Menopause + sexual dysfunction Flashcards
(39 cards)
what stage of menopause: mood changes, heavy bleeding, hot flashes, fatigue, cramping, night sweats, poor sleep, skipped periods
perimenopause
Mean cycle shortens over time due to shortened follicular phase with luteal phase remaining stable
perimenopause
Progesterone levels similar to young women
Estradiol levels lower
FSH levels higher
LH levels stable
perimenopause
Atrophic vaginitis, increase in vaginal pH (predisposed to infection), atrophic changes to the cervix (reduced secretion of cervical mucus → dryness and dyspareunia), atrophy of uterus, oviducts, ovaries
Atrophic cystitis (urinary urgency, frequency, incontinence, dysuria), with loss of urethral tone
Regression of breast size
menopause
what can cause early menopause?
smoking
menopause onset is usually at what age?
50-51 years
What are the two types of menopause?
1 Physiologic
Oocyte number decreases throughout reproductive years (ovulation and atresia)
Can be from premature or primary ovarian insufficiency, disease processes
2 Artificial
Surgical removal of ovaries or by radiation therapy, treatment for endometriosis, side effect of intra abdominal disease treatment
definition of menopause:
when you have not had a period for at least 12 months
perimenopause is generally in your
40s, and can last 8-10 years
Low androstenedione
Normal testosterone
Low DHEA, DHEAS
Low estradiol, estrone
Low progesterone
FSH and LH rise >100
menopause
how do you treat perimenopause (which is really when you are the most symptomatic, and when you need treatment)?
Hormonal therapy if no CI
– <60 within 5-10 years of onset
Estrogen only if no uterus
Estrogen + progestin if uterus still present
(at lowest doses possible)
Consider SSRIs
Vulvovaginal atrophy – vaginal pruritus, leukorrhea, burning, soreness, dyspareunia
Thin/watery or serosanguinous discharge
Urinary: frequency, urgency, dysuria, urge incontinence
genitourinary syndrome
genitourinary syndrome is a direct consequence of
hypoestrogenic states
how do you treat genitourinary syndrome?
Water soluble lubricants and/or topical vaginal estrogens
Systemic estrogens (vaginal preferred)
SERM – ospemifene to treat dyspareunia
Sudden flushing and perspiration (hot flash) ~4 min from 1-2/hr to 1-2/week
vasomotor symptoms from menopause
how do you treat vasomotor symptoms?
Behavioral modifications – layers, thermostat, avoid spicy foods, reduce obesity, training, hypnosis, acupuncture
Hormone therapy – healthy symptomatic women within 10 years of menopause or under 60 with no CI
Nonhormone therapy – clonidine, SSRIs, SNRIs (paroxetine, escitalopram, venlafaxine), gabapentin
Complementary/alternative - isoflavones, herbs (black cohosh, ginseng, St. Johns, ginkgo, vitamins E and K)
How do you treat sexual dysfunction from menopause?
Vaginal symptoms:
-Vaginal lubricants + moisturizers
-Estrogen - systemic or local
Androgen therapy
-Testosterone to improve sexual function
-DHEA (still being studied)
What are consequences of estrogen decline?
CAD, bone resorption acceleration (osteoporosis)
What DEXA score is concerning?
</= -2.5
Any uterine bleeding in a postmenopausal woman is
abnormal
Endometrial atrophy, proliferation or hyperplasia, endometrial or cervical cancer, administration of estrogens w/o or w/ added progestin
OR - atrophic vaginitis, trauma, endometrial polyps
can cause:
postmenopausal bleeding
PE: inspect vulva and vagina (bleeding, ulcers, neoplasms)
Cervical cytology if indicated
TV US to measure endometrial thickness
postmenopausal bleeding
TVUS: Endometrial stripe </= 4mm =
low likelihood of hyperplasia or endometrial cancer
TVUS: >4mm or persistent bleeding
endometrial sampling
