MRT Flashcards
Menopausal sx
management
Conservative manage
stress reduction,
regular exercise,
optimal weight management,
appropriate diet and avoidance of smoking. Excessive alcohol and caffeine intake should also be addressed.
There is no firm evidence for herbal / alternative treatment sat this time
Non hormonal treatments
gabapentin / clonidine
SSRI / SNRI
Hormonal options tibolone
SERMS eg tamoxifen
Gold standard if no contraindications
Estrogen is the treatment for vasomotor symptoms
benefits Improves VMS Urogenital atrophy Bone protect CV protection Mood and psychosexual function
risks
VTE
Stroke
Breast cancer after 5 of use
contraception if SA
Support groups
Written information
Follow up
review 6 months - aim to have lowest dose for shortest duration that adequately treats symptoms
annual review
Absolute Risk increases after 5 years of use and decision to continue should be individualized
Mammograms 2 years 45-69
menopausal and prev Breast cancer
Cardiovascular risk assessment
BP lipid profile HbA1c smoking status
weight loss Avoid caffeine smoking cessation dress in layers Regular low impact layers
SSRIs
SNRIs
Clonidpine match
In consultation with med onc consider ovestin
Menopausal woman spiel
This is a perimenopausal woman
Analysis of
Review of RF for Osteoperosis +/- bone density
CV risk assessment
Cardiovascular risk assessment
considering age BP lipid profile HbA1c smoking status
BF risk personal risk
Review mammogram cx screening results
Consider her need for contraception and sexual health screen
MHT
contraindications
Contraindications to HRT (RANZCOG) Preexisting cardiovascular disease Prev VTE Breast cancer Abnormal undiagnosed bleeding
Use with caution Endometrial cancer Active SLE Active cardiovascular disease Abnormal LFTs
Osteoperosis risk factors
Genetic Female Caucasian Family History Low Body Weight Lifestyle Smoking Sedentary Lifestyle
Diet Inadequate dietary calcium Inadequate vit D Excess caffeine Excess alcohol
Estrogen deficiency Premature Menopause Surgical Oophorectomy Hysterectomy Hypothalamic amenorrhoea Turner’s syndrome Ovarian dysgenesis Hyperprolactinaemia
Medical Conditions Hyperthyroidism Hyperparathyroidism Cushing’s syndrome Diabetes Malabsorption
Drugs GnRH analogues ? Depot Provera Thyroxine Anticonvulsants Heparin Corticosteroids SSRI’s
Vulval pagets
Extramammary pagets disease is an intra epithelial adenocarcinoma that accounts for less than one percent of all vulvar malignancies
Generally affects those in 60-70s and usually Caucasian
Typically present with pruritis and eczematoid skin change on the vulva with well demarcation raised lesions on a red background often dotting with small pale islands
Invasive adenocarcinomas may occur in 4 - 17%
Synchronous neoplasms occur in 20-30% typically involving breast, colon, bladder, gallbladder, cervix, ovary, breast, uterus
Therefore need to exclude these - cervical smear, mammograph, colonoscopy, cystoscopy, abdomino pelvic imaging (USS or CT)
Book for surgical excision
Vulval pagets
Extramammary pagets disease is an intra epithelial adenocarcinoma that accounts for less than one percent of all vulvar malignancies
Generally affects those in 60-70s and usually Caucasian
Typically present with pruritis and eczematoid skin change on the vulva with well demarcation raised lesions on a red background often dotting with small pale islands
Invasive adenocarcinomas may occur in 4 - 17%
Synchronous neoplasms occur in 20-30% typically involving breast, colon, bladder, gallbladder, cervix, ovary, breast, uterus
Therefore need to exclude these - cervical smear, mammograph, colonoscopy, cystoscopy, abdomino pelvic imaging (USS or CT)
Book for surgical excision
Line of excision should be at least 5 cm wider than lesion itself as it tends to spread
high risk of recurrence
Recurrence needs surgical treatment
Also needs regular ongoing surveillance for synchronous tumours
What is this?
Genital examination reveals a pruritic rash - velvety red with dotted white islands
this is pagets
Who gets a DEXA?
Bone DEXA recommended for all women >65yrs AND younger postmenopausal women with one or more risk factors other than being white or menopausal;
Asian or Caucasian Age Previous hx fragility # Family hx fragility # Smoker Low BMI Family hx osteoporosis Amenorrhoea Calcium or vit D deficiency Use of bone losing meds Sedentary lifestyle Excessive use of alcohol Rheumatoid arthritis Early menopause
