Menopause Flashcards
A point in time 12 months after a woman’s last period.
Menopause
Four stages of menopause:
Premature menopause (before 40)
Perimenopause
Menopause
Postmenopause
The transition state of menopause can start as early as ____.
forty and can take over a decade.
Symptoms associated with menopause:
Hot flashes
Night sweats
Mood swings
Vaginal dryness
Osteoporosis
Treatment and Management of symptoms:
-Hot flashes and night sweats; avoid spice foods, hot drinks, ETOH, and caffeine. Maintain a cool environment.
-Mood Swings: may be treated with SSRI
-Vaginal Dryness: vaginal estrogen, moisturizer, lubricants.
Osteoporosis: Vitamin D & Calcium Supplements. Obtain a Dexa scan.
Hormone Replacement Therapy
Is indicated for severe s/s and prevents bone loss.
Non-Hormone Therapy
used for mild s/s
Vaginal topical estrogen
is helpful for uncomfortable vaginal atrophy and may decrease recurrent urinary tract infections.
Post-menopausal bleeding
It is abnormal for those who are not on HRT and are not having cyclical bleeding due to their menopausal status on HRT.
Common Cause of Post-Menopausal Bleeding:
Vaginal atrophy, causing dryness and pain, requires local treatment such as estrogen therapy
A 79-year-old woman with a 1.5-cm breast cancer underwent lumpectomy. Pathology revealed ductal carcinoma that is hormone receptor negative (estrogen receptor 0%, progesterone receptor 1%) and HER2/neu negative. Surgical margins were adequate and uninvolved with cancer. Sentinel lymph node sampling was negative for lymph node involvement. She has good performance status and no activities of daily living (ADL) or instrumental (IADL) dependencies. What treatment would you recommend?
a. Adjuvant chemotherapy
b. Adjuvant chemotherapy with irradiation
c. Adjuvant irradiation only
d. Hormonal therapy only
d. Hormonal therapy only
On admission to the hospital, an 85-year-old woman was found to have a fungating mass on her right breast. The mass is 9 cm in diameter, partially ulcerated, and associated with edema of the arm and obvious pain. The patient has no children and had lived alone until recently, when a neighbor became concerned for what appeared to be a progressive loss of memory and neglect of the house. A nephew living in another city eventually came to take care of the situation and arranged for the admission. The
patient appears confused and withdrawn; her appearance is disheveled, but she seems
to be independent in her ADLs. The medical history is negative for any serious illnesses. She was able to drive her own car until shortly before this admission. The nephew does not wish to authorize hospice “right now.” A positron-emission tomography scan was negative for metastatic disease. In addition to determining the cause of her delirium, which of the following is the best way to address the breast mass?
a. Tamoxifen should be initiated immediately. If no response is seen in 3 months, the
patient should receive chemotherapy.
b. The mass should be biopsied to study hormone receptor and HER2/neu antigen status.
c. The patient should undergo surgery as initial treatment.
d. The initial treatment should be radiation therapy.
e. No treatment is indicated because the patient’s average life expectancy is less than 1
b. The mass should be biopsied to study hormone receptor and HER2/neu antigen
status.
An 80-year-old woman has no weight loss, no pain, and no distention but over 2 years
increasingly complains of constipation despite adequate medical treatment. A colonoscopy is negative. An abdominal CT is performed. It reveals well circumscribed pelvic masses, the largest adherent to the ovarian ligament. The best first step is:
a. Referral to a gynecological oncologist.
b. Transcutaneous CT guided biopsy.
c. Because it is unrelated to her symptoms advise observation.
d. Refer to hospice because massive ovarian cancer is unlikely to be curable.
e. Invite her to return with a family member and have a long talk about the diagnostic and therapeutic options.
e. Invite her to return with a family member and have a long talk about the diagnostic and therapeutic options.
