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GYN > Middle and Older Woman > Flashcards

Middle and Older Woman Flashcards

1
Q

Age of Menoapuse

A

Avg is 51

5% after 55

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2
Q

Age of Perimenopause

A

Usually in 40s

Lasts about 3.7 years

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3
Q

Perimenopausal bleeding

A
  • Irregular, unpredictable bleeding is common
  • Heavy, unpredictable is common
  • If persists despite treatment, investigate cause
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4
Q

Medical Issues in Perimenopause

A
  • Heavy Bleeding

- Anovulatory cycles can lead to endometrial hyperplasia and endometrial cancer

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5
Q

Hormonal Changes in Perimenopause

A
  • FSH decreases due to decrease in Inhibin B (fluctuation common)
  • AMH - Produced by growing follicles, decreases 5 years before menopause (rarely used, expensive)
  • FSH low and Estrogen high is reproductive cycle
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6
Q

Causes of AUB

A
  • Anovulatory cycles
  • Physical abnormalities (polyp)
  • Medical (pregnancy, medication, anovulatory due to illness)
  • Endometrial hyperplasia
  • Adenomyosis
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7
Q

Describe Anovulatory bleeding

A
  • Normally progesterone takes over sloughing uterine lining
  • During menopause no regular ovulation so build up of estrogen –> building up of uterine lining
  • When bleeding does occur can be “catastrophic”
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8
Q

Endometrial Hyperplasia

A
  • Unopposed estrogen –> build up of lining –> Hyperplasia
  • Risk factor for cancer
  • Do a biopsy if you can’t figure out why pt is bleeding
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9
Q

Polyps

A
  • Almost always benign
  • Bleed easily with sex, running, ect.
  • Assess lining of uterus
  • Can resolve on its own or D&C
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10
Q

Adenomyosis

A
  • Boggy uterus
  • Endometrial cells embedded in myometrium
  • Painful, irregular bleeding and menses
  • Seen on US
  • May do hysterectomy
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11
Q

Fibroids

A
  • Almost always benign
  • Cause irregular heavy bleeding
  • Pain on position
  • Become bulky
  • Myomectomy or hysterectomy
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12
Q

Endometrial Cancer

A
  • Fullness on bimanula exam

- US shows growth or complex cyst

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13
Q

Gestational trophoblastic disease

A
  • Not true pregnancy
  • Can be malignancy
  • Often bleeding is first sign
  • R/O with UPT
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14
Q

Atrial venous malformations

A
  • Rare
  • Irregular attachment of arteries and veins
  • Require surgery
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15
Q

Coagulopathy

A

von Wilebrand’s Disease

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16
Q

Lab tests at Perimenopause

A
  • R/o pregnancy
  • GC/CT - Cervix may bleed
  • CBC/Iron
  • TSH
  • Prolactin - Galatorrhea, alteration of cycle
  • TVUS
  • Endometrial bx
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17
Q

TVUS Uses

A

-Best for uterine bleeding
-Can avoid biopsy if it looks good
3-6 months of treatment failure
Increased risk of endometiral cancer
Polyps, fibroids, endometrial lining, carcinoma

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18
Q

EMB Uses

A
  • Hyper plasia
  • Endometrial Cancer
  • If not diagnostic, sonohysterogram and hysteroscopy
  • If US clear but bleeding continues
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19
Q

Risk factors for endometrial cancer

A
  • Estrogen or Tamoxifen use
  • Endometrial hyperplasia
  • Obesity
  • DM
  • Chronic anovulation
  • HTN
  • Family Hx BC, OC, CC, E/M Ca
20
Q

Endometrial Biopsy Results

A

-Proliferative - Concerning if patient is far past menopause
(can be normal into 50s)
-Complex hyperplasia w/o atypical you repeat 6-12mo
-With atypia is highest risk for endometrial cancer

21
Q

Anovulatory bleeding recommendations

A
  • Endometrial evaluation 35 and older
  • Under 35 if not able to treat
  • Obese women with uncontrolled DM are at risk
22
Q

At risk of endometrial cancer

A
  • Mostly postmenopausal

- 25% are premenopausal (mostly obese with uncontrolled DM)

23
Q

AUB recommednations

A
  • R/O pregnancy, systemic disease, organic etiology, CA

- Most respond to medication

24
Q

Treatment for benign AUB

A
  • NSAIDS (decrease bleeding)
  • Tranexamic Acid - Antifibrinolytic agent that reduces bleeding (caution with pt at risk for clot)
  • COC if not contraindcated (can continue through menopause)
  • Progestin only (Not at risk of pregnancy, or COC CI). Use to stop acute bleeding
  • Mirena - Very effective. Slough lining and prevent further bleeding
  • GnRH agnoists - Cause amenorrhea, induces menopause. Only 6 months a time, pre-surgery
25
Q

NSAIDS to tx AUB

A
  • 600-800 mg
  • MUST take around the clock
  • Sporadically can increase bleeding
26
Q

Risks of Combined Hormone Therapy

A
  • Breast Cancer
  • CHD
  • Stroke
  • Pulmonary Embolism
  • Risks > benefits of reduced fracture and colorectal cancer
27
Q

Risks of Estrogen only

A
  • STROKE
  • Insignificant reduction in breast cancer risk
  • Better for younger people
  • Patients with a hysterectomy ONLY need Estrogen
28
Q

Uses for HT

A

-NOT to prevent chronic illness
-Short term for vasomotor sxs
-Healthy arteries respond better then atherosclerotic
>63 worse results

29
Q

Combined HT initiated close to menopause

A
  • Reduced risk of CHD

- Increased risk of breast cancer

30
Q

Estrogen therapy initiated close to menopause

A
  • No difference based on age of initiation
  • Benefit for CHD
  • Increased risk of stroke
  • Neutral for breast cancer
31
Q

HT at age 70

A

Higher risk of CHD

32
Q

HT and vasomotor sxs

A
  • Hot flashes, poor sleep, irritability, concentration problems
  • Primary indication HT
  • Any kind except low dose transdermal estradiol
  • Progesterone alone not as effective
33
Q

Duration of HT

A

> 5 years increased risk of breast cancer with Combined HT and CVD for all HT

34
Q

Non Hormonal approaches to Hot flashes

A
  • Lifestyle changes
  • Reduce ETOH, smoking, caffeine
  • Yoga/Meditation
  • SSRI at lower dose
35
Q

Non hormonal approaches to vaginal sxs

A
  • Dryness, atropy, dyspareunia
  • Moisturizers, vitamin E, lubricants
  • Estrogen creams (local), progesterone not as helpful
  • Evaluate all postmenopausal bleeding
36
Q

Urinary Tract Health

A
  • Estradiol ring may help overactive bladder
  • Systemic HT may increase kidney stones and stress incontinence
  • Estrogen cream to protect meatus from cracking and infection
  • NOT systemic - local
37
Q

UTI

A
  • Common, E.Coli
  • Check resistance, culture
  • Ampicillin no longer first line
  • Nitrofurantin x5d
  • Macrobid post-coital
38
Q

Osteoporosis

A
  • Aging and decreased estrogen lead to decreased bone strength and increased risk of factor
  • Other RF: genetics, thinness, smoking, low Ca+, low Vit D, ethnicity
39
Q

Osteoporosis prevention/Osteopenia tx

A 
Vit D 800-1000
Calcium 600 in diet 600 supplement
Walking 2-3 miles
-Healthy weight
-Smoking cessation (reduces estrogen if you smoke)
-Avoid ETOH excess
-Prevent falls
40
Q

DEXA (When)

A

> 65 or >50 with risk factors: previous fracture, smoking, FMH, rheumatoid arthritis, ETOH,

41
Q

DEXA (What)

A
  • Total hip, lumbar spine, femoral neck, forearm
  • Tscore - compared to 20yo
  • Zscore - compared to others her age
42
Q

Cause of Low BMD

A
  • Hyperthyroid
  • DM 1
  • Ankylosing spondylitits
  • RA
43
Q

Cardiovascular disease

A
  • Heart disease #1 cause of death

- RF: Metabolic syndrome, abd obesity, high triglycerides, low HDL, elevated BP, elevated FBS

44
Q

Lichen Sclerosis sxs and tx

A
  • Itching, severe at night
  • Diminished labial architecture
  • Etiology unknown (Autoimmune)
  • Increase after menopause w/low estrogen
  • Tx with high potency steroid
  • Risk of vulvar cancer
45
Q

Cardiovascular Triad

A

Waist circumference, HTN, Hyperglycemia = 3 fold increase in mortality

46
Q

Cardiovascular Assessment

A
  • Measure the waist
  • Lipid panel once a year
  • BP both arms
  • Urine for glucose/protein
  • Smoking cessation
  • Physical activity
47
Q

Pregnancy and Metabolic Syndrome

A
  • Insulin resistance
  • Increased inflammation
  • Increase in coagulation factors
  • Can cause GD, preeclampsia
  • Predisposition to risk later in life

GYN (7 decks)

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