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Primary Care Exam 4 > Menopause > Flashcards

Menopause Flashcards

1
Q

how do you define menopause?

A

no menses for 12 consecutive months

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2
Q

what is the most commonly reported symptom of menopause?

A

abnormal uterine bleeding
- 90% of women
- HMB, or heavy menstrual bleeding, when cycles become closer together/more often and heavier
OR
- cycles becomes farther apart/less often and lighter

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3
Q

what is a complication of abnormal uterine bleeding?

A
  • anemia 2/2 HMB
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4
Q

what are some diagnostics for abnormal uterine bleeding 2/2 menopause?

A
  • pregnancy HCG
  • STI testing
  • hematological parameters (CBC, LFTs, coagulation profile)
  • serum hormone levels (TSH, FSH, estradiol, progesterone, testosterone, DHEAS)
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5
Q

1st line tx for AUB

A

medical management + hormonal management

medical:

  • NSAIDs
  • tranexamic acid
  • desmopression (if underlying bleeding disorder)

hormonal:

  • gonadotropin-releasing hormone (GnRH) agonists
  • oral progestogens
  • contraceptive options (low-dose oral contraceptive pills, depot MPA, and levonorgestrel-releasing IUD
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6
Q

average age of menopause?

A

50, means women will start noticing hormonal effects in their 40s

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7
Q

most common cause of irregular menses

A

anovulation - in menopause, women move to permanent anovulation

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8
Q

some other commom s/s of menopause

A
  • vasomotor sx (hot flashes + night sweats)
  • genitourinary changes (vulvovaginal atrophy)
  • CNS changes (depression, sleep disturbance, decrease in sexual activity)
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9
Q

what are some characteristics of menopausal estrogen supplementation?

A
  • look like low dose birth control because they have progesterone to prevent uninhibited estrogen effect at the endometrium (to prevent endometrial cancer)
  • given for a little thermoregulation - not as high dose because not trying to shut down the whole FSH/LH/ovarian system like with birth control
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10
Q

contraindications for estrogen supplementation

A
  • clotting disorders
  • uncontrolled HTN
  • cardiac disease
  • smoking
  • highest risk of cardiac effect is within 1st year of estrogen supplementation*
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11
Q

do hormones cause breast cancer?

A

no, except families with BRCA gene or early FH breast cancer

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12
Q

pathophysiology of endometrial cancer

A

proliferation of endometrial tissue from uninhibited estrogen effect at endometrium

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13
Q

risk factors for endometrial cancer

A
  • never had kids
  • never breastfed
  • never birth control
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14
Q

how do we reduce the risk of endometrial cancer

A

putting on birth control or Mirena IUD

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15
Q

s/s endometrial cancer

A

AUB

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16
Q

diagnostics for endometrial cancer

A

EMB, endometrial biopsy
US
MRI

17
Q

pharmocological tx for VMS (hot flashes, night sweats)

A

estrogen

  • oral pills
  • vaginal creams (Premarin, Estrace)
  • vaginal estradiol rings (Estring, Femring)
  • vaginal tablet, Vagifem
  • transdermal patch
18
Q

Lifestyle changes to manage hot flashes and night sweats

A
  • Stay hydrated, avoid things that are dehydrating such as alcohol
  • Recognize and avoid triggers such as spicy food, coffee, tight clothing, Etc.
  • Sleep
  • Exercise
  • Reduce BMI
  • Black Cohosh
  • Red Clover
19
Q

Treatment for genitourinary syndrome of menopause or Volvo vaginal atrophy

A
  • vagifem

- Educate not to douche

20
Q

Treatment for sleep disturbance

A
  • Depends on mental health history
  • Obstructive sleep apnea screening
  • Estrogen is not a good treatment unless night sweats or hot flashes are waking them up
  • Cognitive behavioral therapy or acupuncture for anxiety related
  • Low dose Paxil (SSRI)
  • Prometrium 100 mg at night: very safe, no side effects, no drug interactions, may help with night sweats too
  • Prometrim is made in peanut oil so do not give it to someone with a peanut allergy
21
Q

What are bio identical hormones?

A
  • Synthetic, same risk factors of other hormones
  • Estrovent: Made from plants, supplements
  • They’re all different, made in compounding pharmacies
  • Would not recommend at this time
22
Q

What is Mona Lisa touch?

A
  • Laser therapy for Volvo vaginal atrophy
  • Placed in the vagina for five minutes
  • At the beginning, treatment is every 3 to 6 months, then every 6 to 12 months
  • Each treatment cost $3000-$5000, and it is not covered by insurance
  • People say it makes their vagina feel much better
  • Causes proliferation of cells of the vagina to help with lubrication
23
Q

What are the take home points about menopause?

A
  • Trying not to use estrogen
  • Talk about lifestyle factors and sex lives
  • Talk about lube in moisturizers
  • Menopause is healthy aging

Primary Care Exam 4 (3 decks)

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