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Special Pops Exam 1 > Menopause -> > Flashcards

Menopause -> Flashcards

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1
Q

What is perimenopause/menopausal transition (MT)?

A

Period leading up to & immediately following menopause

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2
Q

How can menopause be induced?

A

Surgically via bilateral oophorectomy

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3
Q

What is postmenopause?

A

Phase of life that comes after menopause

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4
Q

Premature menopause is menstrual cessation before what age?

A

40

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5
Q

Causes of premature menopause?

A

Genetic, autoimmune, induced

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6
Q

Duration of perimenopause/MT?

A

Variable
begins: avg. 4yrs before FMP
overlaps with: late reproductive stage

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7
Q

How long does perimenopause/MT extend?

A

To 12 months after menopause (last meses)

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8
Q

Ovulation becomes ______ during perimenopause/MT

A

Sporadic

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9
Q

What is perimenopause/MT characterized by?

A

Irregular menstrual cycles, endocrine changes, & hot flashes

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10
Q

Pathophys of perimenopause/MT?

A

Decline in quality/quantity of follicles, ovaries lose sensitivity to LH/FSH, dec. levels of estrogen and inhibin B (slight inc. in FSH/LH) —> anovulatory cycles, unpredictable menses, estrogen insensitivity, menopause, permanent amenorrhea

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11
Q

Clinical manifestations of perimenopause/MT?

A

Vasomotor sx (hot flashes), irregular menses, sx of dec estrogen (insomnia, vaginal dryness, depression), inc. androgen sx -> hirsutism

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12
Q

Most common sx w/ perimenopause/MT?

A

Hot flashes (seconds to 10 minutes, frequency of 1-2/hr - 1-2/wk), cause sleep disturbance/mood changes

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13
Q

Treatment of hot flashes?

A

Mild: lower room temp, fans, avoiding triggers (spicy food/stress), etc.
Moderate/severe: OCPs, estrogen, SSRI/SNRI, gabapentin, soy, black cohosh

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14
Q

Why is further workup required with irregular menses as a result of perimenopause/MT?

A

Organic disease can occur at the same time (fibroids, polyps, hyperplasia, cancer)

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15
Q

Ddx for vaginal dryness with perimenopause/MT?

A

Stress, meds (antihistamines), vulvar/vaginal lesions (whitening, thickening, cracking of vulvar tissue, raised/erosive lesions should be bx), menopause (atrophic vaginitis)

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16
Q

Tx for vaginal dryness from perimenopause/MT?

A

Lubricants (KY jelly, astroglide) prior to intercourse, moisturizers (longer term tx - Replens, Gyn-Moistrin), Vit E oil

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17
Q

What is menopause?

A

Cessation of menses > 1 yr d/t loss of ovarian function (leads to dec. estrogen/progesterone production)

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18
Q

When if menopause officially diagnosed?

A

after 12 mos of amenorrhea in absence of other causes (test HCG, prolactin, TSH)

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19
Q

What age is considered premature menopause?

A

<40

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20
Q

Average age of onset for menopause?

A

50-52 (may occur 45-55)

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21
Q

What is the only risk factor associated w/ early menopause?

A

Smoking

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22
Q

Hormonal level changes w/ menopause?

A

Decreased progesterone & estradiol (estradiol <20pg/mL)
Increased LH/FSH (>100mU/mL)
*FSH>LH

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23
Q

S/Sx of estrogen deficiency w/ menopause?

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A

Menstrual cycle alterations, hot flashes (vasomotor), sleep disturbances, mood changes, skin/nail/hair changes, inc. cardiovascular events, HLD, osteoporosis, vaginal atrophy, dyspareunia

24
Q

PE for menopause?

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A

Dec. bone density, dry/thin skin w/ dec. elasticity, vaginal atrophy: thin mucosa that is pale/smooth, small uterus/cervix, dec. breast size

25
Physical changes of the reproductive tract w/ menopause?
Atrophy of labia majora, vaginal epithelium Vaginal wall smooth/loses rugation Increase in vaginal pH >/=5 Canal/cervix dec in size, dec secretions Fibroids if present: shrink Endometriosis/adenomyosis resolve if present Minimal trauma w/ exams or sex Ovaries dec in size/no longer palpable Loss of pelvic muscle tone/prolapse of organs
26
What is atrophic vaginitis?
Atrophy of epitheliu w/ dec blood supply: thin/shiny/pale surface that is more susceptible to trauma and infection
27
Sx of atrophic vaginitis?
Dryness, spotting, vaginal pain/burning, dyspareunia, possible urinary sx
28
How to dx atrophic vaginitis?
Clinical (H&P)
29
Tx options for atrophic vaginitis?
1st line: mositurizers, lubes, Vit. E oil 2nd line: Estrogen vaginal creams or ring (cream nightly x 2wks followed by twice wkly, ring left in for 3 mos)
30
Physical changes of the urinary tract w/ menopause?
Atrophic changes of epithelial lining of bladder/urethra (can lead to atrophic cystitis: urgency, frequency, dysuria, incont) --> can lead to frequent UTIs and loss of urethral tone
31
Mammary gland changes w/ menopause?
Dec in breast size, dense tissue replaced w/ adipose tissue
32
Skin/hair changes w/ menopause?
Thinning of skin, dec elasticity Loss of pubic/axillary hair Inc. coarse hair on upper lip/chin
33
Psychological changes w/ menopause?
Depression, dec libido, memory loss
34
Bone changed w/ menopause?
Bone mineral density dec --> osteoporosis
35
Increased chance for what w/ menopasue?
Coronary artery disease
36
Diagnostics for menopause?
12 mos of amenorrhea w/o other cause Serum HCG, prolactin, TSH (FSH often measured but not required for dx) *inc serum FSH >25, inc LH, dec estrogen
37
The "big three" of management of menopause?
Symptoms (hot flashes, vaginal dryness), osteoporosis, CVD
38
Women lose how much bone mass in the first 5-7 years after menopause?
20%
39
Diagnostics for osteoporosis?
DEXA scan (T scores), monitor height changes
40
Tx for osteoporosis from menopause?
Wt bearing exercise, calc/Vit D, bisphosphonates, HRT, SERMS (Raloxifene), Calcitonin, PTH
41
After menopause, the risk of coronary heart disease increases how much compared to premenopausal women of the same age?
2-3x (estrogen deficiency thought to be partially responsible)
42
Is HRT recommended for disease prevention?
No, found to be more harmful than helpful (but can be beneficial for some women depending on risk factors --> Menopausal hormone therapy/MHT)
43
Proven benefits of HRT?
Estrogen/progestin combo: lowers risk of colorectal CA, fractures and improves vasomotor/GU sx Estrogen alone (women w/o uterus): lowers risk of fractures, improves vasomotor/GU sx
44
Complications of HRT?
Estrogen/progestin combo: inc. risk of breast CA, stroke, MI, blood clots, gallbladder dz Estrogen alone: inc risk of stroke, blood clots, gallbladder dz, endometrial CA
45
Recommendations when using HRT?
Use lowest dose possible for shortest time (<5yrs), not indicated for cardioprotection, women w/ intact uterus must take progestine w/ estrogen to prevent endometrial hyperplasia/uterine cancer
46
Current indications for HRT?
Tx of: vasomotor sx, vulvovaginal atrophy/atrophic vaginitis Prevention of: osteoporosis (reserved for women already on estrogen for menopausal sx and cannot tolerate antiresorptive drugs)
47
Formulations of HRT?
Systemic (oral and transdermal patch/gel), Local topical (little systemic abs -> endometrial proliferation rare w/ minimal doses)
48
Possible S/E of HRT?
Nausea, bloating, wt gain, fluid retention, mood swings, breakthrough bleeding, breast tenderness
49
C/I for HRT?
Undiagnosed abnormal vaginal bleeding, known/suspected breast CA or estrogen dependent neoplasia, active or hx of DVT/PE, thromboembolic dz (Factor V Leiden), TIA/stroke, liver dysfunction/dz, endometrial CA or high risk for it
50
Alternatives to HRT for hot flashes?
SSRIs (Paxil, Zoloft effective), soy products, herbal therapies, avoid spicy food/caffeine
51
Alternatives to HRT for osteoporosis?
Calcium/Vit. D dialy, bisphosphonates, wt bearing exercise, avoid RF (smoking, excess alcohol, steroids)
52
Alternatives to HRT for CVD?
Maintain normal cholesterol, treat HTN, exercise, weight control
53
When does HRT take effect in increasing the risk of breast CA?
After 5 years of continuous therapy
54
Estrogen alone in women w/ an intact uterus increases the risk of what?
Endometrial cancer
55
HRT increases the risk of what?
Thromboembolism
56
Treatment for HRT is always what?
Individualized

Special Pops Exam 1 (8 decks)

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