menopause Flashcards
(43 cards)
when do you begin screening women for osteoporosis
healthy women by age 65
earlier if women smoke, drink, RA, hx of fractures, dz/meds that add to the risk, body weight less than 127
combo estrogen and progestin Hormone Therapy
increases risk of
but decreases risk of
increases risk of:
- thromboembolic events
- breast CA
- CVD
- stroke
decreases risk of
- fractures
- colon CA
what are some non-pharmacologic osteoporosis preventative measures that pts can take
exercise: weight bearing, resistance, walking, aerobics
nutrition:
increase Ca to 1200 mg/ day at age 50
increase Vit D to 800 at age 70
avoid:
smoking, ETOH
laboratory diagnosis of perimenopause
FSH > 25
what are the non-hormonal pharmacological treatments for the vasomotor sxs of perimenopause and menopause
SSRIs (esp. LD paroxetine)
SNRIs
centrally acting anti-epileptics (gabapentin, pregabalin, clonidine)
vaginal vault apical pelvic prolapse
enterocele
stage 1 pelvic organ prolapse
more than 1 cm from the hymenal ring (inside)
Hispanic women are more susceptible to ___
pelvic organ prolapse
stage 3 pelvic organ prolapse
beyond 1 cm past the hymenal ring but still in vagina
what type of hormone therapy do you give
to a woman who has
undergone a hysterectomy
estrogen only
posterior compartment pelvic prolapse
rectocele
why is progestin added to estrogen in Hormone Therapy for women with a uterus
to decrease the risk of endometrial hyperplasia and endometrial CA
what type of hormone therapy do you give
to a woman who
still has an intact uterus
combo estrogen and progestin
(b/c unopposed estrogen with a uterus can cause endometrial hyperplasia and increase the risk of endometrial CA)
what are the components of the genitourinary syndrome of menopause
vulvovaginal atrophy (dryness, itching, dyspareunia)
sexual dysfunction
urinary frequency
recurrent bladder infections
white women and menopausal side effects
more susceptible to ___
osteoporosis
DEXA T score’s:
normal
osteopenia
osteoporosis
normal = - 1 +
osteopenia = - 1 to - 2.5
osteoporosis = less than - 2.5
when treating a patient w/ systemic hormone therapy,
what should the dose be?
for how long should they take it?
lowest effective dose
for the shorterst duration needed
(generally not more than 5 years or beyond 60)
how do you treat the sexual dysfunction sxs of postmenopause
why would not give everyone this (side effects)?
testosterone
but
side effects: lipids, clitoromegaly, hirsutism, and acne
risk factors for pelvic organ prolapse
- vaginal deliveries
- advanced age/ menopause
- obesity
- CT disorder
- chronic dz (constipation/ COPD)
- Hispanic
stage 4 pelvic organ prolapse
beyond the vagina
asian women and menopausal side effects
more susceptible to ___
less susceptible to ___
more susceptible to osteoporosis
less susceptible to vasomotor sxs
how often do you monitor osteoporosis once you begin?
- normal BMD- Q 5 to 15 years
- osteopenia (-1.5 to -1.99)- Q 5 years
- osteopenia (-2 to -2.5)- yearly
- osteoporosis- after tx Q2 years
pelvic organ prolapse treatment
pessary
pelvic floor muscle exercises (kegels)
surgical tx (symptomatic/ refractory)
what are the non-pharmacological treatments for the vasomotor sxs of perimenopause and menopause
lifestyle mods (layering clothes, avoid ETOH and caffeine)
exercise
phytoestrogens (soy, red clover)
herbal remedies (black cohosh, ginseng, ginkgo
vitamin E
accupuncture
** limited data for all of this **
