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0 - OB2 > Untitled Deck > Flashcards

Untitled Deck Flashcards

1
Q

What is the clinical definition of menopause?

A

Permanent cessation of menses confirmed after 1 year of no menstrual bleeding due to ovarian follicular failure.

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2
Q

What is the average age of menopause in Western and Filipino populations?

A

Western: 51-52 years; Filipino: 47-48 years.

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3
Q

What key physiological change signals the onset of menopause?

A

Decreased AMH and ovarian inhibin-B, accompanied by increased FSH.

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4
Q

How does smoking affect the age of menopause onset?

A

It causes menopause 1-2 years earlier.

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5
Q

What impact does BMI have on the onset of menopause?

A

Higher BMI delays menopause onset.

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6
Q

What are common early symptoms of menopause (40-45 years)?

A

Hot flushes, sweating, insomnia, menstrual irregularity, and psychological symptoms.

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7
Q

What are the hallmark intermediate symptoms of menopause (50-60 years)?

A

Vaginal atrophy, dyspareunia, skin atrophy, and urge-stress incontinence.

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8
Q

Which late-stage conditions are associated with menopause (65+ years)?

A

Osteoporosis, atherosclerosis, cardiovascular disease, and Alzheimer’s disease.

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9
Q

What is the most symptomatic phase of menopause?

A

Perimenopause (the menopausal transition).

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10
Q

What is induced menopause, and what are its causes?

A

Menopause caused by medical interventions like bilateral oophorectomy, chemotherapy, or radiation.

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11
Q

What is the most common cause of premature ovarian insufficiency?

A

Autoimmune disorders.

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12
Q

What causes hot flushes in menopausal women?

A

Narrowing of the thermoregulatory zone due to decreased estrogen levels.

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13
Q

What is the role of estrogen in preventing Alzheimer’s disease?

A

Early estrogen exposure decreases free radical brain damage and promotes synaptic maintenance.

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14
Q

What is the ‘Timing Hypothesis’ in hormone therapy?

A

Early intervention with hormone therapy benefits cognition, but late intervention can be harmful.

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15
Q

How does menopause affect collagen levels?

A

Estrogen deficiency reduces collagen content, causing skin thinning and pelvic tissue weakening.

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16
Q

Which exercises can help stress incontinence in menopausal women?

A

Kegel exercises.

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17
Q

What is the new term for vulvovaginal atrophy?

A

Genitourinary Syndrome of Menopause (GSM).

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18
Q

What are the treatment options for GSM?

A

Regular sexual activity, lubricants, moisturizers, and local vaginal estrogen.

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19
Q

What defines osteoporosis based on T-scores?

A

Osteoporosis: T-score ≤ -2.5; Osteopenia: -1.0 to -2.5.

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20
Q

What is the standard diagnostic tool for osteoporosis?

A

Dual-Energy X-ray Absorptiometry (DEXA).

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21
Q

How does estrogen prevent osteoporosis?

A

Estrogen suppresses osteoclast activity by increasing apoptosis and maintaining bone formation balance.

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22
Q

Why does cardiovascular disease risk increase after menopause?

A

Declining estrogen leads to increased LDL, reduced HDL, and vascular changes.

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23
Q

Which lifestyle management steps can reduce cardiovascular risk?

A

Maintaining cholesterol <200 mg/dL, BP <120/80 mmHg, and BMI <25 kg/m², and regular physical activity.

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24
Q

What is the recommended frequency of mammograms for women aged 50-74?

A

Every 2 years.

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25
Q

Which cancers should menopausal women regularly screen for?

A

Breast, colorectal, endometrial, cervical, and ovarian cancers.

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26
Q

What lifestyle changes are recommended for menopausal women?

A

Smoking cessation, alcohol moderation, physical activity, and weight loss.

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27
Q

What common sense solutions can help vasomotor symptoms (VMS)?

A

Wearing comfortable clothing and staying hydrated.

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28
Q

When is unopposed estrogen therapy appropriate?

A

For women without a uterus.

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29
Q

What is the first-line pharmacologic treatment for menopausal symptoms?

A

Hormone Therapy (HT).

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30
Q

Why is progesterone added to estrogen therapy in women with a uterus?

A

To prevent endometrial hyperplasia and cancer.

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31
Q

What are contraindications to hormone therapy?

A

History of thromboembolic events, unexplained vaginal bleeding, and active liver disease.

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32
Q

Which medications are used for osteoporosis treatment?

A

Bisphosphonates, calcitonin, SERMs (e.g., raloxifene), and parathyroid hormone (e.g., teriparatide).

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33
Q

What adjunctive measures are recommended for osteoporosis prevention?

A

Calcium 1500 mg daily, vitamin D 400-800 IU, and weight-bearing exercises.

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34
Q

Which antidepressants are used off-label for vasomotor symptoms?

A

SSRIs (e.g., fluoxetine, paroxetine) and SNRIs (e.g., venlafaxine).

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35
Q

Which anticonvulsant is used for hot flushes?

A

Gabapentin.

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36
Q

What are examples of complementary therapies for menopause?

A

Soy isoflavones, black cohosh, and Traditional Chinese Medicine.

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37
Q

What OTC hormone is commonly used for menopause symptoms?

A

Topical progesterone.

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38
Q

What is a key diagnostic difference between menopause and other forms of menstrual cessation?

A

Menopause involves absent or non-functional ovaries; hysterectomy with functional ovaries is not menopause.

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39
Q

What genetic causes might lead to premature ovarian failure?

A

Genetic mutations, enzymatic defects, or gonadotropin receptor abnormalities.

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40
Q

How does parity affect menopause onset?

A

Higher parity is associated with later onset of menopause.

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41
Q

What psychological symptoms may occur in early menopause?

A

Mood swings, irritability, anxiety, and mild depression.

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42
Q

What causes dyspareunia in menopausal women?

A

Vaginal atrophy due to estrogen deficiency.

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43
Q

Which intermediate symptom involves thinning and drying of the skin?

A

Skin atrophy.

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44
Q

What cardiovascular condition is more likely in late menopause stages?

A

Coronary heart disease (CHD).

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45
Q

What is the primary treatment for irregular bleeding in perimenopause?

A

Short-term use of oral contraceptives with 20 mcg ethinyl estradiol.

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46
Q

What is the likelihood of spontaneous pregnancy in premature ovarian insufficiency?

A

Around 5%.

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47
Q

Which autoimmune condition is commonly screened for in premature ovarian failure?

A

Hashimoto’s thyroiditis.

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48
Q

What neurotransmitter functions does estrogen enhance in the brain?

A

Cholinergic and serotonergic functions.

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49
Q

Why is late initiation of hormone therapy potentially harmful for cognition?

A

It may worsen cognition and increase the risk of stroke.

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50
Q

What hormone replacement timing improves mood disorders in menopause?

A

Early initiation of estrogen therapy.

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51
Q

What role does estrogen play in urinary incontinence?

A

Estrogen reduces collagen atrophy and improves bladder control.

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52
Q

Which type of incontinence is commonly seen early in menopause?

A

Stress incontinence.

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53
Q

What is a non-hormonal strategy to manage incontinence?

A

Weight loss in overweight women.

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54
Q

What is the pH change in vaginal atrophy caused by estrogen deficiency?

A

Vaginal pH increases above 5.

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55
Q

What are petechiae in the context of vulvovaginal atrophy?

A

Small red spots on the vaginal mucosa due to thinning and fragility.

56
Q

Why do vasomotor symptoms differ from vaginal atrophy in their progression?

A

Vasomotor symptoms abate over time, while vaginal atrophy progresses.

57
Q

Which type of bone is more affected by estrogen deficiency?

A

Trabecular bone (e.g., spine).

58
Q

What bone turnover marker reflects resorption activity?

A

C-terminal telopeptide of type I collagen (CTX).

59
Q

What bone turnover marker reflects formation activity?

A

Serum procollagen type I N-terminal propeptide (P1NP).

60
Q

What is the role of osteocytes in bone remodeling during estrogen deficiency?

A

They signal increased osteoclast recruitment.

61
Q

What is the impact of menopause on HDL-C levels?

A

HDL-C levels trend downward slightly but inconsistently.

62
Q

What direct vascular effect of estrogen helps maintain cardiovascular health?

A

Increased prostacyclin production and vasodilation.

63
Q

What lifestyle factor significantly reduces cardiovascular risks in postmenopausal women?

A

Regular physical activity (≥150 minutes/week moderate or ≥75 minutes vigorous).

64
Q

What is the most common cancer-related death in postmenopausal women?

A

Coronary artery disease (CAD).

65
Q

Why is there no routine screening for ovarian cancer?

A

Lack of effective screening tests; evaluation is symptom-based.

66
Q

What test is recommended for postmenopausal bleeding?

A

Pelvic ultrasound and/or endometrial biopsy.

67
Q

Which dietary adjustments can reduce vasomotor symptoms?

A

Avoiding caffeine, alcohol, and spicy foods.

68
Q

What type of clothing is recommended for managing hot flushes?

A

Loose, breathable layers.

69
Q

What is the preferred hormone therapy for women with vaginal dryness only?

A

Low-dose local estrogen therapy (e.g., vaginal tablets or creams).

70
Q

What progestogen is commonly combined with estrogen in hormone therapy?

A

Medroxyprogesterone acetate (MPA).

71
Q

What systemic side effects can occur with hormone therapy?

A

Breast tenderness, nausea, and weight changes.

72
Q

What is the contraindication for hormone therapy in active liver disease?

A

Estrogen is metabolized in the liver, exacerbating the condition.

73
Q

What is the mechanism of bisphosphonates in osteoporosis treatment?

A

Inhibition of osteoclast activity, reducing bone resorption.

74
Q

What rare complication can long-term bisphosphonate use cause?

A

Osteonecrosis of the jaw.

75
Q

Which osteoporosis drug has anabolic effects on bone?

A

Teriparatide (parathyroid hormone analog).

76
Q

Why is calcium with vitamin D insufficient alone to prevent osteoporosis?

A

It does not prevent bone loss in younger postmenopausal women.

77
Q

Which antihypertensive is used off-label for hot flushes?

A

Clonidine.

78
Q

What is the mechanism of gabapentin for vasomotor symptoms?

A

Modulation of central thermoregulation.

79
Q

What are soy isoflavones, and how do they help menopause symptoms?

A

Plant-based phytoestrogens that mimic estrogen effects.

80
Q

Which herb is commonly used for hot flushes and mood swings?

A

Black cohosh.

81
Q

What role does melatonin play in menopause management?

A

Improves sleep quality.

82
Q

How does yoga benefit menopausal women?

A

Reduces stress and alleviates mood swings.

83
Q

What is a simple measure to prevent overheating at night for women with hot flushes?

A

Sleeping in a cool room.

84
Q

Why are cold drinks recommended during hot flushes?

A

They help lower core body temperature rapidly.

85
Q

What role does regular sexual activity play in GSM?

A

Helps maintain vaginal elasticity and blood flow.

86
Q

What dietary modification can help prevent osteoporosis?

A

Increased intake of calcium-rich foods like dairy and leafy greens.

87
Q

Why is mindfulness recommended during menopause?

A

It helps manage anxiety and emotional fluctuations effectively.

88
Q

What medical intervention can lead to induced menopause?

A

Bilateral oophorectomy, chemotherapy, or pelvic radiation therapy.

89
Q

Why is hysterectomy associated with earlier menopause?

A

Reduced blood supply to the ovaries accelerates follicular depletion.

90
Q

What does a decrease in anti-Müllerian hormone (AMH) signify in menopause?

A

It marks declining ovarian reserve and the onset of menopause.

91
Q

What happens to FSH levels as menopause approaches?

A

FSH levels increase due to reduced ovarian feedback.

92
Q

What causes insomnia in menopausal women?

A

Sleep disruption due to hot flushes and night sweats.

93
Q

Why do menopausal women experience a higher prevalence of urinary incontinence?

A

Collagen atrophy weakens pelvic floor support.

94
Q

Which cognitive changes are common in menopause?

A

Memory lapses and difficulties in verbal recall.

95
Q

What distinguishes premature ovarian insufficiency (POI) from natural menopause?

A

POI occurs before age 40 and often has an autoimmune or genetic basis.

96
Q

What fertility option is available for women with POI who wish to conceive?

A

Oocyte donation.

97
Q

What is the main goal of treatment during perimenopause?

A

Manage irregular bleeding and alleviate early vasomotor symptoms.

98
Q

What is the hallmark vasomotor symptom of menopause?

A

Hot flushes.

99
Q

How does estrogen deficiency affect thermoregulation?

A

It narrows the thermoregulatory zone, causing sweating and shivering.

100
Q

What are the primary complaints of women with hot flushes at night?

A

Sleep disruption and night sweats.

101
Q

What neurotransmitter-related benefit does estrogen provide?

A

Enhances cholinergic neurotransmission, potentially delaying Alzheimer’s disease.

102
Q

How does estrogen deficiency affect pelvic support structures?

A

Causes weakening of collagen, increasing the risk of pelvic organ prolapse.

103
Q

What are the urinary benefits of estrogen replacement therapy?

A

Reduces urgency, frequency, and recurrent UTIs.

104
Q

What skin changes are caused by reduced collagen levels after menopause?

A

Thinner, less elastic, and drier skin.

105
Q

Why do women with vaginal atrophy often experience dyspareunia?

A

Decreased vaginal moisture and thinning of mucosa lead to pain during intercourse.

106
Q

What vaginal pH value indicates estrogen deficiency?

A

A pH greater than 5.

107
Q

How does local estrogen therapy differ from systemic therapy?

A

Local estrogen targets vaginal symptoms without affecting systemic estrogen levels.

108
Q

Why is trabecular bone more vulnerable to osteoporosis than cortical bone?

A

Trabecular bone has a higher turnover rate, making it more sensitive to estrogen deficiency.

109
Q

What is the significance of the FRAX tool in osteoporosis management?

A

It calculates a 10-year risk of major osteoporotic and hip fractures.

110
Q

What is the role of estrogen in maintaining bone remodeling balance?

A

It suppresses osteoclast activity and promotes osteoblast survival.

111
Q

What happens to the bone formation phase during estrogen deficiency?

A

It shortens, leading to net bone loss.

112
Q

What lipid changes are characteristic of postmenopausal women?

A

Increased LDL cholesterol and decreased HDL cholesterol.

113
Q

How does estrogen deficiency affect vascular endothelial function?

A

Reduces nitric oxide production, impairing vasodilation.

114
Q

What cardiovascular risk is associated with premature ovarian failure?

A

A 2-3 times higher risk of myocardial infarction.

115
Q

What is the first-line screening tool for colorectal cancer in menopausal women?

A

Colonoscopy, performed every 10 years.

116
Q

How is cervical cancer screening modified for women aged ≥65?

A

No further screening if the last three PAP tests were normal.

117
Q

Why is ovarian cancer challenging to screen for in menopausal women?

A

There are no reliable screening tests for asymptomatic women.

118
Q

What is the primary benefit of hormone therapy for vasomotor symptoms?

A

Reduces the frequency and severity of hot flushes.

119
Q

What is the rationale for avoiding unopposed estrogen therapy in women with a uterus?

A

It increases the risk of endometrial hyperplasia and cancer.

120
Q

Which progestogens are commonly used in combination with estrogen?

A

Medroxyprogesterone acetate (MPA) and norethindrone acetate.

121
Q

What side effect of hormone therapy might mimic premenstrual symptoms?

A

Breast tenderness.

122
Q

What is the benefit of low-dose vaginal estrogen for GSM?

A

Alleviates local symptoms like dryness and dyspareunia without systemic effects.

123
Q

What is the safest hormone therapy preparation for women at high risk for thromboembolism?

A

Transdermal estrogen.

124
Q

What precaution should be taken in diabetic women on hormone therapy?

A

Monitor triglyceride levels, as hormone therapy can exacerbate hypertriglyceridemia.

125
Q

What is the mechanism of action of SERMs like raloxifene?

A

They mimic estrogen’s effects on bones while antagonizing estrogen in breast tissue.

126
Q

Why is tibolone unique among osteoporosis treatments?

A

It has mixed estrogenic, progestogenic, and androgenic properties.

127
Q

What is the role of calcitonin in osteoporosis?

A

Inhibits bone resorption and provides pain relief for vertebral fractures.

128
Q

What is the recommended duration of teriparatide therapy?

A

No longer than 18 months.

129
Q

Why should bisphosphonates be taken with water on an empty stomach?

A

To improve absorption and reduce the risk of esophageal irritation.

130
Q

Which SSRI is FDA-approved for vasomotor symptom management?

A

Paroxetine.

131
Q

What is the role of eszopiclone in menopause?

A

It is a hypnotic used to improve sleep quality.

132
Q

Which traditional medicine practices are commonly used for menopause symptoms?

A

Traditional Chinese Medicine and Ayurvedic medicine.

133
Q

What is valerian root commonly used for in menopause?

A

Managing insomnia and mild anxiety.

134
Q

How does St. John’s Wort help menopausal women?

A

It alleviates mild depression.

135
Q

What is the DASH diet, and why is it recommended for menopausal women?

A

The Dietary Approaches to Stop Hypertension diet promotes cardiovascular health.

136
Q

What specific physical activities are recommended for menopausal women?

A

Weight-bearing exercises like walking or dancing to maintain bone density.

137
Q

How can mindfulness meditation improve menopause symptoms?

A

Reduces stress and alleviates mood swings.

0 - OB2 (13 decks)

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