Week 2: Menopause Flashcards
What is the differential for AUB?
Pregnancy
Structural
- Polyp (overgrowth of endometrium, or cervical polyp)
- Adenomyosis (erosions of endometrium into the myometrium
- Leiomyoma (overgrowth of myometrium)
- Malignancy
Non-structual
- coagulopathy
- endometrial (?)
- Iatrogenic (?)
- ovulatory DFx (DUB)
DUB= irregular bleeding in anovulatory women
What is the difference in pathophysiology between hypothalamic hypogonadism, PCOS, adolescents and perimenopausal?
All causes of DUB.
- PCOS: increased GnRH pulsatility
- Hypothalamic: decreased GnRH pulsatility
- Adolescents: axis immaturity
- Perimenopausal: axis is getting old…
Are uterine polyps and adenomyosis responsive to monthly hormones?
No.
Define oligomenorrhea, polymenorrhea, menorrhagia, metrorrahgia and dysmenorrhea
oligomenorrhea: >35 day cycles
polymenorrhea: <25 day cycles
menorrhagia: heavy flow
metrorrahgia: heavy flow and irregular interval or duration
dysmenorrhea: painful periods
What is the WHO classification for amenorrhea?
- HP Failure (low FSH, LH, EE): e.g. prepuberty, stress, exercise, underweight
- HP DFx (): e.g. PCOS
- Ovarian Failure (high LH/FSH, low EE): menopause, premature ovarian failure
What are the main issues in ovarian failure?(x6)
- Menstrual changes
- Vasomotor symptoms
- Urogenital concerns
- introitus
- vagina (loss of rugae)
- bladder (increase in pH…thinned mucosa= urge)
- urethra (decreased mean closing pressure)
- pelvic floor muscles
- Mood changes
- EE decreases risk of depression because it increases 5HT-1 and decreased MAO activity
- CVD
- Bone health (EE blocks the RANK/RANKL interaction which activates osteoclasts…therefore favors osteoblast activity
What changes are seen in the placenta during maturation? When does the placenta stop growing?
- More branching villi
- Thinner syncytiotrophoblasts
- cytotrophoblasts disappear
- increased uterine blood flow
Stops growing at 37 wks
What are the contraindications for HRT
Hx of breast cancer, endometrial cancer or undiagnosed vaginal bleeding
Severe liver disease
Thromboembolic dz
high trigs (oral E increases trigs during 1st pass metabolism)
Which age group has the highest # of abortions?
20-24, then 25-29, 15-19, 30-34
What percent of women with have had an abortion by 45 y.o
31%
How many global unintended pregnancies are there each year?
100 million intended
80 million unintended–> 35 million are born, 45 million abort, 47 000 women die of unsafe abortion
What amount of blood is lost each month at menses?
25-75 mL
Define amenorrhea
Pimary
- No menses by 14 y.o if no other secondary sex characteristics have developed
- No menses by 16 y.o
Secondary
- Absence of menses in a previously menstruating women for >6 months OR 3 cycle lengths
- Absence of menses for >12 months in a previously oligomenorrheic woman
Menopause results from….
the depletion of primordial follicles from the ovaries/their unresponsiveness to FSH
hypoestrogenism symptoms
hot flashes
superficial dyspareunia
insomnia
lack of energy
depression
atrophy of lower genital tract
Urge incontinence (lower mean urethral pressure)
stress incontinence (weaker pelvic floor muscles- these are estrogen sensitive)
UTIs (bladder epithelium makes less glycogen for the lactobacilli, therefore the pH is higher)
