Week 7: Female Disorders Flashcards
Menopause
Menstrual periods stop permanently
Perimenopause
-Time before menopause
What happens during perimenopause?
- More frequent periods at first then occasional missed periods.
- Periods that are longer or shorter
- Changes in the amount of menstrual flow.
When do most women experience menopause?
Around age 50; usual age range of 45-55.
What happens during menopause?
- Ovaries stop making the hormones estrogen and progesterone.
- Ovaries stop releasing eggs (ova, oocytes)
- No periods for one year.
What happens to the reproductive system as hormone levels fall?
- Vaginal walls become thinner, dryer, less elastic, and possibly irritated.
- Risk of vaginal yeast infections increases.
- External genital tissue decreases and thins.
- Breasts lose fat, tissue, and mammary glands.
What are other common changes of the female reproductive system as women age?
- Menopause symptoms
- Problems with short-term memory
- Decrease in breast tissue
- Increased risk of bone loss (osteoporosis)
- Urinary system changes such as frequency and urgency of urination, increased risk of UTI and incontinence
- Loss of tone in the pubic muscles, resulting in the vagina, uterus or urinary bladder falling out of position
Menopause symptoms include
- Hot flashes
- Moodiness
- Headaches
- Trouble sleeping
- Night sweats
- Breast pain
- Insomnia
- Vasomotor
- Vaginal Atrophy
Characteristics of Perimenopause
- May take 3-5 years before menses actually ends
- Menses become irregular
- Still at risk for pregnancy!
Characteristics of Menopause
- End of reproduction
- Average age of 51
- Absence of menstruation for 1 year
- Increase in FSH/LH
What causes menopause?
Decreased estrogen
Psychological Symptoms of Menopause include
- Mood changes
- Depression
- Irritability
Vaginal Atrophy
- Regression of the reproductive organs
- Dyspareunia
- Atrophic vaginitis
Treatment for Menopause: Pharmacological
-Hormone Replacement therapy
Medication options for Menopause
-Venlafaxine (Effexor XR) or Paroxetine (Paxil) for vasomotor.
New: Ospemifene (Osphena) oral medication indicated for treatment of dyspareunia.
Alternative- OTC Black Cohosh or Estroven not so effective.
How is menopause related to cardiovascular disease?
Absence of estrogen = adverse changes in serum lipids.
- LDL which carries cholesterol to blood vessels increase.
- HDL which carries cholesterol to the liver and protects against CAD decrease.
Why are women more likely than men to die from CAD?
…
Signs and Symptoms of CAD in women
- Fatigue, weakness, unexplained anxiety
- Angina pectoris, or pain with rest
- Dyspnea
- Dizziness
-Upper abdominal pain - Nausea, vomiting, sweating
- Pain in the upper body other than chest
Osteoporosis
- Increased risk during menopause
- Major health concern
What bone sites are most commonly fractured?
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Risk Factors for Osteoporosis in Women include
- Hx of fractures
- Family hx
- Ethnicity- Caucasian & Asian
- Physical status
- Dietary- ↓ Calcium & Vitamin D
- Meds- corticosteroids; Levothyroxine (Synthroid)
- Lifestyle- smoker, ETOH
- Sedentary lifestyle
Osteopenia
Measurable bone loss
T-score= -1 to -2.5
Osteoporosis T-score
> -2.5
Symptoms of Osteoporosis
- Fracture
- Height
- Kyphosis
- Can felt teeth and jaw
Prevention of Osteoporosis: Screening
DEXA Scan “Gold standard” for screening
Osteoporosis Lifestyle Recommendations: Dietary
-Dairy Sources
Osteoporosis Lifestyle Recommendations: Supplements
- Calcium 1,200-1,500 mg/day
- Calcium carbonate with food; Calcium citrate if H2O blocker use
- Vitamin D 1,000 I.U./day
Osteoporosis: Other Lifestyle Recommendations
- Weight-bearing exercise 3-5 times weekly
- Sunlight exposure although limited due to skin cancer risk
- Avoid smoking, ETOH, excess caffeine including soda
Medications for Osteoporosis include
- Estrogen(short term) due to risks
- Bisphosphonates: (Actonel, Boniva, Fosamax)
- SERMs: (Raloxifene/Evista)- protects from breast CA
- Calcitonin- nasal spray
- Forteo - injection
- Zometa - IV
Breast Cancer: Risk Factors
- Early menarche (<12 years); late menopause (> 55 years)
- Nulliparity after 30 years of age
- Personal or family history (First Degree)
- Genetic
- Long-term HRT (> 5 years)
- Previous irradiation of the chest
- Previous abnormal breast biopsy
- Obesity
- ETOH; smokers
Breast Cancer Pathophysiology
- Approx. 65-80% are infiltrating ductal carcinomas; becomes invasive when no longer confined within the mammary duct.
- 10-14% invasive breast cancer assoc. with mil-secreting ducts of breast tissue.
- 1-2% inflammatory breast carcinoma has cutaneous findings with invasive involvement in the dermis.
- 40-50% have axillary lymph node involvement at the time of diagnosis.
Breast Cancer Screening
Teach BSE
Annual clinical breast exam
Mammogram- screening with palpable mass (3-D imaging more sensitive)
ACOG recommendation annual by age 40
Risk Factors for Breast Cancer
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Surgical Management of Breast Cancer
- Lumpectomy-conservative
- Removal of axillary nodes to stage cancer
- Modified radical mastectomy-preserves pectoralis
- Radiation therapy
- Chemotherapy
- Hormone and immunotherapy are adjuvant Rx
- Breast reconstruction option
Psychosocial Concerns for Breast Cancer
- Fear of death
- Quality of life
- Sexuality
- Body image changes
