Miscellaneous Women's Health

Question 0

First line tx of PCOS without DM or impaired glucose:

Answer 0

Contraceptives for menstrual irregularities & hirsutism.

Metformin only prescribed as an addition to contraceptives when presence of PCOS with DM or impaired glucose.

Question 1

Clinicians should evaluate most women with suspected PCOS by ordering what 3 labs?

Answer 1

serum thyroid-stimulating hormone,
prolactin,
and 17-hydroxyprogesterone levels to exclude other common causes of hyperandrogenism and menstrual irregularities

Question 2

Findings present on physical examination of a patient w/BV

Answer 2

+ whiff test
PH > 4.5
Mobilicus bacteria
Thin increased milk-like vaginal secretions

***There are very few wbc’s present on microscopic exam.

Question 3

Which of the following would put a female patient at higher risk of breast cancer?

 early menarche
 age

Answer 3

Correct answer:
early menarche

Early menarche is a situation that might put a woman at higher risk for breast cancer. This is related to longer exposure to estrogen.

Question 4

Laboratory markers of menopause include the following

Answer 4

1) FSH: FSH is the diagnostic marker for ovarian failure
2) LH: increase w/menopause
3) Estradiol: decreases w/menopause
4) Inhibin: decreases w/menopause

An increase in serum follicle-stimulating hormone (FSH) and decreases in estradiol and inhibin are the major endocrine changes that occur during the transition to menopause[1, 2]
FSH levels are higher than luteinizing hormone (LH) levels, and both rise to even higher values than those seen in the surge during the menstrual cycle of the reproductive years.
The FSH rise precedes the LH rise; LH is not necessary to make the diagnosis.

Question 5

Contraindications for estrogen therapy include the following:

Answer 5

Undiagnosed vaginal bleeding
Severe liver disease
Pregnancy
Venous thrombosis
Personal history of breast cancer
Well-differentiated and early endometrial cancer, once treatment for the malignancy is complete, is no longer an absolute contraindication. Progestins alone may relieve symptoms if the patient is unable to tolerate estrogens.

Question 6

Non-hormonal therapy recently approved for the tx of vasomotor symptoms associated w/menopause

Answer 6

paroxetine mesylate (Brisdelle)

Question 7

What is the average age at which menopause occurs?
When does the symptomatic transition to menopause usually commence or start? Factors that can lower the age of physiologic menopause include the following:

Smoking[11, 12]
Hysterectomy
Oophorectomy
Fragile X carrier
Autoimmune disorders
Living at high altitude
History of receiving certain chemotherapy medications or undergoing radiotherapy

Answer 7

1) approximately 50-51 years,
2) symptomatic transition to menopause usually commences at approximately age 45.5-47.5 years. However, sx’s can present up to 6 years prior to menopause.

Question 8

Factors that can lower the age of physiologic menopause include the following:

Answer 8

1) Smoking[11, 12]
2) Hysterectomy
3) Oophorectomy
4) Fragile X carrier
5) Autoimmune disorders
6) Living at high altitude
7) History of receiving certain chemotherapy medications or undergoing radiotherapy

Question 9

Because a slightly elevated or borderline menopausal FSH level in the menopausal transition (MT) may not be a reliable indicator of menopause, how often should FSH and LH levels be drawn to assess whether the pt is transitioning through menopause?

Answer 9

Every 2-3 months

Question 10

When present, What can mimic a urinary tract infection (UTI) in MT & menopausal women, and may report symptoms of urinary frequency, urgency, and incontinence?
What lab is ordered as a precaution & why?

Answer 10

1) atrophic cystitis
2) a urine culture should be obtained in all symptomatic women because atrophic cystitis renders women more prone to UTI during this time.

Question 11

1) Osteopenia is defined as a BMD that is:

2) Osteoporosis is defined as a bone mineral density (BMD) equal to or greater than:

Answer 11

1) BMD of 2.5 standard deviations (SDs) below the peak bone mass, or T score (equal to or > -2.5)
2) BMD of 1.0-2.49 SDs below the T score (equal to or -1.0 to -2.49)

Question 12

What SERM (selective estrogen receptor modulator) is prescribed for reducing the risk of invasive breast cancer in postmenopausal women with osteoporosis or in postmenopausal women at high risk for invasive breast cancer?

Answer 12

Raloxifene (evista)

Question 13

Calcitonin is another medication that can be prescribed for the tx of osteoporosis. How does calcitonin work?

Answer 13

Calcitonin acts directly on osteoclasts, which results in a decrease of bone resorption and attenuation of subchondral bone turnover;
and acts directly on chondrocytes, attenuating cartilage degradation and stimulating cartilage formation

Question 14

What other diseases can calcitonin be Rx’d for besides osteoporosis?

Answer 14

Hypercalcemia
OA
Pagets disease
Phantom limb pain
Studies suggest May help w/spinal stenosis

Question 15

2 medications used to treat over active bladder (OAB).

What must be ruled out first prior to treatment?

Answer 15

1) Oxybutynin immediate release, at 5-10 mg (found to have significant impairment of cognition in older adults 65-76 years old)
2) darifenacin 7.5 to 20 mg (no effect on cognitive function in older adults)
* Rule out UTI prior to tx w/urine culture. If neg, then 24 hour diary of urine x1wk. If NPi (nocturnal polyuria index) elevated, then antimuscarinic therapy such as Oxybutynin can be Rx’d.
* behavioral interventions such as decreased fluid intake especially prior to HS, bathroom Q2hr during daytime. May also Rx LASIX 6hr prior to bed to rid excess fluid if suspected venous insufficiency (leg edema).