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Clin Med3: Womens Health > Menopause - anne > Flashcards

Menopause - anne Flashcards

1
Q

what is the definition of menopause

A

cessation of menses due to loss of ovarian activity, average age 51 in US

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2
Q

what is postmenopausal

A

12+ months after final menses

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3
Q

what is premature menopause

A

ovarian failure before age 40

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4
Q

what is considered early menopause

A

age 40-45

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5
Q

what is surgical menopause

A

cessation of menses due to BSO

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6
Q

what is perimenopause/transition

A

4-6 years of cycle changes and other symptoms before total cessation of menses

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7
Q

what are vasomotor perimenopause symptoms

A

hot flashes, night sweats, insomnia

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8
Q

What are psych preimenopasual symptoms

A

depression, irritability, mood swings

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9
Q

What are cognitive perimenopausal symptoms

A

concentration/memory issues

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10
Q

What are sexual perimenopausal symptoms

A

dryness/dyspareunia, decreased libido

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11
Q

what are other perimenopausal symptoms

A

other: urinary incontinence, dry itchy skin, weight gain

Menstrual changes: shorter or longer cycles, irregular bleeding

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12
Q

What can effect the onset of menopause

A

smoking and malnutrition can make it earlier

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13
Q

what re the hormone changes with menopause

A

decreased ovarian synthesis of estrogens and progesterone
GnRH released at maximal frequency and amplitude (increase FSH by 4-fold)

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14
Q

what is androstenedione converted to

A

peripherally converted in fat and muscle to estrone

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15
Q

what are the types of estrogen

A

E1 (estrone)
E2 (estradiol)
E3 (estriol)

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16
Q

what is Estrone

A

E1 - made after menopause

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17
Q

what is Estradiol

A

E2 - most common type of estrogen
most potent and abundant during reproductive years

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18
Q

what is Estriol

A

E3 - main type of estrogen in a pregnant persons bloodstream, prepares for childbirth
weakest and used for HRT, lower risk of serious side effects

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19
Q

What are early symptoms of estrogen loss

A

hot flashes
insomnia
irritability

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20
Q

what are the physical changes with estrogen loss

A

vaginal atrophy
skin atrophy

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21
Q

what are the disease with estrogen loss

A

osteoporosis
coronary heart diesease

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22
Q

what is luteal insufficiency

A

occurs after age 40, ovarian follicles become less responsive to FSH
-less inhibin and estradiol
-FSH levels increase further
-results in heavier menses

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23
Q

what is the shorted cycle stage of menstraul changes

A

luteal phase remains the same, follicular phase is shorter - overall cycle is shorted
higher FSH levels cause follicles to mautre faster and produce enough estradiol to trigger an LH surge

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24
Q

what is anovulation

A

accelerated declined in responsive follicles
anovulation more common and cycle length and variability increase
bleeding occurs because of fluctuations of estrogen levels
bleeding episodes spread out and then stop

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25
Q

why does skin temperature rise with menopause

A

peripheral vasodilation followed by a drop in core temperature

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26
Q

what is the most common reason that women seek medical care during menopause

A

vasomotor symptoms, skin temperature, chills, anxiety, heart palpitations

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27
Q

what widens thermo-regulatory zone which decreases symptoms

A

exogenous estrogen

28
Q

what can increase someones vasomotor symptoms with menopause

A

induced menopause
AA
obesity
smoking
depression
triggers: alcohol, coffee, exercise, emotional upset

29
Q

what can decrease someones vasomotor symptoms with menopause

A

exercise
asian
avoidance of triggers
acupunctures?
pharmacotherapy

30
Q

what is atrophic vulvovaginitis

A

gradual thinning of genital mucosa
loss of vaginal rugae (folds)
decrease pliancy of tissue, less flexible
decreased transudate (drier)
pH becomes alkaline
changes in microbiome
increase ascension of pathogens to bladder

31
Q

what are the results of atrophic vulvovaginitis

A

genitouritary syndrome of menopause
UTI, Yeast infections, dryness

32
Q

what is dyspareunia

A

pain with sexual activity (less comfortable with stretching and friction)

33
Q

what is the treatment of dyspareunia

A

personal lubricants and moisturizers, vaginal estradiol

34
Q

what are recurrent UTI associated with genitourinary syndrome

A

> 2 culture confirmed UTI’s in 6 months or > 3 in 12 months

check for vaginal or urethral prolapse, check bladder emptying, consider possible stone as nidus for infection

35
Q

what are modifiable risk factors for osteoporosis

A

ETOH use, smoking, low body weight, sedentary lifestyle
low Ca, Vit D and prolonged systemic corticosteroid use

36
Q

what are non-modifiable risk factors for osteoporosis

A

advanced age
caucasian or asian race
AFAB

37
Q

what are the cardiovascular health effects of estrogen

A

decreases vascular resistance and increases blood flow
decreases production of endothelin
increased HDL cholesterol, decreased LDL cholesterol

38
Q

what does the loss of estrogen increase a womens risk of

A

cardiovascular risk

39
Q

what are the skin and hair changes with menopause

A

hirsutism and temporal balding and/or alopecia
thinning skin, wrinkles, pigmentation changes (face, hands)

40
Q

what is early/premature menopause due to

A

ovarian dyfunction

41
Q

what are positive menopausal changes

A

decrease issues with fibroids/endometriosis
end of menstrual migraines and PMS
no more menses
no more contraception

42
Q

what are the treatment options for menopausal symtpoms

A

reassurance
comfort measures: lubricants, natural products
medication

43
Q

what are VMS alternatives when estrogen/progesterone is not desired/contraindicated

A

SSRIs, SNRIs
alpha adrengergic agonists - clonidine
gabapentin
BRAND NEW: Veozah

44
Q

what is Veozah

A

PO med for moderate to severe hot flashes
neuokinin 3 receptor antagonist - first in its class
not hormonal

45
Q

what should be assessed with prolonged, heavy or frequent vaginal bleeding with peri-menopause

A

TVUS +/- endometrial sampling to exclude hyperplasia/neoplasia

46
Q

what is the treatment for perimenopausal VMS

A

lifestyle modification
non-hormonal rx
systemic HRT

47
Q

what is the treatment for perimenopausal GU symtpoms

A

low dose vaginal estradio
personal lubricants

48
Q

what provides symptomatic improvement for both vaginal and urethral atrophy

A

vaginal estrogen

49
Q

what can be used for recurrent UTI in postmenopausal women

A

vaginal estradiol 2x/week
this gradually improves health of urogenital epithelium, pH and microbiome

50
Q

what is postmenopausal care/screenings

A

pap every 3-5 years
mammogram
obesity
HTN
cardiovascular risk
osteoporosis risk
colon cancer risk
urinary incontinence
interpersonal violence
exercise, diet, calcium, vitamin D, fall prevention

51
Q

what are the connective tissues of the pelvis

A

uterine suspensory ligaments
vaginal connective tissue
pelvic floor musculature

52
Q

what are the 4 functions of pelvic floor muscles

A

core control and breathing
sex/orgasms
not peeing your pants
labor and delivery

53
Q

what is the landmark for prolapse of the pelvic floor

A

hymenal remnant tissue

54
Q

what are the types of pelvic organ prolapse

A

anterior vaginal wall (cystocele)
posterior vaginal wall (rectocele)
uterus
can also have urethral prolapse

55
Q

what are risk factors for pelvic organ prolapse

A

obesity
chronic constipation
operative delivery
multi-parity
chronic cough
heavy lifting for work

56
Q

what are obstetrical risk factors

A

episiotomy
tears/extension
vacuum extraction
forceps delivery
shoulder dystocia
breech extraction

57
Q

what is the clinical presentation of pelvic organ prolapse

A

smooth/striated appearing, pink bulging tissue at vaginal opening
bowl/bladder impairments

58
Q

what is the evaluation for pelvic organ prolapse

A

exam to quantify what is descending and how far relative to hymenal remnant at intoitus
staging/quantification systems
POPQ

59
Q

what is POPQ

A

pelvic organ prolapse quantification system : limited adoption

60
Q

what is stage 2 of pelvic organ prolapse

A

presenting part is within 1cm north or south of hymenal remnant

61
Q

what is stage 3 of pelvic organ prolapse

A

presenting part is > 2cm distal to hymen but at least 2cm less than total vaginal length

62
Q

what is stage 4 of pelvic organ prolapse

A

vagina is completely everted

63
Q

what is the treatment of pelvic organ prolapse

A

watchful waiting with reassurance if not bothersome
pelvic floor PT
pessary
surgical repair
vaginal obliterative procedure in select patients

64
Q

what is cystocele

A

anterior vaginal wall

65
Q

what is rectocele

A

posterior vaginal wall

Clin Med3: Womens Health (13 decks)

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