wk 11 key Flashcards
menopause
early menopause
premature menopause/ primary ovarian insufficiency
meno: >45 yoa
early: <45 yoa
POI: < 40 yoa
FSH, AMH and AFC in menopause
increase FSH
decrease AMH and AFC (antral follicle count)
dx menopause
symptom presentation and physical exams
STRAW + 10 classification
dx can be made clinically dont need to measure hormones
when to check CVD (framingham, BP, weight ) and osteoporosis (height) and break and cervical exams in menopause
CVD- 3-5yrs
osteoporosis- annual
Society of Obstetrics and Gynecology Canada (SOGC) indications for pelvic exam
any woman with gyno complaints
–>i..e prolapse, post menopause bleeding, discharge, dyspareunia, urinary incontinence….
AND any woman over 70
- postmenopausal bleeding to exclude malignancy
1st and 2nd line for genitourinary sx of menopause
1st: vaginal moisturizers and lube
2nd: vaginal estrogen
risks for osteoporosis
age >65
early menopause (before 45yoa)
BMD via what scan
and recommednations
DEXA
females >65yoa
younger postmenopausal women with 1+ risk factors
females with previous fracture after 50yoa
females with condition or taking meds associated with low bone mass (i.e. RA and prednisone)
fracture risk assessment tool FRAX
previous fracture, smoke, glucocorticoids, alcohol, RA, femoral neck BMD etc
SOGC guidelines for menopause and osteoporosis
do FRAX
vit D and calcium
consider bisphophonate drug holiday after 5 years
> 65 yoa screen for fracture risk
weight bearing exercise
hormonal therapy
etccccc.
oral estrogen impact on CVD health
raise high-density lipoprotein (HDL) cholesterol and triglycerides and lower low-density lipoprotein (LDL) cholesterol
but also cause hypercaogulabilty –> increase coronary events
studies: good to prevent but not once already have atherosclerosis
do framingham risk score
SOGC for menopuase and CVD
MHT after menopause are low risk for CVD
MHT >10 yrs after menopasue increase risk
MHT not indicated to prevent CVD
MHT may incerase risk of venous thromboembolism
SOGC for mood, sleep and cognition && menopause
CBT, antideprresetns
exercise, black cohosh, valerian for sleep
lifestyle mod for cognitive decline
CTFPHC breast cancer screening recommendations
-never do routine or self exam
- no routine mammography if 40-49yoa
-screen 2-3 yrs if ages 50-74
- no screening on low or average risk women using MRI
high risk for breast cancer
-gene mutation
-personal or family history of cancers
-prior chest wall radiation
SOGC for menopause and breast cancer
mixed evidence on breast cancer risk and MHT
systemic MHT contraindicated if personal history of breast cancer
management of VMS in breast cancer
patients include paced breathing, acupuncture, and cognitive behavioural
therapy
management of GSM in breast cancer survivors include vaginal moisturizers, lubricants for intercourse, pelvic floor
physiotherapy, and dilators or vibrators
can use local vaginal estrogen in breast cancer survivor
transdermal MHT
patients with malabsorption issues,
people who smoke, those with high triglycerides, migraines, low libido,
hypertension or who are shift workers, in addition to patients who have
additional risk factors for VTE
A 52-year-old woman presents to her naturopathic doctor with symptoms typical of menopause, including hot flashes and mood changes. She expresses concerns about the long-term implications of menopause and seeks comprehensive management advice.
Given this patient’s preference, interprofessional care is considered particularly important. Which of the following best represents the best approach to her care?
Question 2 Answer
a.
Collaborative management with a nurse educator and pharmacist to emphasize heart disease prevention, dietary modifications, regular exercise, smoking cessation, and cautious use of hormonal agents
b.
Comprehensive assessment by the primary care provider, including prescription of bisphosphonates for osteoporosis prevention, dietary counseling for calcium and vitamin D intake, and lifestyle advice for heart disease risk reduction
c.
Consultation with a gynecologist for evaluation and consideration of hormone replacement therapy, alongside guidance on lifestyle modifications and dietary advice
d.
Integrated care involving the nurse practitioner, dietician, mental health practitioner, and pharmacist to provide holistic education on lifestyle changes, dietary recommendations, mental health support, and informed medication use
d.
Integrated care involving the nurse practitioner, dietician, mental health practitioner, and pharmacist to provide holistic education on lifestyle changes, dietary recommendations, mental health support, and informed medication use
A 52-year-old woman presents to her naturopathic doctor with irregular menstrual cycles and hot flashes. She reports that her menstrual cycle length varies, with an occasional interval of amenorrhea exceeding 60 days. Her blood tests show elevated Follicle-Stimulating Hormone (FSH) levels.
Which stage of the menopausal transition is she most likely experiencing?
Question 3 Answer
a.
Early postmenopause
b.
Late menopausal transition
c.
Late reproductive
d.
Early menopausal transition
b.
Late menopausal transition
**early menopausal transition will have >7 day length variation of menstrual cycles while late is >60 days between cycles
A 46-year-old woman presents to clinic seeking advice about preparing for menopause. She has been a smoker for the past 30 years, averaging a pack of cigarettes per day. She is concerned about the impact her smoking habit may have on her menopause.
Which of the following statements best describes the relationship between cigarette smoking and menopause?
Question 4 Answer
a.
Cigarette smoking, including a past history of cigarette smoking, has no significant effect on the age of onset of menopause
b.
Smoking cessation in women who smoke does not alter the age of onset of menopause
c.
Cigarette smoking is associated with a delay in the onset of menopause, with longer smoking duration associated with greater delay
d.
Women who smoke tend to experience menopause 1 to 2 years earlier than nonsmoker
d.
Women who smoke tend to experience menopause 1 to 2 years earlier than nonsmoker
A 47-year-old woman presents to clinic with complaints of hot flashes, night sweats, and irregular menstrual periods for the past six months. Her last menstrual period was three months ago. She denies any significant medical history and is not currently on any medications. She is concerned about the changes in her menstrual cycle and the symptoms she is experiencing.
Which one of the following is the most appropriate next step in the management of this patient?
Question 5 Answer
a.
Order serum Follicle Stimulating Hormone (FSH) and estradiol levels to confirm menopause
b.
Perform endometrial sampling to rule out endometrial carcinoma
c.
Schedule a mammography immediately to screen for breast cancer
d.
Advise the patient that perimenopause can be diagnosed based on symptoms alone, and hormonal measurements are not required
d.
Advise the patient that perimenopause can be diagnosed based on symptoms alone, and hormonal measurements are not required
