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Clin Med III exam III > Menopause, Infertility and PCOS > Flashcards

Menopause, Infertility and PCOS Flashcards

(81 cards)

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1
Q

What is menopause

A

permanent cessation of menstruation, 12 months of amenorrhea without any pathological cause

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2
Q

What can cause premature menopause before the age of 40

A
  • primary ovarian insufficiency

- premature ovarian failure

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3
Q

What are the stages of menopause

A

preimenopause–> menopause—> post menopause

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4
Q

What is the pathophys behind menopause

A
  • decline in the quantity and quality of follicles and oocytes
  • granulosa cells stop making estrogen and inhibin–>loss of the negative feedback loop–> FSH and LG production increased with no response from the ovary
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5
Q

Signs and symptoms of menopause

A
  • vasomotor sx’s
  • sleep disturbances
  • mood changes
  • cognitive changes
  • breast pain/tenderness
  • joint aches and pains
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6
Q

PE findings of menopause

A
  • fusion/ resorption of labia minora
  • vagina–> atrophic, pale, lack of rugae, diminished elasticity, shorter/ narrower
  • cervix–>atrophic, decreases in size, flush with top of vaginal vault, can become stenotic
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7
Q

What are long term effects of menopause

A
  • dementia
  • cardiovascular disease
  • osteoperosis
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8
Q

Lifestyle modifications to treat menopause

A
  • lower room temp
  • use fans
  • dress in layers
  • avoid triggers
  • smoking cessation
  • exercise
  • weight loss
  • lubricants
  • vaginal dilators or intercourse
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9
Q

When is hormone replacement therapy indicated

A

women whose sx’s cannot be controlled by lifestyle modifications

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10
Q

Hormone replacement therapy is not indicated for what two things

A
  • long term use

- prevention of disease

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11
Q

Contraindications of hormone replacement therapy

A
  • CAD
  • VTE
  • CVA
  • TIA
  • liver/gallbladder disease
  • breast/endometrial cancer
  • unexplained vaginal bleeding
  • hypertriglyceridemia
  • known thrombophilias
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12
Q

Administration forms of estrogen for HRT

A
  • oral
  • transdermal
  • topical gels and lotions
  • intravaginal creams and tablets
  • vaginal rings
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13
Q

Why do you start on a low dose and then titrate with HRT

A

the lower doses have fewer effects on coagulation and inflammatory markers —> possible lower risk of stroke and VTE

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14
Q

Which type of estrogen is best for lipid profiles

A

oral 17-beta estradiol

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15
Q

Which medication for HRT has a lower risk for VTE and stroke

A

transdermal 17-beta estradiol

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16
Q

First line for HRT

A

oral micronized progesterone

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17
Q

All women with a uterus need ___ to prevent ___ (HRT)

A

need progestin to prevent endometrial hyperplasia

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18
Q

What are the side effects of progestin

A
  • mood changes

- bloating

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19
Q

Benefits of topical vaginal estrogen replacement

A
  • can be used indefinitely

- low risk for adverse effects

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20
Q

Topical vaginal estrogen only treats, ___ not ___

A

only treats vaginal atrophy, not hot flashes

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21
Q

What are SERMs used for

A

treatment of menopausal vasomotor sx’s and osteoperosis prevention

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22
Q

Do you need to give progestin with SERMs? Why or why not?

A

No because SERMs prevent estrogen induced endometrial hyperplasia

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23
Q

Which women are candidates for SERMs

A

women with moderate-to severe hot flashes who have breast tenderness w/ standard EPT
-women that cannot tolerate progestin therapy because of side effects

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24
Q

SERMs increase what risk

A

VTE risk

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25
When are OCPs used for menopause
- used in perimenopausal women who also desire contraception | - women who need control o fheavy bleeding
26
OCPs should be avoided in which women
- obese d/t VTE risk | - hx of smoking, HTN or migraines
27
What are some non hormonal options for menopause treatment
- clonidine - SSRIs (paroxeinte, fluoxetine) - venlafaxine - gabapentin - bellergal
28
What is infertility based on
fecundability
29
What is fecundability
the probability of being pregnant in a single menstrual cycle
30
What is primary infertility
inability to conceive in a couple who has never been pregnant
31
What is secondary infertility
inability to conceive in a couple with a hx of prior pregnancy
32
What type of work up is done for infertility
- history and physical - evaluation of lifestyle - female evaluation - male evaluation
33
Labs to evaluate a female for infertility
- TSH - prolactin - STI testing - prenatal screening - genetic testing
34
Ovarian evaluation for infertility
-first need to confirm evaluation Ovarian reserve testing - FSH and estradiol day 3 labs - clomiphene citrate challanges test - anti mullerian hormone - antral follicle count
35
Uterine evaluation for infertility
- hysterosalpingogram - hysterosalpingo contrast sonography - hysteroscopy - sonohystogram - pelvic US - laparoscopy
36
What things are done for a male evaluation for infertility
- scrotal US - semen analysis - STI testing - genetic testing - endocrine labs in indicated
37
What is the most frequent cause of male infertility
oligiospermia
38
What is oligiospermia
low concentration of sperm in ejaculate
39
What is azoospermia
complete absence of sperm
40
What is asthenospermia
abnormal sperm motility
41
What is teratospermia
abnormal sperm morphology
42
All infertility therapies center around what
manipulation of the physiologic HPO axis
43
What are the two ways that the HPO axis can be manipulated
- ovulation induction | - controlled ovarian stimulation
44
What are the 3 classes of drugs used for ovulation induction
- SERMs (clomiphene citrate, tamoxifen) - Aromatase inhibitors (letrozole) - dopamine agonist (bromocriptine, cabergoline)
45
How does clomiphene cirtrae work
competes with estrogen in the body to bind with estrogen receptors--> inhibits and depletes the available receptors--> block the negative feedback of endogenous estrogen on hypothalamus---> higher plasma levels of FSH and LH--> stimulation of ovarian follicular growth
46
What is the first line treatment for ovulation induction
clomiphene citrate
47
What population is clomiphene citrate most successful in
women with oligio or anovulation who are normogonadotrophic
48
When is clomiphere citrate given
in the early follicular phase
49
If your patient is taking clomiphene citrate what should you monitor
- urinary LH - retrospectively with basal body temperature charting - tranvaginal US
50
Why are transvaginal US done on women that are taking clompihene citrate
to assess follicular response and timed administration of hCG to trigger ovulation
51
When do pregnancy rates decrease with clomiphene citrate
after 6 cycles
52
Side effects of clomiphene citrate
- vasomotor sx's - mood swings - visual sx's (blurred or double vision)
53
What are adverse effects of clomiphene citrate
- miscarriage - birth defects - ovarian cancer if used for >12 months - increased risk of multiples
54
Tamoxifen might increase the risk of what
miscarriage
55
How do aromatase inhibitors work
block the enzyme that converts androgens to estrogens--> decreases estrogen levels--> decreases negative feedback and increases release of FSH
56
Aromatase inhibitors may be more effective than Clomid in women with what
PCOS
57
Side effects of aromatase inhibitors
- hot flashes | - GI upset
58
Aromatase inhibitors have what effect on the uterus
anti estrogen effects
59
When are dopamine agonists used in infertility
restoration of ovulation in women with hyperprolactinemia
60
Out of the two options for dopamine agonists which is better. Why?
cabergoline because it is more elective and has fewer side effects
61
How do dopamine agonists work
acts like dopamine which suppresses prolactin synthesis and release--> normilization of prolactin returns HPO axis to normal
62
When should you expect a drop in prolatin when using dopamine agonists
2-3 weeks
63
What should accompany normalization of prolactin levels when using dopamine agonists
normal menstrula cycles
64
Side effects of dopamine agonists
- dizziness - nausea - hypotension
65
What can be done to improve side effects of dopamine agonists
administer vaginally
66
How is intrauterine insemination done
semen is spun down in lab, washed and injected into uterine cavity via catheter threaded through the cervix
67
Steps to IVF
- medication given to control ovulation stimulation - ovarian follicle development is done - HCG or lupron is given to trigger maturation - Oocyte is retrieved - oocyte and sperm is placed in IVF culture medium - fertilization and embryo transfer
68
What is intracytoplasmic sperm injection
procedure where a sinlge sperm is directly injected into each mature egg
69
When is ICSI used? Why?
"severe male factor" because the probability the sperm will penetrate the oocyte on its own is low
70
What is assisted hatching
a procedure in which a hole is made in the zona pellucida just prior to embryo transfer to facilitate hatching of the embryo
71
Assisted hatching is used in....
- older women | - couples who have had unsuccessful prior IVF attempts
72
When is preimplantation genetic screening done? What does it screen for
used in couple that are both chromosomally normal with recurrent pregnancy loss screens embryos for aneuploidy
73
When is preimplantation genetic diagnosis done? What does it screen for?
used when one or both parents carry a specific known genetic mutation or defect screens for that specific defect
74
Women with PCOS have an increased risk of what types of things
- CV disease - obesity - glucose intolerance/T2DM - metabolic syndrome - dyslipidemia - fatty liver disease - obstructive sleep apnea
75
What are common signs and syndromes of PCOS
- irregular menstrual cycles - obesity - acanthosis nigrans - hyperandrogenism - elevated serum testosterone - "string of pearls" on ovaries - mood changes
76
What criteria is used to diagnose PCOS
rotterdam criteria
77
What is the rotterdam criteria
2/3 of the following - ovulatory dysfunction - chemical and/or biochemical signs of hyperandrogenism - polycystic ovaries on ultrasound
78
What are the goals of PCOS treatment
- improve hyperandrogenic symptoms - manae underlying metabolic abnormalities and reduce risk factors - prevention of endometrial hyperplasia and endometrial carcinoma
79
First line intervention for PCOS
weight loss via diet and exercise
80
Treatment for PCOS is women not pursuing pregnancy
- OCPs - metformin (alternative) - spironolactone - GnRH agonist
81
Treatment for PCOS in women pursuing pregnancy
- clomid - letrozole - metformin

Clin Med III exam III (10 decks)

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