Menopause

Question 1

Menopause is defined as

Answer 1

the cessation of menses due to loss of ovarian activity, average age 51 in the US

Question 2

Postmenopausal =

Answer 2

12+ months after final menses

Question 3

Perimenopausal/ transition =

Answer 3

4-6 years of cycle changes and other sx before total cessation of menses

Question 4

Premature menopause =

Answer 4

ovarian failure before the age of 40

Question 5

Early menopause age =

Answer 5

40-45

Question 6

Surgical menopause =

Answer 6

cessation of menses due to BSO

Question 7

Menopause is a part of the normal …

Answer 7

aging process, is NOT a disease process

Question 8

Menopause can be early in

Answer 8

smokers and in setting of malnutrition

Question 9

Perimenopause:
Onset age =
Average length =
When does this begin?
What leads to pt’s having sx?

Answer 9

47
4-8 years
begins when the menstrual cycles begin to be irregular
erratic fluctuations of hormones lead to sx

Question 10

Perimenopausal sx =

Answer 10

Vasomotor - hot flashes, night sweats, insomnia
Psych - depression, irritability, mood swings
Cognitive - concentration/ memory issues
Sexual - vaginal dryness/ dysparenia
Menstrual changes - longer/shorter cycles, irregular bleeding
other - urinary incontinence, dry itchy skin, wt gain

Question 11

Physiology of Perimenopausal =

Answer 11

decrease synthesis of estrogens and progesterone
GnRH released at max - increasing androgens
testosterone production may continue for several more years after menopause

Question 12

Types of estrogen:

Answer 12

Estrone (E1) = made after menopause
Estradiol (E2) = most common type of estrogen, most potent/ abundant during reproductive years
Estriol (E3) = main type of estrogen in a pregnant person’s bloodstream, prepares for childbirth

Question 13

Consequences of estrogen loss

Answer 13

sx (early) - hot flashes, insomnia, irritability
Physical changes (intermediate) - vaginal atrophy, skin atrophy
Diseases (later) - osteoporosis, Coronary heart disease

Question 14

Menopausal Menstrual changes

Answer 14

Luteal insufficiency - follicles become less responsive to FSH
fewer oocytes available in early follicular phase - FSH levels increase further
Corpus Luteum doesn’t function as well and progesterone secretion is diminished - result heavier menses

Question 15

Changes in menstrual cycle during menopause

Answer 15

shortened cycles - luteal phase stays the same at 14 days but the follicular phase shortens because there are higher rates of follicular maturity

anovulation - accelerated decline in responsive follicles, bleeding episodes eventually spread out and then stop

Question 16

What causes the follicular phase to shorten during menopause

Answer 16

Higher FSH levels cause follicles to mature faster - ovulation occurs earlier (hence the overall cycle is shortened)

Question 17

Vasomotor symptoms that occur with menopause

Answer 17

hot flashes and night sweats
present in 75% of women

Question 18

Hot flashes and night sweats are when

Answer 18

there is a sudden sensation of heat centered in face and chest that rapidly becomes generalized
can last 2-4 min - can have one or more per day
average duration is approx 5 years (but can continue for up to 10 after LMP)
can arouse from sleep leading to sleep disturbance

Question 19

What is the most common reason women seek medical attention during menopause?

Answer 19

vasomotor sx - can significantly impair quality of life

Question 20

VMS etiology

Answer 20

not fully understood
skin temps rise because of peripheral vasodilation followed by drop in core temp

Question 21

How to treat VMS

Answer 21

Exogenous estrogen widens thermo-regulatory zone so fewer sx

Question 22

Atrophic Vulvovaginitis is when

Answer 22

there is a gradual thinning of the genital mucosa
loss of vaginal rugae (folds)
decreased pliancy of the tissue, less flexible
Drier
pH becomes alkaline, change in microbiome

Question 23

Sexual changes with Atrophic Vulvovaginitis

Answer 23

dyspareunia
decreased lubrication with arousal
increased frequency of UTI/ candidal infection
lack of desire, longer arousal cycle

Question 24

Treatment of Atrophic Vulvovaginitis

Answer 24

personal lubricants and moisturizers, vaginal estradiol
encourage communication with partners, provide education

Question 25

Recurrent UTI - Genitourinary syndrome of menopause --> is dx when

Answer 25

> 2 culture confirmed UTI's in 6 months or > 3 in 12 months

Question 26

Women are at an increased risk when reached menopause

Answer 26

cardiovascular health - MI bone health - osteoporosis cognitive changes - depression, anxiety, sleep disturbance, brain fog hair and skin changes - thinning of skin and hair, hirsutism

Question 27

Early and premature menopause is due to

Answer 27

ovarian dysfunction ages 40-45 = early menopause before age 40 = premature menopause

Question 28

treatment of early and premature menopause

Answer 28

unless contraindicated may want to use HRT until natural menopause age (51)

Question 29

Positive menopausal changes include

Answer 29

decreased issues with fibroids and endometriosis end of menstrual migraines and PMS no more need for contraceptives, no more menses and monthly hormonal cycles

Question 30

Treatment for menopausal sx

Answer 30

reassurance - this is a normal aging process comfort measures - vaginal lubricants, natural products VMS- estrogen/ progesterone - if contraindicated you can use SSRIs SNRIs clonidine

Question 31

Prolonged, heavy or frequent vaginal bleeding (peri-menopausal care) you should

Answer 31

transvaginal US +/- endometrial sampling to exclude hyperplasia/ neoplasia

Question 32

Why do you always have to give estrogen with progesterone

Answer 32

to prevent endometrial carcinoma if the pt has had a hysterectomy - you can give estrogen by itself

Question 33

Special concerns for any vaginal bleeding after one year of amenorrhea

Answer 33

must be investigated high suspicion for malignancy endometrial polyps endometrial hyperplasia

Question 34

If estrogen HRT is being used, patients may have

Answer 34

spotting

Question 35

Postmenopausal Care and Screening

Answer 35

Pap every 3-5 years Mammogram Osteoporosis/ Cardiovascular/ Colon cancer risk

Question 36

Pelvic organ prolapse is when

Answer 36

descent toward the vaginal introitus of some or all: - anterior vaginal wall (cystocele) - posterior vaginal wall (rectocele) - uterus (enterocele)

Question 37

Pelvic organ prolapse develops _______ and _______ with age

Answer 37

gradually increases

Question 38

Pelvic organ prolapse often seems to the pt to be

Answer 38

sudden and concern for a tumor

Question 39

Pelvic organ prolapse risk factors

Answer 39

obesity chronic constipation operative delivery multiparity chronic cough heavy lifting for work

Question 40

Pelvic organ prolapse clinical presentation

Answer 40

smooth/striated appearing, pink bulging tissue at vaginal opening Cystocele can make voiding difficult Rectocele can impair bowl evacuation Prolapse can feel heavy, cause dull backache - but does not cause severe pain

Question 41

Pelvic organ prolapse treatment

Answer 41

watchful waiting with reassurance if not bothersome pelvic floor exercises pessary surgical repair (if uterus then hysterectomy) Vaginal obliterative procedure in select pts