Hysterectomy & Menopause Flashcards
(17 cards)
What are the different types of hysterectomies?
Abdominal
Vaginal
Wertheims (for cervical cancers)
Laparoscopic (use camera – uterus removed via vagina)
What are the different approaches to hysterectomies?
Abdominal
Vaginal
Conventional laparoscopic
Robot-assisted laparoscopic
List the indications for a hysterectomy
Fibroids (aka uterine leiomyomas)
Pelvic organ prolapse/pain/infection (eg: endometriosis, pelvic inflammatory diseases)
Abnormal uterine bleeding
Malignant & pre-malignant disease
List & explain the alternatives to a hysterectomy
Embolization for fibroids (thin tube inserted into groin to occlude blood supply to fibroids; fibroids shrink & die)
For abdnormal uterine bleeding:
- Mirena (loop inserted into uterus secretes progesterone daily to thin endometrium stop bleeding)
- Endometrial ablation (heating device that cooks endometrium allowing for lining to come away stop bleeding)
Ring pesarry for prolapse (ring that holds up prolapse – for elderly pts unfit for/dotn want surgery)
Chemotherapy & radiation therapy for cancer
Why would the ovaries be removed?
If there’s a risk of ovarian cancer (ie: BRCA gene abberation)
What are the consequences of removing the ovaries?
Decreased sex drive & libido
Increased risk of cardiac diseases
Suddenly become menopausal
What are the long-term consequences of a hysterectomy?
Prolapse of the bladder ,vault , rectum
Bowel obstruction
Pain
Menopause (if ovary’s removed)
What is menopause & its epidemiology?
Permanent cessation of menstrual periods
Consided positive if a woman has experienced 12 months of amenorrhea
Median age of 51.4 years
Menopause before age 40 = abnormal
Consequences of menopause: bone
• Joint pain
• Decrease bone density – highest loss of bone density during a year/two before final period
• Can lead to osteopenia (low bone density) & osteoporosis (severely low bone density) increased fracture risk
Consequences of menopause: genitourinary
• Vaginal atrophy & dryness
• Dyspareunia (painful sex)
• Sexual dysfunction
• Frequent bladder infections
Rx for vaginal atrohpy
Estrogen that is taken orally does NOT work in the vagina – use vaginal oestrogen instead
Local estrogen in the vagina 3x a week causes:
- Increased lubrication & rugae (folds & wrinkles)
- Decreases incidence of urinary tract infections - frequency & urgency
Consequences of menopause: hot flushes
Sudden sensation of heat centred on the upper chest & face that becomes generalized
Occur in up to 80 % of womenonly 20-30% of women seek medical attention
“nightsweats” – mistaken for TB
Each one lasts 2-4 min
Stop spontaneously within 4-5 yrs of onset
Rx for meopause
• reat symptoms - Use the lowest dose to control symptoms
• Women with a uterus need BOTH estrogen & progesterone
• Women with a hysterectomy need estrogen ONLY
Oestrogen & breats cancer
WHI study showed that
- 5/10 000 women who don’t take estrogen develop breast cancer
- 8/10 000 women who do take estrogen develop breast cancer
Breast cancer increased in pts taking a combo of estrogen & progesterone
Not increased in the estrogen only group
It works great for hot flushes
Contras for oral oestrogen & progesterone as Rx for menopause
• Current, past or suspected breast cancer
• Known/suspected estrogen-dependent malignant tumours
• Undiagnosed genital bleeding
• Previous idiopathic/current VTE (thromboembolic disease)
• Porphyria cutanea tarda
• Known arterial CHD
• Active liver disease
• Thrombophilia
• Untreated endometrial hyperplasia
Alternative medicine for hot flushes
• Phyto-oestrogens (soy & red clover) express pharmaceutical effects via isoflavones
• Black cohosh = hepatotoxic
• Avoid use in women being treated for breast cancer
Benefits of exercise on menopause
Increases:
- Cardiorespiratory function
- HDL
- Bone mass
- Mood
Decreases:
- LDL
- Stress
- Hot flushes
- Lower back pain
Alters the hip to waist ratio
