Clinician's Guide Menopause - Chapter 2 Flashcards
(156 cards)
1
Q
What are the relevant anatomical features of the vagina?
A
The vagina is composed of an adventitial layer of connective tissue, smooth muscle, and an inner lumen made up of a lamina propria and nonkeratinized stratified squamous epithelium.
2
Q
What is the role of estrogen in vulvovaginal health?
A
Estrogen maintains blood flow, collagen in the epithelium, hyaluronic acid, mucopolysaccharides, supports the microbiome, and protects tissue from pathogens.
3
Q
What is the average pH of the vagina and what maintains it?
A
The average pH of the vagina is 4.5, maintained by lactobacilli that convert glucose into lactic acid.
4
Q
True or False: All types of lactobacilli are equally effective at lowering vaginal pH.
A
False
5
Q
What happens to glycogen content in the vaginal epithelium during menopause?
A
There is a decrease in glycogen content, leading to a reduced substrate for lactobacilli and an increase in vaginal pH.
6
Q
What are the consequences of decreased estrogen levels during menopause?
A
Thinning of the superficial epithelial layer, loss of elasticity, narrowing of the vaginal canal, and potential pain with vaginal penetration.
7
Q
What is the genitourinary syndrome of menopause?
A
It refers to genital and urinary symptoms experienced by women due to gonadal hormone decline during menopause.
8
Q
What changes occur in the urinary tract during menopause?
A
Higher rates of urinary tract infections, frequency, urgency, dysuria, and potential increased pelvic organ prolapse.
9
Q
What is the prevalence of obesity in women in the United States as of 2013-2014?
A
40.4% of women had a body mass index (BMI) ≥30 kg/m2.
10
Q
What is the relationship between menopause and weight gain?
A
Weight gain during menopause is primarily related to aging and lifestyle, rather than menopause itself or hormone therapy.
11
Q
What body composition changes are observed during menopause?
A
Increased abdominal and visceral fat, decreased lean body mass, independent of age.
12
Q
What health risks are associated with higher levels of body weight and fat?
A
Increased risk for cardiovascular disease, type 2 diabetes, hypertension, several cancers, osteoarthritis, and premature mortality.
13
Q
What effect does obesity have on breast cancer rates in postmenopausal women?
A
Postmenopausal women with obesity have a higher rate of breast cancer compared to those of normal weight.
14
Q
What is the effect of weight loss on glycemic control?
A
A 3% sustained weight loss improves glycemic control and triglycerides, while 5% to 10% weight loss further reduces hyperglycemia and triglycerides.
15
Q
What is a common recommendation for managing weight in perimenopausal and postmenopausal women?
A
Eat a healthy diet, increase physical activity, and minimize weight gain.
16
Q
Fill in the blank: The average pH of the vagina is ______.
A
4.5
17
Q
What is the significance of community state types in vaginal health?
A
They are characterized by the proportion of different lactobacilli and other organisms, reflecting vaginal health.
18
Q
What is the role of androgens in vulvovaginal health?
A
Androgens have been shown to stimulate nerve fibers and mucification of the epithelium.
19
Q
True or False: Increased trunk-mass-to-leg-fat-mass ratio is associated with better metabolic health.
A
False
20
Q
What is the impact of local vaginal estrogen on urinary stress incontinence?
A
Local vaginal estrogen appears to improve urinary stress incontinence.
21
Q
What percentage reduction in progression to type 2 DM was observed in the Diabetes Prevention Program with moderate lifestyle intervention?
A
58%
The intervention involved a 7% weight loss maintained over 6 months.
22
Q
For every kilogram of weight loss, what is the percentage reduction in the risk of developing type 2 DM?
A
16%
This statistic highlights the importance of weight management in diabetes prevention.
23
Q
What is the recommended number of sessions for comprehensive lifestyle interventions for women with obesity according to joint guidelines?
A
At least 14 sessions over 6 months
This recommendation is from the American College of Cardiology, the American Heart Association, and the Obesity Society.
24
Q
What counseling strategy can improve behavior counseling in women ambivalent about behavior change?
A
Motivational interviewing
This technique focuses on building motivation and personalized problem-solving.
25
What are the components of the '5 As' framework for behavior change?
* Assess
* Advise
* Agree
* Assist
* Arrange
## Footnote
This framework is adapted for behavior therapy for obesity.
26
What caloric reduction is estimated to lead to weight loss of 1 to 1.5 lb per week?
500 to 750 calories per day
## Footnote
This reduction is key for achieving an energy deficit.
27
What is the rule-of-thumb caloric intake goal for most women to achieve weight loss?
1,200 to 1,500 calories per day
28
What type of diet has shown similar weight loss outcomes across various macronutrient compositions?
Clinically meaningful weight loss can occur across a broad range of macronutrient compositions
## Footnote
This includes variations in fat, protein, and carbohydrate content.
29
What type of exercise is particularly valuable for minimizing weight gain in midlife women?
Aerobic and resistance exercises
## Footnote
Resistance exercises improve lean body mass and body fat.
30
What is the recommended amount of aerobic physical activity to help achieve an energy deficit?
At least 30 minutes of brisk walking on most days of the week (≥150 min/wk)
## Footnote
Higher activity levels (200-300 min/wk) are recommended for long-term weight maintenance.
31
What is the expected weight loss percentage after 1 year for the most popular commercial weight-loss programs?
Weight Watchers: 2.6%; Jenny Craig: 4.9%
## Footnote
This is compared with controls in a meta-analysis of randomized controlled trials.
32
What are very-low-calorie diets defined as?
800 to <1,000 kcal/d
## Footnote
These diets should be provided under medical supervision due to potential complications.
33
What are the general diet and lifestyle recommendations from the American Heart Association?
* Maintain a healthy body weight
* Consume a diet rich in vegetables and fruits
* Choose whole-grain, high-fiber foods
* Consume fish at least twice a week
* Limit intake of saturated and trans fat
* Minimize intake of sugar-sweetened beverages
* Choose foods with less salt
* Consume alcohol in moderation
* Minimize eating foods prepared outside the home
## Footnote
These recommendations aim to reduce CVD risk.
34
How is inadequate or disordered sleep associated with obesity?
It leads to a range of appetitive, immune, stress, and inflammatory mediators that may contribute to weight gain
## Footnote
Sleep deprivation is linked to hormonal changes that affect weight.
35
What is the weight loss range associated with long-term obesity medications?
5% to 15%
## Footnote
This varies depending on the medication and population studied.
36
What is Orlistat and how does it work?
A pancreatic lipase inhibitor that decreases fat absorption
## Footnote
It has shown significant weight loss in conjunction with behavior counseling.
37
What is the average body weight loss achieved with Lorcaserin after one year of treatment?
Approximately 7%
## Footnote
Lorcaserin also improves several cardiovascular risk factors.
38
What are the most common adverse events associated with Orlistat?
Gastrointestinal (GI) related, including diarrhea and flatulence
## Footnote
These occur when consuming large amounts of fat while on the medication.
39
What percentage improvement in glycated hemoglobin is associated with 2 DM?
0.9% improvement
## Footnote
This improvement is comparable to many type 2 DM medications.
40
What is the classification of Lorcaserin?
Schedule IV substance
41
What are the dosing options for Lorcaserin?
10 mg twice daily or 20 mg extended release once daily
42
What are the most common adverse effects (AEs) of Lorcaserin?
* Headache
* Dizziness
* Fatigue
* Nausea
* Dry mouth
* Constipation
43
What precautions should be taken when using Lorcaserin?
Caution with serotonergic or antidopaminergic medications
44
What is Phentermine-topiramate ER used for?
Weight loss
45
What are the effects of Phentermine?
Decreases appetite and leads to short-term weight loss
46
What is the average weight loss achieved with Phentermine-topiramate ER in the SEQUEL trial?
Approximately 10% of body weight
47
What improvements were observed in participants treated with Phentermine-topiramate ER?
* Reduced blood pressure
* Improved lipids
* 76% reduction in progression to type 2 DM compared to placebo
48
What are the common AEs of Phentermine-topiramate ER?
* Paresthesia
* Dizziness
* Dysgeusia
* Insomnia
* Constipation
* Dry mouth
49
What is the classification of Phentermine-topiramate ER?
Schedule IV substance
50
What should be ruled out before starting Phentermine-topiramate ER in women?
Pregnancy
51
What is the weight loss percentage associated with naltrexone-bupropion SR after one year of treatment?
Approximately 8.2% of baseline body weight
52
What are the common AEs of naltrexone-bupropion SR?
* Nausea
* Constipation
* Diarrhea
* Headache
* Vomiting
53
What is Liraglutide 3.0 mg used for?
Chronic weight management
54
What is the average weight loss achieved with Liraglutide 3.0 mg compared to placebo?
Approximately 9% weight loss
55
What are the most common AEs of Liraglutide 3.0 mg?
* Nausea
* GI complaints
56
What is the indication for bariatric surgery?
BMI of 40 kg/m2 or higher or BMI of 35 kg/m2 or higher with obesity-related comorbidity
57
What are the most common bariatric surgeries?
* Vertical sleeve gastrectomy
* Roux-en-Y gastric bypass
58
What is the average weight loss for vertical sleeve gastrectomy after 2 years?
25% of body weight
59
What are some common skin changes due to aging?
* Lines and wrinkles
* Skin laxity
* Blotchiness and dyschromia
* Increased skin fragility
60
What is the most important endogenous factor influencing skin changes during menopause?
Decline in beta-estradiol
61
What happens to collagen production as estrogen levels fall?
Significant decrease in fibroblast activity and collagen production
62
What effect does aging have on glycosaminoglycan production?
Decreased production
63
What is the effect of decreased estrogen on the skin's ability to retain moisture?
Increased transepidermal water loss
64
What is the impact of estrogen on the dermal vascular system?
Reduces blood flow and decreases angiogenesis
65
What are the effects of estrogen depletion on melanocytes?
Increased activity leading to blotchiness and dyschromia
66
What factors contribute to facial aging?
* Changes in skin layers
* Loss of fat
* Bone resorption
67
What is the 'triangle of youth' in facial anatomy?
A shape that inverts with age due to fat redistribution
68
What is the recommended method for maintaining healthy skin?
Proper ultraviolet light protection or avoidance
69
What are the effects of UVB rays on the skin?
Cause sunburn and oxidative stress
70
What are the types of skin cancer associated with UV exposure?
* Basal-cell carcinoma
* Squamous-cell carcinoma
* Malignant melanoma
71
What can a benign angiofibroma or flat wart rarely be mistaken for?
Basal-cell carcinoma if there is telangiectasia or a pearly appearance
## Footnote
Telangiectasia refers to small dilated blood vessels near the surface of the skin.
72
What are solar lentigos and what can they heighten suspicion for?
Occasionally asymmetric and multicolored, heightening suspicion for superficial spreading melanoma or lentigo maligna melanoma
73
What is recommended if there are clinical questions differentiating benign from malignant growths?
Referral to a dermatologist or a small shave biopsy is warranted
74
What should be discussed at every well-woman visit?
Ultraviolet exposure and proper sunscreen use
75
What is the role of physical-based sunblock?
Prevention of skin cancer, hindering skin aging and photodamage
76
What type of UV rays do chemical-based sun blocks primarily block?
UVB rays
77
What are the most effective physical-based sunblocks available in the United States?
Zinc or titanium oxide
78
What is essential regarding sunscreen application during outdoor activities?
Reapplying every 2 to 3 hours
79
What dietary habits are beneficial for overall health and skin health?
Healthy diet and avoidance of smoking
80
What do moisturizers that minimize transepidermal water loss do?
Make the skin appear more hydrated
81
What are common ingredients in cream-based moisturizers?
* Ceramides
* Glycerin
* Shea butter
82
What do topical retinoids affect?
Most components of the skin, including keratinocytes, melanocytes, and the pilosebaceous unit
83
What is a common side effect of using topical retinoids?
Facial irritation or excessive dryness
84
What strategy can increase tolerability when using topical retinoids?
Starting with three times-per-week application and slowly increasing frequency
85
What is the second most studied topical agent family?
Alpha- and beta-hydroxy topical acid preparations
86
What do peeling agents improve?
Skin texture and normalize pigmentary alterations
87
What are common superficial peeling agents?
* Glycolic acid
* Salicylic acid
* Lactic acid
88
What do fractional lasers create?
Thousands of microscopic thermal columns of damage per square centimeter
89
What is the primary action of botulinum toxin injections?
Temporarily blocking acetylcholine release at the neuromuscular junction
90
What are most dermal filling agents made from?
Hyaluronic acid gels of nonanimal origin
91
What is the typical duration of action for available toxin extracts used in the United States?
3 to 4 months
92
What is the effect of repeated use of toxins and fillers on their duration of effectiveness?
Results tend to last longer over time
93
What does radiofrequency treatment stimulate?
Collagen production via heating dermal tissue
94
What are collagen stimulators such as poly L lactic acid known to do?
Diminish the skin and stimulate fibroblasts to make new collagen
95
What can hyaluronic acid gel agents be used for?
Volume loss in the midface and restoring craniofacial skeletal plane
96
What is a potential future advance in cosmetic therapies?
Stem-cell therapy or targeted intravenous infusion
97
What is androgenetic alopecia?
A hair loss phenomenon associated with menopause
98
What are the most common causes of hair loss during menopause?
* Female pattern hair loss (FPHL)
* Telogen effluvium (TE)
99
What characterizes telogen effluvium?
A sudden onset of hair shedding following a major life stressor
100
What psychological effects can hair growth aberrations have?
Affect body image, self-esteem, quality of life, and emotional well-being
101
What characterizes telogen effluvium (TE)?
A sudden onset of hair shedding after a major life stressor or chronic illness.
102
In female pattern hair loss (FPHL), where does hair thinning primarily occur?
On the crown of the scalp.
103
What is a common initial sign of FPHL?
Widening through the center hair part.
104
True or False: The frontal hairline typically remains intact in FPHL.
True.
105
How does male pattern hair loss (MPHL) present in women?
Vertex balding and bitemporal recession.
106
What is frontal fibrosing alopecia (FFA) characterized by?
Frontotemporal recession, follicular hyperkeratosis, perifollicular erythema, and eyebrow/eyelash/body hair loss.
107
Who is most commonly affected by frontal fibrosing alopecia?
Postmenopausal women.
108
What is the proposed pathogenesis of FFA?
An autoreactive immune response against an unknown antigen.
109
Which hormone is believed to protect against hair loss?
Estrogen.
110
What happens to testosterone levels during postmenopause?
They decrease, but not as significantly as estrogen levels.
111
What is the typical ratio of hair in the anagen phase in a normal adult scalp?
Approximately 80% to 90%.
112
Fill in the blank: Microinflammation of the hair follicles is often seen with hair __________.
miniaturization.
113
What environmental factors have been associated with FPHL?
* Longer sleep duration
* Higher levels of stress
* Smoking
* Diabetes Mellitus
* Hypertension
114
What should be included in a complete medical history for women presenting with hair loss?
Menstrual history, pregnancies, menopause symptoms, HT use, symptoms of androgen excess.
115
What is the diagnostic ratio of terminal to vellus hairs in FPHL?
Less than 4:1.
116
What is the goal of treatment for FPHL?
To prevent progression of hair loss.
117
What is the only FDA-approved treatment for FPHL?
Topical minoxidil.
118
What are potential side effects of topical minoxidil?
* Facial hypertrichosis
* Contact dermatitis
* Irritation
119
What is the typical duration before stabilization or improvement of hair growth with minoxidil?
At least 4 to 6 months.
120
What class of medications competes with androgens for androgen receptors?
Antiandrogens.
121
What is a risk associated with spironolactone therapy?
Hyperkalemia.
122
What is the significance of testosterone and DHEA levels greater than 140 ng/dL to 200 ng/dL and 700 µg/dL, respectively?
They are suggestive of an ovarian or adrenal tumor.
123
True or False: Estrogen therapy has consistently promoted hair growth in postmenopausal women.
False.
124
What is the relationship between estrogen and hair density during pregnancy?
Increased hair density due to prolonged anagen phase.
125
What is the effect of androgens on susceptible hair follicles?
Progressive miniaturization and shortening of the anagen phase.
126
What type of alopecia can occur in women that has cicatricial characteristics?
Frontal fibrosing alopecia (FFA).
127
What does the presence of lateral eyebrow hair loss indicate?
Hypothyroidism.
128
What factors should be ruled out in laboratory investigations for hair loss?
* Systemic disease
* Thyroid disease
* Nutritional deficiency
129
What type of hair loss does a positive hair pull test indicate?
Telogen effluvium (TE).
130
What is one treatment option for women who retain thicker hair in the occipital scalp?
Hair transplantation.
131
What are FPHL treatments classified as?
FPHL treatments are used off-label.
132
What is the function of antiandrogens?
Antiandrogens compete with circulating androgens for the high-affinity AR.
133
What is spironolactone's role in treating FPHL?
Spironolactone competitively blocks the AR and suppresses ovarian androgen synthesis.
134
Is spironolactone FDA approved for FPHL?
No, spironolactone is not FDA approved for FPHL.
135
What are some adverse effects (AEs) of spironolactone?
* Hyperkalemia
* Fatigue
* Postural hypotension
* Liver abnormalities
136
What risks are associated with spironolactone according to animal studies?
* Tumorigenic
* Teratogenic
137
Is there a link between spironolactone and estrogen-dependent tumors in postmenopausal women?
Several large studies have shown no association.
138
What is the mechanism of action of finasteride?
Finasteride prevents conversion of testosterone to the more potent DHEA.
139
Is finasteride approved for use in women?
No, finasteride is not approved for any indication in women.
140
What can precipitate hair shedding in women?
Cessation of estrogen therapy or hormone contraception.
141
What role does estrogen therapy play in hair growth?
Estrogen therapy sometimes supports hair growth but is not consistently effective.
142
What is Bimatoprost used for?
Bimatoprost is used to control glaucoma and manage ocular hypertension.
143
Has Bimatoprost been found effective for FPHL?
No, it has not been found effective for FPHL at the approved concentration.
144
What is the concentration of ketoconazole shampoo used as an antiandrogen?
2% ketoconazole shampoo.
145
What is the potential benefit of anti-dandruff shampoos containing zinc pyrithione?
They may promote hair growth.
146
What are low-energy laser-light products used for?
They are designed for the treatment of alopecia.
147
What is a common condition associated with hirsutism?
Polycystic ovary syndrome (PCOS).
148
What is the typical cause of hirsutism?
Ovarian androgen overproduction or peripheral hypersensitivity to normal androgen levels.
149
What is the prevalence of hirsutism in women?
Hirsutism affects between 5% and 15% of women.
150
What is the first step in managing hirsutism?
Focus on any underlying cause and the woman's goals and expectations.
151
What treatments may be used for hirsutism?
* Hormone drugs
* Peripheral androgen blockage
* Mechanical depilation
152
What are some methods of direct hair removal?
* Plucking
* Waxing
* Shaving
153
What is a potential complication of electrolysis?
Folliculitis and postinflammatory dyspigmentation.
154
What adverse effects can occur with laser treatment for hirsutism?
* Dyspigmentation
* Hypertrophic scars
* Thermal burns
155
What is paradoxical hypertrichosis?
A rare adverse effect seen in patients treated with certain laser devices.
156
What is the effect of estrogen therapy on hirsutism?
It may delay progression but will not change coarse terminal hairs into softer vellus hairs.
