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OB/GYN > Perimenopause and Menopause > Flashcards

Perimenopause and Menopause Flashcards

1
Q

sx of decreased estrogen include

A

hot flashes (flushing), depression, sweating (night sweats), insomnia (sleep disturbances), mood swings, atrophic vaginitis, fatigue, HA

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2
Q

Tx for perimenopause

A

OCP’s, uterine ablation, symptomatic tx

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3
Q

How does menarche affect perimenopausal period

A

the earlier the onset of menarche, the shorter the duration of perimenopausal period

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4
Q

Patient at 38 presents with increased sweating, flushing for the past few months and reports no period x 5 months. you do pregnancy test, but it is negative. next course of action…

A

sx consistent with perimenopause- hot flashes, night sweats. patient is very young- suspect premature ovarian failure. Confirm with FSH (will be increased- 40 instead of 10-15).

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5
Q

effect of smoking on menopause

A

get menopause 3-5 years earlier than expected

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6
Q

patient is concerned about what caused her premature ovarian failure. what do you say?

A

could be chemo, radiation- ask about hx any exposure to these things? cancer? autoimmune diseases, genetic factors- turnerns syndrome, savage syndrome, hysterectomy, infection, smoking

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7
Q

what is savage syndrome?

A

gonadotropin resistant ovary syndrome- ovaries are resistent to FSH and LH but have normal numbers of follicles

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8
Q

menopause…

A

1 year without periods

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9
Q

two types of menopause

A

physiological and artificial

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10
Q

average age of menopause

A

50-52, but mean is increasing

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11
Q

how does body habitus affect onset of menopause and severity of sx?

A

obese females get menopause later, less sx. thinner females have earlier onset, worse sx

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12
Q

obese females have increased risk of..

A

endometriosis

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13
Q

major estrogen made after menopause found in women’s blood

A

estrone

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14
Q

estrone is directly related to…

A

weight

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15
Q

triggers for hot flashes

A

hot spicy foods, alcohol, caffeine, certain meds, hot drinks, stress

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16
Q

tx of sx in menopause

A

vasomotor tx- HRT, black cohash 40 mg/d, progestins, sleep disturbances- HRT, sleeping aids, atrophic vaginitis- oral HRT, estrogen creams, kegals, vaginal weights, stay sexually active everyday, osteoporosis- estrogen tx, calcium, vitamin D, CV/lipid changes- if strong family hx of CV events, HRT not a good option

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17
Q

risk of ERT alone

A

inc risk of endometrial cancer and hyperplasia

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18
Q

risk of HRT

A

increases risk of breast cancer (esp only progestin therapy)

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19
Q

risk of HRT a/w

A

bloating, breast tenderness, inc risk of CHD and VTE, and cholelithiasis

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20
Q

HRT in pregnant woman?

A

NO!!!

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21
Q

adenarche

A

activation of adrenal cortex at ages 8-10. adrenal glands increase the production of androgens which prepares the body for the process of secondary sexual maturation

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22
Q

time period of secondary sexual maturation

A

4 years

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23
Q

what processes involved in secondary sexual maturation/

A

growth accelarion, thelarche (breast dev), pubarche (pubic hair dev), menarche (onset of menstruation), and ovulation

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24
Q

days of follicular vs. luteal phase

A

follicular days 1-14, luteal days 14-28

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25
Q

average cycle lasts

A

28-35 days

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26
Q

can expect pretty stable cycles at what ages

A

20-40

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27
Q

cyclical variability occurs…

A

during teen years, and last 10 years before menopause

28
Q

range and average age of menarche

A

8-16, average is 12 years old

29
Q

Menarche should occur by age __ otherwise workup

A

16, 17 MUST. by 15, if no secondary sexual characteristics

30
Q

pain during ovulation

A

mittelshmerz

31
Q

proliferative vs. secretory endometrium

A

proliferative- estrogen stimulates endometrical growth in follicular phase. secretory- progesterone causes changes in the endometrial cells in luteal phase

32
Q

HPO axis compartments

A

4 of them- most distal is 1, most cephalic is 4

33
Q

reasons for anovulation, when no oocyte is released from follicle in ovary

A

adolescense- cycle not totally developed yet (hormones), perimenopause- no more eggs, decreased hormones, and extreme obesity- increased estrogen

34
Q

what are the 2 most frequent gynecologic disorders of reproductive age women

A

amenorrhea and non cyclic bleeding

35
Q

dysfunctional uterine bleeding can include

A

amenorrhea, dysmenorrhea, metorrhagia, menorrhagia, menometorrhagia, hypomenorrhea, oligomenorrhea, polymenorrhea

36
Q

Primary amenorrhea

A

lack of menstruation by age 16 in the presence of normal growth and secondary sexual characteristics, lack of pubarche by age 13, lack of menstruation within 2 years of puberty onset (breast bud development, tanner stage 2)

37
Q

secondary amenorrhea

A

lack of menstruation for more than 6 months in a woman witih previously normal menstruation or absence of menstruation for 12 months in woman with previous hx of oligomenorrhea

38
Q

List the 4 compartments of primary amenorrhea

A

1- outflow problems, II- ovarian problems, III- pituitary dysfunciton, III- hypothalamic dysfunction

39
Q

outflow problems in primary amenorrhea

A

imperforate hymen, mullerian agenesis (no vagina, cervix, or uterus)

40
Q

ovarian dysfunction in primary amenorrhea causes

A

gonadal dysgenesis, turner syndrome

41
Q

tx of turner syndrome

A

estrogen- low dose initially, then increased after menarche.progestrins not given until tanner stage IV

42
Q

HPO axis abnormalities causing primary amenorrhea

A

hypogonadotropic hypogonadism

43
Q

no breast development and elevated FSH, primary amenorrhea

A

gonadal agenesis - ovarian dysfunction

44
Q

primary amenorrhea, uterus absent but FSH normal

A

mullerian agenesis

45
Q

secondary amenorrhea compartments

A

I- endometrial atrophy, II- premature ovarian failure, III- pit dysfunciton, IV- hypothalamic dysfunction

46
Q

secondary amenorrhea cause of endometrial atrophy

A

asherman’s syndrome (scarring of uterine lining), radiation tx

47
Q

FSH high, with breast development in woman that previously had periods but stopped at age 38

A

premature ovarian failure- comp II secondary amenorrhea

48
Q

asherman’s syndrome

A

scarring of uterine lining - causes endometrial atrophy. comp I, secondary amenorrhea

49
Q

causes of pit dysfunciton in secondary amenorrhea

A

sheehan’s syndrome

50
Q

hypothalamic dysfunction in secondary amenorrhea

A

eating disorders, weight loss

51
Q

secondary amenorrhea workup

A

TSH, hCG serum, progesterone challenge

52
Q

if progesterone challenge normal-

A

bleeding occurs and outflow tract is normal, endometrium is normal, patient is not ovulating

53
Q

tx of amenorrhea

A

BCP’s, cyclic progesterone, ovulation inducers, surgery

54
Q

primary vs secondary dysmenorrhea

A

primary- begins soon after menarche, no pathologic findings. secondary- new onset in older women, usually has organic cause

55
Q

This type of dysmenorrhea is associated with ovulatory cycles and prostaglanding mediated.

A

primary

56
Q

tx for primary and secondary dysmenorrhea

A

NSAIDS treat pain, BCP’s suppress ovulation

57
Q

dx of secondary dysmenorrhea

A

laparoscopy with laser ablation

58
Q

surgical tx for secondary dysmenorrhea

A

laser ablation, excision, electrocautery, TAH/BSO

59
Q

menorrhagia vs. metorrhagia

A

menorrhagia- no intermenstrual bleeding, heavy and prolonged flow of periods. metorrhagia- normal flow, but spotting between periods

60
Q

cause of menorrhagia, consider:

A

hyperplasia-unopposed estrogen, fibroids

61
Q

causes for metorrhagia, consider:

A

noncompliance with BCP’s, pregnancy, endometrial polyps, endometrial and cervical cancers

62
Q

oligomenorrhea cycle lenth

A

more than 35 days but less than 6 months

63
Q

polymenorrhea cycle length

A

less than 21 days between periods

64
Q

always work up these reasons for cancer:

A

post coital bleeding and post menopausal bleeding

65
Q

post-coital bleeding causes:

A

cervicitis, cervical cancer

66
Q

number 1 symptom of cervical cancer

A

post coital bleeding

67
Q

4 characteristics of PCOS

A

anovulation (amenorrhea, oligomenorrhea), infertility, insulin resistance, androgen hormones, polycystic ovaries on ultrasound

OB/GYN (10 decks)

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