Menopause: seibert Flashcards
(63 cards)
1
Q
Describe Menopause:
- what is this event?
- defined as:
A
is a normal, natural event, defined as the final menstrual period (FMP), confirmed after 1 year of no menstrual bleeding
-Portion of aging process where a woman moves from her reproductive years to her non-reproductive years
2
Q
Menopause represents the permanent cessation of ______
A
menses–> resulting from loss of ovarian follicular function, usually due to aging
3
Q
When is menopause? (average age)
A
Naturally (spontaneously), average age 51
4
Q
Can menopause occur prematurely?
A
YES–> Prematurely from medical intervention (eg, bilateral oophorectomy, chemotherapy)
5
Q
Menopause can occur any time from impaired ______ function
A
ovarian
6
Q
___% of women stop menstruating between 44-55yo
A
95%
7
Q
Menopause: sx
A
Symptoms vary by individual and cultural expectations/life circumstance
8
Q
Menopause: classic Sx
A
- Change in menstrual cycle pattern (early)
- Vasomotor symptoms (includes night sweats)
- Vulvovaginal symptoms (dyspareunia)
- Urinary symptoms
9
Q
Menopause: other Sx sometimes associated w menopause
A
- Sleep disturbances besides night sweats
- Cognitive concerns (memory, concentration)
- Psychological symptoms (depression, anxiety, moodiness)
10
Q
Terminology: Perimenopause
A
=The time around menopause, also called “the menopause transition”
-Menstrual cycle and hormonal changes that occur a few years before and 12 months after the final menstrual period
11
Q
Induced menopause= cessation of menstruation that follows _____
A
bilateral oophorectomy (with or without hysterectomy) or chemotherapy, pelvic radiation therapy, or iatrogenic menopause
12
Q
Premature menopause=
A
- Any menopause that occurs before age 40
- Can be natural or induced
- Also called premature ovarian failure
- 0.9% of US population
- Reasons for premature ovarian failure are unknown
13
Q
T/F: Smoking associated with early menopause
A
true
14
Q
Postmenopause=
A
=The years after the FMP resulting from natural (spontaneous) or premature menopause
-With current life expectancy, the postmenopausal years make up about 1/3 of the lifespan of most North American women
15
Q
Menopause: diagnostic studies (list 2 main ones)
A
- Estradiol <20 and FSH level 21-100 helpful in establishing diagnosis
- *FSH of greater than 30mIU/ml is highly suggestive of menopause
16
Q
Changes in both menstrual flow and frequency are common and usually normal:
(describe)
A
Lighter bleeding Heavier bleeding Duration of bleeding Cycle length Skipped menstrual periods Amenorrhea
17
Q
Abnormal uterine bleeding (AUB)=
A
=Heavy menstrual bleeding (avg. blood loss >80 mL), especially with clots
- Menstrual bleeding lasting >7 days or ≥2 days longer than usual
- Intervals <21 days from the onset of one menstrual period to the onset of the next one
- Any spotting or bleeding between periods
- Bleeding after sexual intercourse
- Organic disease can occur – consider endometrial biopsy
18
Q
Vasomotor symptoms:
-describe “hot flashes”
A
- Recurrent, transient episodes of flushing accompanied by a sensation of warmth to intense heat on the upper body and face
- Perspiration and cutaneous vasodilation, may also experience palpitations
- As many as 75% of perimenopausal women have hot flashes
19
Q
Hot flashes: tx?
A
-Treatment based on symptom severity and a woman’s risks and personal attitudes about menopause and medication
–**Estrogens, Progestins, Clonidine, SSRIs and SNRIs, Black cohosh, Gabapentin
20
Q
Hot flash physiology illustration
A
- increased core body temp
- increased skin blood flow
- increased HR
- increased sweating!!
- intense feeling of “heat” with reddening of upper body
- in the end: chills, shivering
21
Q
Menopause: Vaginal symptoms
A
- Sx such as vaginal dryness, vulvovaginal irritation/itching, and dyspareunia are experienced by postmenopausal women
- Unlike vasomotor symptoms, which abate over time, ***vaginal atrophy is typically progressive and unlikely to resolve on its own
- +/- dysuria, urge incontinence, pelvic relaxation, atrophic cystitis, and easy bleeding
22
Q
Vaginal Sx: tx?
A
lubricants and moisturizers, and local vaginal estrogen
23
Q
Menopause: Urinary symptoms
hint: atrophy of ?
A
- Most menopausal women experience varying degree of atrophic changes of vaginal epithelium -> atrophic vaginitis
- Atrophic changes to cervix -> decrease in size and stenosis, reduced secretion of cervical mucus
- Atrophy of uterus, fallopian tubes, and ovaries
- Supporting structures of reproductive organs suffer loss of tone
24
Q
Estrogen plays role in maintaining epithelium of bladder and _____
A
urethra
25
Declining estrogen during menopause may give rise to..
atrophic cystitis, characterized by urinary urgency, frequency, incontinence, and dysuria
26
Atrophic vaginitis: tx?
**Kegel exercises can reduce more than 50% of cases of stress incontinence when performed regularly
27
Menopause:
sexual health changes
-decreased ______ generally increases with aging
libido**
28
Menopause:
sexual health changes
-effects of decreased estrogen?
- Decreased estrogen causes a decline in vaginal lubrication and elasticity
- Decreased testosterone may contribute to a decline in sexual desire and sensation
29
Decreased libido and vaginal health: tx?
An active sex life, lubricants and moisturizers, and local vaginal estrogen help maintain vaginal health
30
Don’t forget STI screening!
| -why?
- Clinicians should not assume that peri- and postmenopausal women are not at risk for STIs
- **Vaginal atrophy increases the risk for contracting an STI
- *Older women may not be as knowledgeable as younger women about infection risks or steps to take to reduce those risks
31
Menopause: sleep disturbances
Peri- and postmenopausal women sleep less, have more frequent insomnia, and are more likely to use prescription sleeping aids
32
Perceived decline in sleep quality may be attributed to:
- General aging effects (eg, nocturnal urination)
- Sleep-related disorders (eg, apnea) or other illness (eg, chronic pain, depression)
- Stress, negative mood
- Ovarian hormone changes (hot flushes and nighttime awakening)
33
Women with frequent flushes may experience flushes and awakening episodes hourly, which may cause profound sleep disturbance that can lead to:
cognitive and anxiety disorders in some
34
Sleep disturbances: Decisions on whether and how to treat—with behavioral or drug therapy, or both—depend on:
- Severity of sleep disturbance
- Context of sleep problem (eg, distressing hot flashes or life stress)
- Severity of daytime consequences
35
Menopause: Cognitive changes
| -Midlife women should be counseled that:
memory and concentration problems are probably not related to menopause but rather to normal aging and/or mood, stress, sleep disturbances, or other life circumstances.
36
Studies show estrogen influences areas of brain important in _____, but recent studies have shown that estrogen alone or in combo with progestin can increase the risk of _____ _____ in women older than 65yo.
memory
-cognitive decline
37
Menopause: mood disorders
Feelings of upset, loss of control, irritability, fatigue, and blue moods (dysphoria) at midlife may be caused by fluctuating hormone levels that perturb neural systems transiently
38
Mood disorders:
| -who is most vulnerable?
- Women with a history of premenstrual syndrome, significant stress, sexual dysfunction, physical inactivity, or hot flashes are more vulnerable to depressive symptoms
- Studies assessing effects of estrogen on depression and other mood disorders are mixed
39
The most predictive factor for depression at midlife and beyond is prior history of ______
clinical depression
40
Mood disorders: tx?
Relaxation and stress reduction techniques, antidepressants, and counseling, or psychotherapy are options to consider in symptom management
41
Menopause: Skin and Hair Changes
- Skin becomes thinner and less elastic
- Hair loss increases
- Nails become brittle
- Facial hair may increase
42
Menopause: osteoporosis
- defined as?
- Definitions based on BMD results:
=systemic skeletal disorder characterized by low bone mass and deterioration with an increase risk in fragility and susceptibility to fracture
-Peak bone mass 25-30yo, then bone loss begins and accelerates in women at menopause, can lose up to 20% of bone mass in 5-7 years after menopause
- Definitions based on BMD results:
- -Normal: T-score greater than or equal to –1.0
- -Low bone mass (osteopenia): T-score between –1.0 and –2.5
- -Osteoporosis: T-score less than or equal to –2.5
43
Osteoporosis risk factors
```
Advanced age (40-90)
Previous fracture (adult life)
Parental history of fragility fracture
Female sex
Current tobacco smoking
Weight (low weight)
Long-term use of glucocorticoids
```
44
National Osteoporosis Foundation recommendations for BMD testing:
- All postmenopausal patients younger than 65yo w/ > or equal to one additional risk factor (other than white, postmenopausal, and female)
- All women age 65yo and older
- Postmenopausal women who present with fractures
- Women considering therapy for osteoporosis if testing would help decision
- Women who have been on HRT for prolonged periods
- Women who have been on treatment to monitor treatment effect
- Women considering discontinuation of treatment
45
Osteoporosis Treatment
-All individuals at risk for or who have been diagnosed with osteoporosis should be advised to consume adequate calcium (minimum of 1200mg daily) and Vitamin D (800-1,000 IU/d), smoking cessation, avoid excess alcohol, and regular weight bearing exercise.
- Pharm therapy is recommended for:
- -Women who have had vertebral or hip fracture
- -Women with T-scores ≤−2.5 with no risk factors
- -Women with T-scores from −1.0 and below with a 10-year FRAX risk of major osteoporotic fracture of at least 20% or of hip fracture of at least 3%
- --Example - Bisphosphonates
-Alendronate 70 mg tablet po q weekly
46
Menopause: Cardiovascular disease
- Heart disease affects about 8 million women in US
- Deaths from CHD in women number more than 230,000 per year
-CHD increases with age
Before age of menopause, very few women die from CHD
- After menopause rate of CHD increases 2-3x
- Numerous studies show estrogen and progesterone receptors present in heart and aorta
- HRT should not be prescribed for prevention of CHD, decision to use should be based on benefits of other systems, potential risks, and patient preference
47
For better cardiovascular health:
| -advise Pt to ____
have good cholesterol, blood pressure, blood glucose, BMI, quit smoking, eat healthy and be physically active
48
Because cancer rates increase with age, screen for the following cancers regularly:
Breast cancer
Colorectal cancer
Cervical cancer
49
Hormone therapy (HT) FDA approved indications:
prevention of osteoporosis, treatment of vasomotor symptoms, and treatment of vulvovaginal atrophy. HT encompasses both estrogen-alone and estrogen-progestogen therapies.
50
Estrogen therapy (ET)=
Unopposed estrogen is prescribed both a) systemically for women who do not have a uterus, and b) locally in very low doses for any woman with vaginal symptoms
51
Estrogen-progestogen therapy (EPT)=
Progestogen is added to ET to protect women with a uterus against endometrial cancer, which can be caused by estrogen alone
52
Bioidentical hormone therapy (BHT)=
Consists of hormones chemically identical or very similar to those made in the body. Available from two sources: 1) FDA-approved and tested; 2) unapproved and untested from compounding pharmacies
53
Hormone therapy—what we know today
-HT formulation, route of administration, and timing of initiation produce different effects (e.g. transdermal route may carry lower risk for thrombosis)
54
Absolute risks for HT include:
- thrombosis, stroke, and cardiovascular events
- HT initiation in older women carries greater risks
- **Breast cancer risk increases with EPT in WHI study
- Consider each woman’s priorities and risk factors prior to initiating HT
55
Contraindications to (HRT) hormone replacement therapy: (list)
- Undiagnosed vaginal bleeding
- Active DVT or PE or a history of these conditions
- **Arterial thromboembolic disease (MI and stroke)
- Liver disease
- History of endometrial or breast cancer
56
Alternatives to hormone therapy:
| -Nonhormonal prescription drugs (off-label use):
- Antidepressants:
- -SSRIs: fluoxetine, paroxetine, escitalopram
- -SNRIs: venlafaxine and desvenlafaxine
- Insomnia:
- -Eszopiclone - (Lunesta)
- Anticonvulsant:
- -Gabapentin
- Antihypertensive:
- -Clonidine
-Neuropathic pain drug:
Pregabalin
57
Complementary & Alternative Medicine (list Ex's)
- Soy isoflavones:(phytoestrogen)
- Traditional Chinese medicine
```
-Herbs:
Black cohosh
Cranberry
St. John’s wort
Valerian- good for anxiety
```
-Over-the-counter hormones: (dietary supplements)
Melatonin
58
Lifestyle changes:
- Try relaxation techniques (eg. yoga, meditation)
- Eat a healthy diet
- Get regular exercise
- Avoid hot flash triggers (eg, caffeine, alcohol, spicy food)
- Keep cool:
- -Dress in layers (eg. light clothing)
- -Sleep in cool room (eg. fan, thermoregulating pillow)
- -Consume cold drinks
-Reduce sexual discomfort and increase sensitivity with moisturizers, lubricants, and vibrators
59
POSTMENOPAUSAL HEALTH:
The menopause transition and the time afterward are important periods for implementing lifestyle and behavioral changes to ensure that each woman:
maximizes her health moving forward.
60
Lifestyle counseling for midlife women:
| -Discontinue unhealthy habits: (list)
Tobacco use
Excess Alcohol
Drug/medication abuse
61
Lifestyle counseling for midlife women:
| -Promote healthy food and exercise:
Limit fat and cholesterol intake
Maintain caloric balance
Consume whole grains, fruits, vegetables, water
Ensure adequate vitamin and mineral intake, especially calcium and vitamin D
Engage in regular physical activity
62
Lifestyle counseling for midlife women:
| -injury prevention ?
-Wear lap/shoulder belts in the car
- Institute fall prevention methods
- Appropriate helmet and other safety equipment
- An adequate number of smoke and carbon monoxide detectors
- Ensure safe storage or removal of firearms
- Set water heater thermostat between 120°F and 130°F or lower
- Train household members to deliver cardiopulmonary resuscitation
63
Lifestyle counseling for midlife women
| -Sexual behavior?
- Institute prevention of sexually transmitted infections
- Avoid high-risk sexual behavior
- Use condoms or female barrier, or both
- Prevent unintended pregnancies with appropriate contraception
