PCOS and Menopause Flashcards
typical PCOS presentations
chronic anovulation (oligo/amenorrhea, infertility)
hyperanrogenism (hirsutism, acne, alopecia)
clinical effects of treating PCOS with OCPs
suppress ovarian androgen secretion via suppression of gonadotropins
increases SHBG
decreases free T from free androgen index
improves hirsutism
regulates menses, provides progesterone to protect endometrial lining
clinical impact CEE with Bazedoxifene
releases VMS and vaginal atrophy
blocks bone resoption
BAZ proides endometrial protection and an alternative to progesterone for pt adverse to bleeding, breast tenderness, altered mood
non-hormone alternatives for vasomotor symptoms of menopause
SNRI/SSRI - paroxetine, venlafaxine
gabapentin
clonidine
indications for menopausal hormone therapy
symptomatic post menopausal women
progestin or SERM (bazedoxifene) must be prescribed with systemic ET for uterine protection in women with uterus
NOT indicated for prevention of chronic disease
contradictions for MHT
unexplained vaginal bleeding
Stroke
TIA / MI
breast+endometrial cancer
Pulmonay emboli VTE
Acute liver disease
premature menopause cut-off
Ospemifene =
SERM taking orally for atrophic vaginitis and dyspareunia
clinical impact of treating PCOS with spironolactone
improve androgenic symptoms
does not inhbit androgen secretion
Pt still requires reliable contraception
typical onset time for hypergonadism symptoms in PCOS
peripubertal
consequences of estrogen deficiency in post menopausal years
increased risk of osteoporosis
increased risk of diabetes
increased risk of CHD and CVD
Changes in body composition (decreased lean mass)
skin changes
similarities of PCOS and metabolic syndrome related to insulin resistance
Central obesity
hyperinsulinemia
low SHBG
elevated TG, low HDL
Increased non alcoholic steatohepatitis
dx criteria for PCOS (rotterdam consensus)
2 of 3:
Oligo or anovulation
clinical/biochemical signs of hyperandrgogenism
polycystic ovaries on imaging
AND
absence of 2ndry causes (CAH, androgen secreting tumor, Cushings)
most effective treatment for vasomotor symptoms
Estrogen
vasomotor symptoms most likely at (period)
early post menopause
(also in latet transition phase)
