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Nurp 501 > Week 6- Menopause > Flashcards

Week 6- Menopause Flashcards

1
Q

This is defined as the point in time which there has been a cessation of menstruation for at least 12 consecutive months.

A

Natural menopause

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2
Q

This occurs following either surgical excision of both ovaries (bilateral oophorectomy) or ovarian function ablation caused by medication, chemo, or radiation.

A

Induced menopause

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3
Q

Which type of menopause has more severe hot flashes?

A

Induced

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4
Q

What is premature menopause?

A

Menopause that occurs before the age of 40.

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5
Q

Normal age range of natural menopause?

A

40-58 with the average at 52

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6
Q

What are the factors that influence natural menopause?

A 
Lower socioeconomic status 
Lower body weight
Nulliparity 
Smoking 
Hx of not using oral contraceptives 
Cycle lengths of less than 21 days
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7
Q

During menopause the ovaries become resistant to what?

A

FSH

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8
Q

During menopause the ovaries become more resistant to FSH which causes them to produce less?

A

Estrogen and androgen

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9
Q

What happens to levels of FSH and LH during menopause?

A

Increase

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10
Q

What happens to testosterone levels during menopause?

A

Remain about the same as pre-menopausal levels

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11
Q

What happens to estradiol levels after menopause?

A

They are lower than in reproductive years

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12
Q

Higher weight/ higher amounts of adipose tissue after menopause =

A

Higher levels of estrogen

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13
Q

How do you diagnose menopause?

A

No clinical test to predict or confirm

12 months amenorrhea with other causes ruled out.

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14
Q

What does Asherman’a syndrome cause?

A

Scar tissue causing amenorrhea

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15
Q

Treatments for vagina dryness during menopause include:

A

Non-hormonal lubricants

Moisturizers

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16
Q

Mood management during menopause:

A

Non-hormonal prescription- SSRI/SNRIs

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17
Q

Treatment of sleep disorders during menopause include:

A

Gabapentin for sleep
Catapres/clonidine
Non-pharm options

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18
Q

If patient had hysterectomy, HT for menopause would include:

A

Estrogen

If patient has intact uterus need both estrogen and progesterone

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19
Q

Contraindications for estrogen/HT?

A
  1. Vagina bleeding (investigate)
  2. Hx of breast cancer or some form of estrogen dependent cancer
  3. DVT hx
  4. MI hx
  5. CVA hx
  6. Liver disease
  7. Pregnancy
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20
Q

How long is it possible to get pregnant after onset of menopausal amenorrhea?

A

12 months

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21
Q

Women’s health initiative study found:

A

Estrogen/progesterone therapy was found to be more harmful then beneficial overall

  • elevated risk of breast cancer
  • elevated risk of CV issues
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22
Q

This is characterized by low bone mass, deterioration of bone tissue, and disruption of bone architecture resulting in reduced bone strength that increases the risk for fracture.

A

Osteoporosis

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23
Q

What are the 3 types of osteoporosis?

A
  1. Primary- associated with aging (estrogen depletion)
  2. Secondary- response to medication or other disease processes
  3. Idiopathic- in young adults with no other identified cause
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24
Q

This identifies the number of standard deviations that the patient’s bone mineral density is greater than or less than for a young-adult, gender-matched norm.

A

T score

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25
Q

This is compared to the bone mineral density of an age, sex, and ethnicity-matched reference population (don’t usually go by this score unless they are young patients).

A

Z score

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26
Q

Who is screened for osteoporosis?

A

All women over 65

All women under 65 with risk equivalent to that of a 65-year-old

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27
Q

What is the cornerstone therapy of osteoporosis?

A

Prevention- exercise and diet

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28
Q

When do you start medication for osteoporosis?

A

For women with T score of -2.5 sd or less and those with vertebral or hip fractures.

Women with FRAX of 10-year probability of hip fractures greater than 3%, or 20% or greater risk of major osteoporotic fracture.

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29
Q

What is the FRAX tool?

A

A tool used to assess the patient’s 10 year probability of hip fracture and major osteoporotic fracture (it is an algorithm)

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30
Q

What is the first line medication for osteoporosis?

A

Biphosphonates- however patients don’t adhere to these

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31
Q

These are nodular masses that are associated with hormonal stimulation (fluctuate with menstrual cycle).

A

Fibrocystic changes of the breast

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32
Q

Are fibrocystic changes of the breast typically unilateral or bilateral?

A

Bilateral (bilateral generally means it is normal)

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33
Q

These are fluid filled cysts that are well-delineated, derived from obstructive breast lobules, and are influenced by hormones during menstrual cycle.

A

Breast cysts

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34
Q

How do you manage simple cysts?

A

Monitor

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35
Q

How do you manage complex cysts?

A

Biopsy and rule out malignant diagnoses

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36
Q

These are discrete, smooth, round or oval, nontender and mobile masses. They are usually found in adolescents, unilateral, and commonly resolve spontaneously.

A

Fibroadenoma

37
Q

How do you manage fibroadenomas?

A

Diagnose with ultrasound if needed.
Biopsy if needed.
Then excision if necessary (inconclusive biopsy; becomes enlarged/distorts the breast; age greater than 35; size greater than 2.5 cm)

38
Q

Unilateral or bilateral masses in breasts should be considered cancer and ruled out?

A

Unilateral can be indicative of pathology

39
Q

What makes a mass bad?

A

If it is red, hardened, or inflamed

40
Q

This is cyclic breast pain during the luteal phase.

A

Mastalgia

41
Q

How do you manage mastalgia?

A

Well-fitting/supportive bras
NSAIDS
Primrose oil and flaxseed
Adjusting (lowering) estrogen or hormone exposure in contraception

42
Q

This is milky, clear, or green nipple discharge.

A

Galactorrhea

43
Q

Galactorrhea is associated with pregnancy and can persist for months, however, it is also concerning for:

A

Pituitary adenoma
Renal failure/insufficiency
Thyroid disorder

44
Q

How do you manage galactorrhea?

A 
Check prolactin level
Thyroid hormone levels 
Creatinine level 
MRI of pituitary  
Possibly refer to endo
45
Q

How do you manage mastitis in non-lactating women?

A

Antibiotic therapy
Evaluate abscess with ultrasound
Biopsy- if fails to resolve

46
Q

What are modifiable risk factors for breast cancer?

A 
Exercise 
Smoke cessation 
Diet 
Limiting alcohol 
Weight management
47
Q

With this type of biopsy you cannot distinguish between invasive/non-invasive cancer.

A

Fine needle biopsy

48
Q

With this type of biopsy you can distinguish between invasive/non-invasive cancer.

A

Core needle biopsy

49
Q

According to NAMS, HT should be individualized taking what 3 things into account?

A
  1. Her quality of life priorities
  2. Woman’s health
  3. Personal risk factors
50
Q

If you start HT in a woman 50-59 or within 10 years of menopause to treat menopausal symptoms, will it increase risk of CAD?

A

No

51
Q

Estrogen/progesterone therapy should be limited to how long and why?

A

3-5 years

Risk of breast cancer

52
Q

What is recommended when only vaginal symptoms are present?

A

Low dose local estrogen therapy

53
Q

Can you use HT to prevent cognitive changes, Alzheimer’s,

Or CAD?

A

No

54
Q

Symptoms of menopause can mask other disorders such as:

A 
Thyroid disorders 
DM
Depression 
Pregnancy 
Tumors
55
Q

When are hot flashes most common and even do they start to subside?

A

First 2 years and can start to subside in 5 years

56
Q

What causes a hot flash?

A

Normal fluctuation of hormones caused by a decrease in estrogen and a surge of LH. Leads to peripheral vascular dilation.

57
Q

What other symptoms can a women have with hot flashes other than intense heat?

A

Anxiety
Palpitations
Flushing

58
Q

What women are more prone to having hot flashes?

A 
African Americans 
Surgically induced menopause-BSO
Younger onset menopause 
Higher BMI 
Smokers
59
Q

What are some physical findings you will see with women in menopause?

A 
Vaginal dryness
Thinning of the vagina 
Decreased or absent rugae folds
Micro abrasions 
Smaller cervix 
More exam discomfort
60
Q

During physical exam in a postmenopausal women, what would you do if you felt a large ovary?

A

Work up for adnexal mass

61
Q

What GU symptoms can occur if during menopause and after?

A

Urinary incontinence
Overactive bladder
Frequent uti
Changing of the vaginal pH making it uninhabitable for microbes

62
Q

What changes during menopause can make a women more at risk for STI and BV?

A

Thinning of the vagina-leads to microabrasians

Change in vaginal pH

63
Q

When is it contraindicated to give estrogen therapy for menopause?

A 
Undiagnosed vaginal bleeding 
Hx of breast cancer 
Suspected estrogen dependent cancer
Hx of DVT, PE, stroke, MI
Liver disease 
Pregnancy
64
Q

When you start HT when do you follow up?

A

6-8 weeks

65
Q

What are some symptoms of estrogen HT?

A

Nausea
HA
Can start period or spotting 3-6 months

66
Q

If they are on continuous combined therapy will patient bleed/spot?

A

No- eventually lining of uterus will thin

67
Q

You should educate patient that symptom relief will start how long after starting HT?

A

2-6 weeks

68
Q

What can you recommend for a woman to change about her diet to help with hot flashes?

A 
Avoid:
Hot drinks/meals
Spicy food 
Alcohol 
Caffeine 
Chocolate 
Sweets
69
Q

What is the one FDA approved med for hyposexual desire for women?

A

Flibanserin or ADDY- expensive

70
Q

If your patient is high-risk for breast cancer at what age should they begin MRI and mammogram?

A

30 -annually

71
Q

What are symptoms or changes of breast cancer with breast pain?

A

More likely unilateral
Peau D’orange
Blood nipple discharge

72
Q

What skin changes are seen with breast cancer?

A

Dimpling
Retractions
Peau D’orange

73
Q

You have a patient with a unilateral, nontender breast mass, what might you suspect?

A

Fibroadenoma

74
Q

How would a fibroadenoma feel?

A

Hard, mobile, firm, rubbery, nontender, well circumcised

75
Q

What ages does fibroadenoma usually occur?

A

Peak at 20-30

76
Q

Do fibroadenomas resolve spontaneously?

A

About 40% do

77
Q

If you suspected fibroadenoma in a 21-year-old what would you order?

A

Ultrasound

78
Q

When do we remove a fibroadenoma?

A

Greater than 4cm
Growing rapidly
Bothering patient

79
Q

How would a breast cyst feel?

A 
Tender
Unilateral 
Soft 
Mobile
Mushy
80
Q

Can an ultrasound diagnose cyst?

A

Yes

81
Q

What are some treatment options for cysts?

A

Needle aspiration

82
Q

With a simple cyst is biopsy needed?

A

No

83
Q

What will an ultrasound tell you about a mass?

A

If it is solid or has fluid

84
Q

T or F: fibroadenomas can increase in size during pregnancy or estrogen therapy and regress after menopause?

A

True

85
Q

When should women begin to get a mammogram yearly?

A

45

45-54

86
Q

How long should breast cancer screening continue?

A

As long as a women is in good health and is expected to live 10 years or more.

87
Q

Women should have the choice to start annual breast cancer screening at these ages:

A

40-44

88
Q

What is the most important risk factor for breast cancer?

A

Age

Nurp 501 (8 decks)

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