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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
average cycle lasts
28-35 days
26
can expect pretty stable cycles at what ages
20-40
27
cyclical variability occurs...
during teen years, and last 10 years before menopause
28
range and average age of menarche
8-16, average is 12 years old
29
Menarche should occur by age __ otherwise workup
16, 17 MUST. by 15, if no secondary sexual characteristics
30
pain during ovulation
mittelshmerz
31
proliferative vs. secretory endometrium
proliferative- estrogen stimulates endometrical growth in follicular phase. secretory- progesterone causes changes in the endometrial cells in luteal phase
32
HPO axis compartments
4 of them- most distal is 1, most cephalic is 4
33
reasons for anovulation, when no oocyte is released from follicle in ovary
adolescense- cycle not totally developed yet (hormones), perimenopause- no more eggs, decreased hormones, and extreme obesity- increased estrogen
34
what are the 2 most frequent gynecologic disorders of reproductive age women
amenorrhea and non cyclic bleeding
35
dysfunctional uterine bleeding can include
amenorrhea, dysmenorrhea, metorrhagia, menorrhagia, menometorrhagia, hypomenorrhea, oligomenorrhea, polymenorrhea
36
Primary amenorrhea
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
secondary amenorrhea
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
List the 4 compartments of primary amenorrhea
1- outflow problems, II- ovarian problems, III- pituitary dysfunciton, III- hypothalamic dysfunction
39
outflow problems in primary amenorrhea
imperforate hymen, mullerian agenesis (no vagina, cervix, or uterus)
40
ovarian dysfunction in primary amenorrhea causes
gonadal dysgenesis, turner syndrome
41
tx of turner syndrome
estrogen- low dose initially, then increased after menarche.progestrins not given until tanner stage IV
42
HPO axis abnormalities causing primary amenorrhea
hypogonadotropic hypogonadism
43
no breast development and elevated FSH, primary amenorrhea
gonadal agenesis - ovarian dysfunction
44
primary amenorrhea, uterus absent but FSH normal
mullerian agenesis
45
secondary amenorrhea compartments
I- endometrial atrophy, II- premature ovarian failure, III- pit dysfunciton, IV- hypothalamic dysfunction
46
secondary amenorrhea cause of endometrial atrophy
asherman's syndrome (scarring of uterine lining), radiation tx
47
FSH high, with breast development in woman that previously had periods but stopped at age 38
premature ovarian failure- comp II secondary amenorrhea
48
asherman's syndrome
scarring of uterine lining - causes endometrial atrophy. comp I, secondary amenorrhea
49
causes of pit dysfunciton in secondary amenorrhea
sheehan's syndrome
50
hypothalamic dysfunction in secondary amenorrhea
eating disorders, weight loss
51
secondary amenorrhea workup
TSH, hCG serum, progesterone challenge
52
if progesterone challenge normal-
bleeding occurs and outflow tract is normal, endometrium is normal, patient is not ovulating
53
tx of amenorrhea
BCP's, cyclic progesterone, ovulation inducers, surgery
54
primary vs secondary dysmenorrhea
primary- begins soon after menarche, no pathologic findings. secondary- new onset in older women, usually has organic cause
55
This type of dysmenorrhea is associated with ovulatory cycles and prostaglanding mediated.
primary
56
tx for primary and secondary dysmenorrhea
NSAIDS treat pain, BCP's suppress ovulation
57
dx of secondary dysmenorrhea
laparoscopy with laser ablation
58
surgical tx for secondary dysmenorrhea
laser ablation, excision, electrocautery, TAH/BSO
59
menorrhagia vs. metorrhagia
menorrhagia- no intermenstrual bleeding, heavy and prolonged flow of periods. metorrhagia- normal flow, but spotting between periods
60
cause of menorrhagia, consider:
hyperplasia-unopposed estrogen, fibroids
61
causes for metorrhagia, consider:
noncompliance with BCP's, pregnancy, endometrial polyps, endometrial and cervical cancers
62
oligomenorrhea cycle lenth
more than 35 days but less than 6 months
63
polymenorrhea cycle length
less than 21 days between periods
64
always work up these reasons for cancer:
post coital bleeding and post menopausal bleeding
65
post-coital bleeding causes:
cervicitis, cervical cancer
66
number 1 symptom of cervical cancer
post coital bleeding
67
4 characteristics of PCOS
anovulation (amenorrhea, oligomenorrhea), infertility, insulin resistance, androgen hormones, polycystic ovaries on ultrasound

OB/GYN (10 decks)

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