Clinician's Guide Menopause Practice Chapter 4 Flashcards
(142 cards)
What is the definition of the genitourinary syndrome of menopause (GSM)?
A collection of signs and symptoms associated with estrogen deficiency involving changes to the labia, introitus, vagina, clitoris, bladder, and urethra.
GSM includes genital, urinary, and sexual symptoms such as dryness, irritation, dysuria, and pain.
What are the common symptoms associated with GSM?
- Genital symptoms: dryness, irritation, burning
- Urinary symptoms: dysuria, urgency, recurrent UTIs
- Sexual symptoms: dryness, pain
Symptoms must be bothersome for diagnosis and not caused by other conditions.
What is vulvovaginal atrophy (VVA)?
A component of GSM affecting approximately 20% to 84% of menopausal women, characterized by atrophic changes in the vulvovaginal area.
VVA symptoms significantly impact women’s quality of life.
What is the significance of a complete medical history in diagnosing vulvovaginal complaints?
It helps determine onset, duration, predominant symptom, prior treatment, and any possible underlying conditions.
A careful history can guide diagnosis and treatment.
What should be included in a physical examination for vulvovaginal complaints?
- Evaluation of external genitalia, introitus, and perineum
- Check for plaques, lesions, and tenderness
- Assess vaginal atrophy and perform bimanual examination
This thorough examination helps identify any concomitant diseases or issues.
True or False: Biopsy is necessary for any vulvar lesion that does not respond to treatment.
True.
Biopsy is essential for accurate diagnosis and to rule out malignancy.
What factors can increase the risk of symptomatic VVA in women?
- Low estrogen levels from primary ovarian insufficiency
- Hypothalamic amenorrhea
- Prolonged lactation
- Cancer treatments such as chemotherapy or pelvic radiation
These conditions can lead to estrogen deficiency and associated symptoms.
What are some nonhormone over-the-counter products for treating GSM?
- Vaginal moisturizers
- Vaginal lubricants
These products can provide relief from symptoms associated with GSM.
Fill in the blank: Low-dose vaginal _______ therapy is highly effective if nonhormone interventions do not improve symptoms.
estrogen
Low-dose vaginal estrogen helps restore vaginal health and alleviate symptoms.
What are the approved formulations for low-dose vaginal estrogen therapy?
- Vaginal ring
- Tablets
- Creams
These formulations are effective for treating VVA and are minimally absorbed.
What is the purpose of pelvic floor physical therapy (PT) in treating severe GSM?
To increase pelvic floor muscle tone and address issues like provoked pelvic floor hypertonus.
PT can be effective in treating discomfort and dyspareunia associated with GSM.
What is the recommended dosing for estradiol vaginal tablets?
10 µg placed in the vagina twice weekly after an initial nightly use of 2 weeks.
This regimen helps in managing VVA symptoms.
What is a common side effect of using lubricants and moisturizers for vaginal health?
Vulvar irritation or contact dermatitis may occur if allergic to components.
Women may need to try different formulations to find a suitable product.
What additional benefit does the 17β-estradiol vaginal ring provide?
It is FDA approved for the treatment of urinary urgency.
This makes it a dual-purpose option for managing both vaginal and urinary symptoms.
What is the FDA-approved initial dosage of 17β-estradiol cream for VVA?
2-4 g/day for 1-2 weeks
VVA stands for vulvovaginal atrophy
What is the maintenance dosage of 17β-estradiol cream for VVA?
1 g one to three times a week
What are the typical doses of estrogen cream used in clinical practice?
0.5-1 g/day used two to three times weekly
What does FDA stand for?
US Food and Drug Administration
What is the recommended initial dosage of conjugated estrogens Premarin Vaginal Cream for VVA?
0.5-2 g/day for 21 days, then off for 7 days
What is the dosage of Estragyn Vaginal Cream?
2-4 g/day
What device contains 2 mg of 17β-estradiol and releases approximately 7.5 µg/day?
Estring
What is the active ingredient in Vagifem vaginal tablets?
Estradiol hemihydrate
What is the initial dosage of Vagifem for VVA?
1 tablet/day for 2 weeks
True or False: Low-dose vaginal ET is contraindicated for women with a history of CVD.
False