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Clin Med Final Material- Semester 2 > Menopause: seibert > Flashcards

Menopause: seibert Flashcards

1
Q

Describe Menopause:

  • what is this event?
  • defined as:
A

is a normal, natural event, defined as the final menstrual period (FMP), confirmed after 1 year of no menstrual bleeding

-Portion of aging process where a woman moves from her reproductive years to her non-reproductive years

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2
Q

Menopause represents the permanent cessation of ______

A

menses–> resulting from loss of ovarian follicular function, usually due to aging

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3
Q

When is menopause? (average age)

A

Naturally (spontaneously), average age 51

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4
Q

Can menopause occur prematurely?

A

YES–> Prematurely from medical intervention (eg, bilateral oophorectomy, chemotherapy)

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5
Q

Menopause can occur any time from impaired ______ function

A

ovarian

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6
Q

___% of women stop menstruating between 44-55yo

A

95%

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7
Q

Menopause: sx

A

Symptoms vary by individual and cultural expectations/life circumstance

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8
Q

Menopause: classic Sx

A
  • Change in menstrual cycle pattern (early)
  • Vasomotor symptoms (includes night sweats)
  • Vulvovaginal symptoms (dyspareunia)
  • Urinary symptoms
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9
Q

Menopause: other Sx sometimes associated w menopause

A
  • Sleep disturbances besides night sweats
  • Cognitive concerns (memory, concentration)
  • Psychological symptoms (depression, anxiety, moodiness)
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10
Q

Terminology: Perimenopause

A

=The time around menopause, also called “the menopause transition”

-Menstrual cycle and hormonal changes that occur a few years before and 12 months after the final menstrual period

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11
Q

Induced menopause= cessation of menstruation that follows _____

A

bilateral oophorectomy (with or without hysterectomy) or chemotherapy, pelvic radiation therapy, or iatrogenic menopause

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12
Q

Premature menopause=

A
  • Any menopause that occurs before age 40
  • Can be natural or induced
  • Also called premature ovarian failure
  • 0.9% of US population
  • Reasons for premature ovarian failure are unknown
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13
Q

T/F: Smoking associated with early menopause

A

true

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14
Q

Postmenopause=

A

=The years after the FMP resulting from natural (spontaneous) or premature menopause

-With current life expectancy, the postmenopausal years make up about 1/3 of the lifespan of most North American women

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15
Q

Menopause: diagnostic studies (list 2 main ones)

A
  • Estradiol <20 and FSH level 21-100 helpful in establishing diagnosis
  • *FSH of greater than 30mIU/ml is highly suggestive of menopause
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16
Q

Changes in both menstrual flow and frequency are common and usually normal:
(describe)

A 
Lighter bleeding
Heavier bleeding
Duration of bleeding
Cycle length
Skipped menstrual periods
Amenorrhea
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17
Q

Abnormal uterine bleeding (AUB)=

A

=Heavy menstrual bleeding (avg. blood loss >80 mL), especially with clots

  • Menstrual bleeding lasting >7 days or ≥2 days longer than usual
  • Intervals <21 days from the onset of one menstrual period to the onset of the next one
  • Any spotting or bleeding between periods
  • Bleeding after sexual intercourse
  • Organic disease can occur – consider endometrial biopsy
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18
Q

Vasomotor symptoms:

-describe “hot flashes”

A
  • Recurrent, transient episodes of flushing accompanied by a sensation of warmth to intense heat on the upper body and face
  • Perspiration and cutaneous vasodilation, may also experience palpitations
  • As many as 75% of perimenopausal women have hot flashes
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19
Q

Hot flashes: tx?

A

-Treatment based on symptom severity and a woman’s risks and personal attitudes about menopause and medication

–**Estrogens, Progestins, Clonidine, SSRIs and SNRIs, Black cohosh, Gabapentin

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20
Q

Hot flash physiology illustration

A
  • increased core body temp
  • increased skin blood flow
  • increased HR
  • increased sweating!!
  • intense feeling of “heat” with reddening of upper body
  • in the end: chills, shivering
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21
Q

Menopause: Vaginal symptoms

A
  • Sx such as vaginal dryness, vulvovaginal irritation/itching, and dyspareunia are experienced by postmenopausal women
  • Unlike vasomotor symptoms, which abate over time, ***vaginal atrophy is typically progressive and unlikely to resolve on its own
  • +/- dysuria, urge incontinence, pelvic relaxation, atrophic cystitis, and easy bleeding
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22
Q

Vaginal Sx: tx?

A

lubricants and moisturizers, and local vaginal estrogen

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23
Q

Menopause: Urinary symptoms

hint: atrophy of ?

A
  • Most menopausal women experience varying degree of atrophic changes of vaginal epithelium -> atrophic vaginitis
  • Atrophic changes to cervix -> decrease in size and stenosis, reduced secretion of cervical mucus
  • Atrophy of uterus, fallopian tubes, and ovaries
  • Supporting structures of reproductive organs suffer loss of tone
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24
Q

Estrogen plays role in maintaining epithelium of bladder and _____

A

urethra

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25
Q

Declining estrogen during menopause may give rise to..

A

atrophic cystitis, characterized by urinary urgency, frequency, incontinence, and dysuria

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26
Q

Atrophic vaginitis: tx?

A

**Kegel exercises can reduce more than 50% of cases of stress incontinence when performed regularly

27
Q

Menopause:
sexual health changes
-decreased ______ generally increases with aging

A

libido**

28
Q

Menopause:
sexual health changes
-effects of decreased estrogen?

A
  • Decreased estrogen causes a decline in vaginal lubrication and elasticity
  • Decreased testosterone may contribute to a decline in sexual desire and sensation
29
Q

Decreased libido and vaginal health: tx?

A

An active sex life,lubricants and moisturizers, and local vaginal estrogen help maintain vaginal health

30
Q

Don’t forget STI screening!

-why?

A
  • Clinicians should not assume that peri- and postmenopausal women are not at risk for STIs
  • **Vaginal atrophy increases the risk for contracting an STI
  • *Older women may not be as knowledgeable as younger women about infection risks or steps to take to reduce those risks
31
Q

Menopause: sleep disturbances

A

Peri- and postmenopausal women sleep less, have more frequent insomnia, and are more likely to use prescription sleeping aids

32
Q

Perceived decline in sleep quality may be attributed to:

A
  • General aging effects (eg, nocturnal urination)
  • Sleep-related disorders (eg, apnea) or other illness (eg, chronic pain, depression)
  • Stress, negative mood
  • Ovarian hormone changes (hot flushes and nighttime awakening)
33
Q

Women with frequent flushes may experience flushes and awakening episodes hourly, which may cause profound sleep disturbance that can lead to:

A

cognitive and anxiety disorders in some

34
Q

Sleep disturbances: Decisions on whether and how to treat—with behavioral or drug therapy, or both—depend on:

A
  • Severity of sleep disturbance
  • Context of sleep problem (eg, distressing hot flashes or life stress)
  • Severity of daytime consequences
35
Q

Menopause: Cognitive changes

-Midlife women should be counseled that:

A

memory and concentration problems are probably not related to menopause but rather to normal aging and/or mood, stress, sleep disturbances, or other life circumstances.

36
Q

Studies show estrogen influences areas of brain important in _____, but recent studies have shown that estrogen alone or in combo with progestin can increase the risk of _____ _____ in women older than 65yo.

A

memory

-cognitive decline

37
Q

Menopause: mood disorders

A

Feelings of upset, loss of control, irritability, fatigue, and blue moods (dysphoria) at midlife may be caused by fluctuating hormone levels that perturb neural systems transiently

38
Q

Mood disorders:

-who is most vulnerable?

A
  • Women with a history of premenstrual syndrome, significant stress, sexual dysfunction, physical inactivity, or hot flashes are more vulnerable to depressive symptoms
  • Studies assessing effects of estrogen on depression and other mood disorders are mixed
39
Q

The most predictive factor for depression at midlife and beyond is prior history of ______

A

clinical depression

40
Q

Mood disorders: tx?

A

Relaxation and stress reduction techniques, antidepressants, and counseling, or psychotherapy are options to consider in symptom management

41
Q

Menopause: Skin and Hair Changes

A
  • Skin becomes thinner and less elastic
  • Hair loss increases
  • Nails become brittle
  • Facial hair may increase
42
Q

Menopause: osteoporosis

  • defined as?
  • Definitions based on BMD results:
A

=systemic skeletal disorder characterized by low bone mass and deterioration with an increase risk in fragility and susceptibility to fracture

-Peak bone mass 25-30yo, then bone loss begins and accelerates in women at menopause, can lose up to 20% of bone mass in 5-7 years after menopause

  • Definitions based on BMD results:
  • -Normal: T-score greater than or equal to –1.0
  • -Low bone mass (osteopenia): T-score between –1.0 and –2.5
  • -Osteoporosis: T-score less than or equal to –2.5
43
Q

Osteoporosis risk factors

A 
Advanced age (40-90)
Previous fracture (adult life)
Parental history of fragility fracture
Female sex
Current tobacco smoking
Weight (low weight)
Long-term use of glucocorticoids
44
Q

National Osteoporosis Foundation recommendations for BMD testing:

A
  • All postmenopausal patients younger than 65yo w/ > or equal to one additional risk factor (other than white, postmenopausal, and female)
  • All women age 65yo and older
  • Postmenopausal women who present with fractures
  • Women considering therapy for osteoporosis if testing would help decision
  • Women who have been on HRT for prolonged periods
  • Women who have been on treatment to monitor treatment effect
  • Women considering discontinuation of treatment
45
Q

Osteoporosis Treatment

A

-All individuals at risk for or who have been diagnosed with osteoporosis should be advised to consume adequate calcium (minimum of 1200mg daily) and Vitamin D (800-1,000 IU/d), smoking cessation, avoid excess alcohol, and regular weight bearing exercise.

  • Pharm therapy is recommended for:
  • -Women who have had vertebral or hip fracture
  • -Women with T-scores ≤−2.5 with no risk factors
  • -Women with T-scores from −1.0 and below with a 10-year FRAX risk of major osteoporotic fracture of at least 20% or of hip fracture of at least 3%
  • –Example - Bisphosphonates

-Alendronate 70 mg tablet po q weekly

46
Q

Menopause: Cardiovascular disease

A
  • Heart disease affects about 8 million women in US
  • Deaths from CHD in women number more than 230,000 per year

-CHD increases with age
Before age of menopause, very few women die from CHD

  • After menopause rate of CHD increases 2-3x
  • Numerous studies show estrogen and progesterone receptors present in heart and aorta
  • HRT should not be prescribed for prevention of CHD, decision to use should be based on benefits of other systems, potential risks, and patient preference
47
Q

For better cardiovascular health:

-advise Pt to ____

A

have good cholesterol, blood pressure, blood glucose, BMI, quit smoking, eat healthy and be physically active

48
Q

Because cancer rates increase with age, screen for the following cancers regularly:

A

Breast cancer
Colorectal cancer
Cervical cancer

49
Q

Hormone therapy (HT) FDA approved indications:

A

prevention of osteoporosis, treatment of vasomotor symptoms, and treatment of vulvovaginal atrophy. HT encompasses both estrogen-alone and estrogen-progestogen therapies.

50
Q

Estrogen therapy (ET)=

A

Unopposed estrogen is prescribed both a) systemically for women who do not have a uterus, and b) locally in very low doses for any woman with vaginal symptoms

51
Q

Estrogen-progestogen therapy (EPT)=

A

Progestogen is added to ET to protect women with a uterus against endometrial cancer, which can be caused by estrogen alone

52
Q

Bioidentical hormone therapy (BHT)=

A

Consists of hormones chemically identical or very similar to those made in the body. Available from two sources: 1) FDA-approved and tested; 2) unapproved and untested from compounding pharmacies

53
Q

Hormone therapy—what we know today

A

-HT formulation, route of administration, and timing of initiation produce different effects (e.g. transdermal route may carry lower risk for thrombosis)

54
Q

Absolute risks for HT include:

A
  • thrombosis, stroke, and cardiovascular events
  • HT initiation in older women carries greater risks
  • **Breast cancer risk increases with EPT in WHI study
  • Consider each woman’s priorities and risk factors prior to initiating HT
55
Q

Contraindications to (HRT) hormone replacement therapy: (list)

A
  • Undiagnosed vaginal bleeding
  • Active DVT or PE or a history of these conditions
  • **Arterial thromboembolic disease (MI and stroke)
  • Liver disease
  • History of endometrial or breast cancer
56
Q

Alternatives to hormone therapy:

-Nonhormonal prescription drugs (off-label use):

A
  • Antidepressants:
  • -SSRIs: fluoxetine, paroxetine, escitalopram
  • -SNRIs: venlafaxine and desvenlafaxine
  • Insomnia:
  • -Eszopiclone - (Lunesta)
  • Anticonvulsant:
  • -Gabapentin
  • Antihypertensive:
  • -Clonidine

-Neuropathic pain drug:
Pregabalin

57
Q

Complementary & Alternative Medicine (list Ex’s)

A
  • Soy isoflavones:(phytoestrogen)
  • Traditional Chinese medicine
-Herbs:
Black cohosh
Cranberry
St. John’s wort
Valerian- good for anxiety

-Over-the-counter hormones: (dietary supplements)
Melatonin

58
Q

Lifestyle changes:

A
  • Try relaxation techniques (eg. yoga, meditation)
  • Eat a healthy diet
  • Get regular exercise
  • Avoid hot flash triggers (eg, caffeine, alcohol, spicy food)
  • Keep cool:
  • -Dress in layers (eg. light clothing)
  • -Sleep in cool room (eg. fan, thermoregulating pillow)
  • -Consume cold drinks

-Reduce sexual discomfort and increase sensitivity with moisturizers, lubricants, and vibrators

59
Q

POSTMENOPAUSAL HEALTH:
The menopause transition and the time afterward are important periods for implementing lifestyle and behavioral changes to ensure that each woman:

A

maximizes her health moving forward.

60
Q

Lifestyle counseling for midlife women:

-Discontinue unhealthy habits: (list)

A

Tobacco use
Excess Alcohol
Drug/medication abuse

61
Q

Lifestyle counseling for midlife women:

-Promote healthy food and exercise:

A

Limit fat and cholesterol intake
Maintain caloric balance
Consume whole grains, fruits, vegetables, water
Ensure adequate vitamin and mineral intake, especially calcium and vitamin D
Engage in regular physical activity

62
Q

Lifestyle counseling for midlife women:

-injury prevention ?

A

-Wear lap/shoulder belts in the car

  • Institute fall prevention methods
  • Appropriate helmet and other safety equipment
  • An adequate number of smoke and carbon monoxide detectors
  • Ensure safe storage or removal of firearms
  • Set water heater thermostat between 120°F and 130°F or lower
  • Train household members to deliver cardiopulmonary resuscitation
63
Q

Lifestyle counseling for midlife women

-Sexual behavior?

A
  • Institute prevention of sexually transmitted infections
  • Avoid high-risk sexual behavior
  • Use condoms or female barrier, or both
  • Prevent unintended pregnancies with appropriate contraception

Clin Med Final Material- Semester 2 (22 decks)

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