteoporsis: =< 2.5

51
Q

Screening for osteoporosis

A

Normal healthy: 65 YO

Postmenopausal w/ risk factors: screen earlier

52
Q

Risk factors to screen early for osteoporosis

A
  • Medical history of a fragility fracture
  • Body weight less than 127 lb
  • Medical causes of bone loss (medications or diseases)
  • Parental medical history of hip fracture • Current smoker
  • Alcoholism
  • Rheumatoid arthritis
  • FRAX 10‐year risk of major osteoporotic fracture > 9.3%
53
Q

Tx for osteoporosis types

A

Lifestyle mod

Pharm

54
Q

Candidates for osteoporosis therapy

A

postmenopausal w/ hx of hip/vertebral fx
T-score <= 2.5
High-risk postmenopausal w/ T-score between -1 and -2.6 (10-year risk >= 20% or risk of hip fx >3%)

55
Q

Pharm tx for osteoporosis

A

BISPHOSPHONATES (1st line)
SERMs
Forteo (teriparatide (PTH-134))
Calcitonin (maicalcin)

56
Q

Role of bisphosphonates

A

reduce bone resorption and turnover

57
Q

Bisphosphonate drugs

A

Alednronate
Risedronate
Ibandronate
Zoledronic Acid

58
Q

SE of bisphosphonates

A

UGI

Osteonecrosis of jaw

59
Q

SERM drug for osteoporosis

A

Raloxifene

60
Q

Goal of raloxifene

A

inhibit bone resorption
decrease risk of vertebral fx
reduce risk of breast CA

61
Q

Used in severe osteoporosis or those that can’t take bisphosphonates, or refractory cases

A

Teriparatide (PTH-134)

62
Q

Calcitonin

A

PTH antagonist
Less preferred
useful in short-term tx of acute pain relief (vertebral fx)

63
Q

Monitoring for osteoporosis

A
  • Normal BMD (T score 0 to ‐1.5): Repeat in 5‐15 years
  • Osteopenia (T‐score of –1.5 to –1.99): Repeat in 5 years
  • Osteopenia (T‐score of –2 to –2.49): Repeat in 1 years
  • Osteoporosis on treatment: Repeat in 1‐2 years, and 2 years thereafter
64
Q

Types of POP

A

Atypical (uterovaginal, vaginal vault (enterocele)
Anterio compartment (cystocele)
Posterior compartment (rectocele)
Procidentia

65
Q

Sx of POP

A

only a problem if having sx:
• Bulge/Something falling outside of vagina
• Heaviness
• Pressure
• Discomfort
• Urinary Symptoms (Incontinence vs retention)
• Defecatory Symptoms (with posterior defects)
• Splinting
• Pain and irritation

66
Q

Risk factors for POP

A 
Parity (vaginal deliveries)
Large BW babies
Advancing age
obesity
CT disorders
Menopausal status
Chronic disease (Constipation, COPD)
Iatrogenic (prior prolapse surgery at increased risk)
Racial/genetic
67
Q

Ethnicity w/ lowest risk of POP

A

African

68
Q

Ethnicity w/ hight risk of POP

A

hispanic women

69
Q

PE for POP

A 
neuro (voluntary mm. control, pelvic floor reflex)
GYN exam (valsalva, cough)
70
Q

Tx for POP

A

Expectant
Conservative (pessary, Kegels)
Surgery (symptomatic who failed or decline conservative)

71
Q

Advantages of pessaries

A

safe

effective

72
Q

Disadvantages of pessaries

A

odor
d/c
vaginal ulcers
most remove for coitus

73
Q

Risk of pessaries

A
  • Erosion into bladder
  • Fistula formation
  • Ureteral obstruction with urosepsis or uremia
  • Small bowel prolapse and incarceration
74
Q

Surgery type for POP

A 
Apical support (sacrospinous fixation, uterosacral ligament fixation)
Sacrocolpopexy
75
Q

Sacrocolpopexy

A

Attachement of vagina or cervix to the anterior longitudinal ligament of the sacrum (goal: correct all compartments)

76
Q

when is POP urgent/emergent?

A

almost never
urinary retention
obstructive nephropathy

77
Q

Tx of urinary retention/obstructive nephropathy

A

indwelling catheter

urogyn consult for pessary or surgery

Women's Health Exam 1 (5 decks)

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