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Menstruation Flashcards

1
Q

Menarche comes after _______ + _______

A

Menarche comes after thelarche (boobs) + pubarche (pubs)

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2
Q

Normal Ranges for Menstruation

  1. Start age
  2. Duration
  3. Blood loss: < ___ mL
  4. Cycle length
A

Normal Ranges for Menstruation

  1. Start age = 11-13
  2. Duration = 3-7 days
  3. Blood loss: < 80 mL
  4. Cycle length =21-35 days
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3
Q

first phase of the menstrual cycle

  1. whats it called (2)
  2. what days/events mark the beginning/end
A

First phase of menstrual cycle

  1. Called the follicular/proliferative phase
  2. Day 1 (menses) - LH surge (usu day 14)
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4
Q

What hormones dominate the follicular/proliferative phase

A

Follicular/proliferative phase dominated by FSH and estrogen

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5
Q

What hormone causes the primary/dominant follicle to be selected and produce estrogen

A

FSH –> primary/dominant follicle selected –> domin follicle produces estrogen

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6
Q

What is the role of estrogen w/ the endometrium

A

Estrogen –> endometrial lining to proliferate

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7
Q

What cycle day does LH surge usually occur and what does it cause

A

LH surge = day 14

  • causes ovulation to occur
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8
Q

second phase of the menstrual cycle

  1. what is the name of it (2)
  2. what hormone dominates it
A

second phase of the menstrual cycle

  1. Luteal/Proliferative phase
  2. dominated by progesterone
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9
Q

Progesterone

  1. What secretes itprogesterone
  2. what is the role of it w/ endometrium
A

Progesterone

  1. secreted by corpus luteum
  2. maintains the endometrium/preps for implantation of ovum
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10
Q

If the ovum is not fertilized in 24 hrs what happens to the corpus luteum, progesterone, and endometrium

A

If the ovum is not fertilized in 24 hrs –> corpeus luteum degenerates –> decr progesterone levels –> slough the endometrium –> menstruation

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11
Q

Primary Amenorrhea definition:

Absence of menarche by:
1. age ___ in presence of pubertal devel

  1. age ___ in ABSENCE of pubertal devel
  2. ___ yrs after completion of sexual maturity
A

Primary Amenorrhea definition:

Absence of menarche by:
1. age 16 in presence of pubertal devel

  1. age 14 in ABSENCE of pubertal devel
  2. 2 yrs after completion of sexual maturity
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12
Q

What PE exam is the marker for ovarian fxn

A

breast exam = marker for ovarian fxn

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13
Q

Amenorrhea Labs

  1. high FSH indicates what type of d/o
  2. low/norm FSH indicates what type of d/o
A

Amenorrhea Labs

  1. high FSH indicates ovarian d/o
    - ovaries not secreting hormones –> neg feedback on FSH –> incr FSH produced)
  2. low/norm FSH indicates hypothal/pituitary d/o
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14
Q

Etiology of Primary Amenorrhea

  1. 2 conditions that cause No breasts or uterus
  2. 2 conditions occur when breasts present but no uterus
  3. 2 conditions where breasts + uterus both present
A

Etiology of Primary Amenorrhea

  1. No breasts or uterus
    - Gonadal agenesis (46 XY)
    - Enzyme defic in testerone syn
  2. Breasts present but no uterus
    - Mullerian Agenesis
    - Testicular Feminization /Androgen Insensitivity
  3. Breasts + uterus present
    - Imperforate hymen
    - Transverse vaginal septum
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15
Q

Etiology of Primary Amenorrhea: No breasts but uterus present

  1. 2 locations of body where these problems occur
A

Etiology of Primary Amenorrhea: No breasts but uterus present

  1. Hypothalamus (HPO axis disruption)
  2. Ovaries (Ovarian Failure)
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16
Q

Etiology of Primary Amenorrhea: Ovarian Failure

name 2 types

A

Etiology of Primary Amenorrhea: Ovarian Failure

  1. Gonadal Agenesis
  2. Turner’s Syn
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17
Q

Etiology of Primary Amenorrhea: HPO Axis Disruption

name 2 possibles causes

A

Etiology of Primary Amenorrhea: HPO Axis Disruption causes

  1. CNS lesion
  2. Inadequate GnRH
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18
Q

Primary Amenorrhea: Ovarian Failure

  1. What lab abnormalities seen
  2. What anatomically is present/absent
  3. how to determine if Gonadal agenesis vs Turners
A

Primary Amenorrhea: Ovarian Failure

  1. decr estradiol –> incr LH and FSH
  2. (+) uterus, (-) breasts
  3. Gonadal agenesis = 46XX, Turner’s = 45XO
    note: decr estradiol –> no breasts
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19
Q

A gonadal streak w/no ovaries, uterus present but no breasts, short stature, webbed neck, infertility, heart defects and learning disabilities are a/w what condition

  • what is the karyotype a/w this condition
A

Gonadal streak w/no ovaries, uterus present but no breasts, short stature, webbed neck, infertility, heart defects and learning disabilities –> Turner’s Syndrome
(45 XO)

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20
Q

What is the Tx for Turner’s Syndrome

A

Tx for Turner’s = replace estrogen (whats missing)

note: usu given w/progesterone to reduce risk of BCA

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21
Q

If pt has no breasts but has uterus how to do you determine if the d/o is due to a problem at the ovaries or the hypothalamus

A

No breasts but uterus present, determine if hypothal or ovary problem –> LABS

Ovarian failure –> decr estradiol, incr LH + FSH

Hypothal prob –> ALL labs decr (GnRH, LH, FSH)

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22
Q

(+) breasts, (-) uterus: Outflow Tract Abn… Mullerian Agenesis vs Androgen Insensitivity

  1. Which is a congental malformation –> no uterus + short vagina
  2. Which is has scant/no axillary or pubic hair
  3. Which a/w high levels of testosterone and 46 XY karyotype
  4. Which is a/w renal anomalies
A

(+) breasts, (-) uterus and norm labs: Outflow Tract Abn… Mullerian Agenesis vs Androgen Insensitivity

  1. congental malformation –> no uterus + short vagina = Mullerian Agenesis
  2. scant/no axillary or pubic hair = Androgen Insensitivity
  3. high levels of testosterone, 46 XY karyotype = Androgen Insensitivity
  4. renal anomalies = Mullerian Agenesis
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23
Q

Primary Amenorrhea: Genital Tract Obstruction

  1. labs: norm or abn
  2. anatomy: whats present/absent
  3. 2 examples
  4. Tx for both (gen)
A

Primary Amenorrhea: Genital Tract Obstruction

  1. labs: normal
  2. anatomy: normal (both breasts + uterus present)
  3. Examples
    - imperforate Hymen
    - tranverse vaginal septum
  4. Tx for both = surgery
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24
Q

Primary Amenorrhea: HPO axis disruption

Name of condition caused by inadequate GnRH
Sxs = ansomia, delayed puberty, lack breast develop
Tx = hormone replacement

A

Primary Amenorrhea: HPO axis disruption

Name of condition caused by inadequate GnRH
Sxs = anosmia, delayed puberty, lack breast develop
Tx = hormone replacement

Kallmann Syndrome

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25
What is the MC cause of delayed puberty/primary amenorrhea what karyotypes can it be a/w it (2)
MC cause of delayed puberty/primary amenorrhea = Gonadal dysgenesis what karyotypes can it be a/w it (2)
26
Definition of 2ndary Amenorrhea Absence of menstruation for: 1. ___ months/cycles in pts w/prev regular cycles or 2. ___ months in pts w/irreg cycles 3. MC cause =
Definition of 2ndary Amenorrhea Absence of menstruation for: 1. 3 months/cycles in pts w/prev regular cycles or 2. 6 months in pts w/irreg cycles 3. MC cause = pregnancy
27
Secondary Amenorrhea: how to determine site of disorder based on labs 1. Site if all labs decr (FSH, LH, Estradiol) 2. Site if PRL abn 3. Site if decr Estradiol, incr FSH and LH 4. Site if normal hormone levels
Secondary Amenorrhea: how to determine site of disorder based on labs 1. all labs decr (FSH, LH, Estradiol) --> Hypothal d/o 2. PRL abn --> pituitary d/o 3. Decr Estradiol, incr FSH and LH --> Ovary d/o 4. normal hormone levels --> uterine d/o
28
Progestin Withdrawal Test: admin DepoProvera x 10 days --> stop progesterone --> see if bleed 1. (+) withdrawal bleed --> problem where 2. (-) withdrawal bleed --> problem where (3)
Progestin Withdrawal Test: admin DepoProvera x 10 days --> stop progesterone --> see if bleed 1. (+) withdrawal bleed --> ovarian problem 2. (-) withdrawal bleed - hypothal, pituitary, or uterine problem
29
2ndary Amenorrhea: Pt presents w/ wt loss, excessive exercise, anorexia nervosa, amenorrhea x 7 months and osteopenia. Labs show decr FSH, LH and estradiol Dx? Best Tx?
Dx = Functional Hypothalamic Amenorrhea Tx = OCPs
30
2ndary Amenorrhea: G2P2 F presents w/ amenorrhea x 8 mo after delivering vaginally. She had postpartum hemorrhage and one episode of HoTN after delivery. She wasnt able to BR feed her baby. Labs showed decr PRL, T4, TSH, FSH, estradiol, and cortisol Dx? Tx?
Dx = Sheehan Syndrome Tx = replace pituitary hormones
31
If pt has pituitary adenoma what is the PRL level expected to be?
Pituitary adenoma --> elevated PRL
32
Menopause before age 40 is called
Menopause before age 40 is called Premature Ovarian Failure
33
What is the hallmark lab value a/w POF
POF --> elevated FSH
34
Pt is 36 y/o F who is experiencing hot flashes, vaginal dryness/atrophy, and incr FSH. Dx? What condition are concerned about in this pt?
Dx = Premature Ovarian Failure Concerned about osteoporosis
35
Another name for PCOS
PCOS also called Stein Leventhal Syndrome
36
Pt w/long standing h/o irregular cycles, obesity, hirsutism, acne. Labs show incr LH:FSH ratio. US showed string of pearls. Dx? Tx? (2) Pt is at risk for what d/t chronic anovulation?
Dx = PCOS Tx = OCPs, metformin Pt is at risk for endometrial CA d/t chronic anovulation
37
Pt c/o 7 mo of amenorrhea after a spontaneous abortion which required a D&C. What is the BEST way to make Dx and Tx? Dx?
Best way to make Dx + Tx = Hysteroscopy Dx = Asherman Syndrome
38
Asherman Syndrome What are the 2 MC ways to Dx it
Asherman Syndrome: 2 MC ways to Dx it 1. HSG- Hysterosalpingogram 2. SIS - Saline Infusion US Other = Pelvic US (not spp)
39
painful cyclic menstruation = 1. a/w no identifiable pelvic pathology 2. a/w pelvic pathology (endometriosis, PID, fibroids, cervical stenosis)
painful cyclic menstruation 1. not a/w identifiable pelvic pathology = Primary dysmenorrhea 2. a/w pelvic pathology (endometriosis, PID, fibroids, cervical stenosis) = secondary dysmenorrhea
40
What is the likely cause of the cyclic pain a/w primary dysmenorrhea
incr PGs --> cyclic pain a/w primary dysmenorrha
41
When does the pain in primary dysmenorrhea occur in relation to menses
Primary dysmenorrhea --> pain in first 2-3 days of menses
42
18 y/o pt presents c/o diffuse pelvic pain and cramping that is worse the first 2-3 days of her menses. Pt also c/o HA, N/V. PE is normal Dx and best Tx (2 things)
Dx = Primary dysmenorrhea Tx = NSAIDs + OCPs
43
Tx of Dysmenorrhea 1. How do NSAIDs decr pain 2. when to start taking NSAIDs and how long to continue them 3. How do OCPs help w/pain 4. What the only type of IUD that CANT be given --> more painful pds
Tx of Dysmenorrhea 1. NSAIDs --> decr PGs --> decr pain 2. start taking NSAIDs 2-3 days before menses and continue for 1-3 days 3. OCPs --> decr PGs, ovulation and endometrial growth --> decr pain 4. Copper/Paraguard IUD CANT be given --> more painful pds
44
When must the Sxs of PMS and PMDD occur (what phase of menstrual cycle) and how many wks before menses
Sxs of PMS and PMDD must occur during 2nd half/luteal phase of menstrual cycle and 2 wks before menses
45
PMS Dx Criteria 1. how many prior menstrual cycles w/Sxs needed to Dx PMS 2. How many Sx free days must occur during the 1st half/follicular phase of menstrual cycle 3. Sxs of PMS must ____ w/ onset of menses
PMS Dx Criteria 1. 3 prior menstrual cycles w/Sxs needed to Dx PMS 2. 7 Sx free days must occur during the 1st half/follicular phase of menstrual cycle 3. Sxs of PMS must RESOLVE w/ onset of menses
46
17 y/o pt comes in c/o of irritability, sad/depressed mood, food cravings, poor concentration, anxiety, bloating, fatigue, breast tenderness, HA, and dizziness for the past 5 months. She says these symptoms occur about 2 wks before her period and get better once she gets her period. Dx?
Dx = PMS
47
How PMDD differs from PMS Dx Criteria 1. Need at least __ Sxs during most cycles over the past ____ 2. One Sx must be: (list 4 things) 3. How many consecutive cycles needed
How PMDD differs from PMS Dx Criteria 1. Need at least 5 Sxs during most cycles over the past YEAR 2. One Sx must be: - depressed mood, anxiety, lability, or irritability 3. 2 consecutive cycles needed
48
17 pt comes in c/o of irritability, sad/depressed mood, food cravings, poor concentration, anxiety, bloating, fatigue, breast tenderness, HA, and dizziness for the past 2 years during most cycles. She says these symptoms occur about 2 wks before her period and get better once she gets her period. The sxs have been getting so bad that she has trouble functioning at school. Dx? why?
Dx = PMDD - Sxs for over 1 yr - has at least 1 of required Sxs - Sxs markedly interferes w/her life - occurred in 2 consecutive cycles
49
Tx for PMS and PMDD 1. Mild Sxs --> (gen) 2. Mod-Sever Sxs --> what drug class is 1st line
Tx for PMS and PMDD 1. Mild Sxs --> Lifestyle modifications 2. Mod-Sever Sxs --> SSRIs 1st line
50
Tx for PMS/PMDD w/SSRIs 4 common SSRIs used
Tx for PMS/PMDD w/SSRIs 1. Fluoxetine (Prozac) 2. Sertraline (Zoloft) 3. Paroxetine (Paxil) 4. Citalopram (Celexa)
51
AUB: what is menometrorrhagia
Menometrorrhagia = excessive AND irregular bleeding
52
What are the structural abnormalities that can cause AUB | hint: acronym
Structural Abn --> AUB = PALM P - Polyp A - Adenomyosis L - Leiomyoma (Fibroids) M - Malig/Hyperplasia
53
What are the non-structural abnormalities that can cause AUB (hint: acronym)
NON- Structural Abn --> AUB = COEIN ``` C - Coagulopathy O - Ovulatory/Ovarian dsyfxn E - Endometrial I - Iatrogenic N - Not classified ```
54
Dx/Imaging Studies in AUB 1. What is mainstay/gold std 2. What is Dx + Tx and allows you to directly visualize 3. What is Dx + Tx and use XR w/fluoroscopy to look at patency of uterus + fallopian tubes 4. What gives good visualization of endometrial lining, Dx polyps and used infertility 5. Other = Pelvic US
Dx/Imaging Studies in AUB 1. What is mainstay/gold std = EMB 2. Dx + Tx and allows you to directly visualize = Hysteroscopy 3. Dx + Tx and use XR w/fluoroscopy to look at patency of uterus + fallopian tubes = HSG 4. good visualization of endometrial lining, Dx polyps, used in infertility = SIS 5. Other = Pelvic US
55
Structural Causes of AUB: hyperplastic overgrowth of endometrial lining that projects from endometrium
Structural Causes of AUB: "P" Endometrial Polyps = hyperplastic overgrowth of endometrial lining that projects from endometrium
56
Structural Causes of AUB: Polyps 1. MC in women > ___ 2. Most benign or malig 3. What med = RF 4. 2 best imaging modalities to Dx 5. What procedure +/- another done to remove them pts present w/ metro/menorrhagia or both
Structural Causes of AUB: Polyps 1. MC in women > 50 2. Most benign 3. tamoxifen = RF 4. 2 best imaging modalities to Dx = US, SIS 5. Hysteroscopy +/- D+C done to remove them
57
Structural Causes of AUB: Polyps 1. MC in women > ___ 2. Most benign or malig 3. What med = RF 4. 2 best imaging modalities to Dx 5. What procedure +/- another done to remove them pts present w/ metro/menorrhagia or both
Structural Causes of AUB: Polyps 1. MC in women > 50 2. Most benign 3. tamoxifen = RF 4. 2 best imaging modalities to Dx = US, SIS 5. Hysteroscopy +/- D+C done to remove them
58
When is it appropriate to remove Asx Endometrial polyps (4)
Removing Asx Endometrial Polyps 1. large (> 1.5 cm) 2. multiple 3. prolapsed thru cervix 4. causing infertility
59
Structural Causes of AUB: Disorder that occurs when endometrial tissue invades the myometrium --> diffusely enlarged uterus
Structural Causes of AUB: Adenomyosis: - endometrial tissue invades the myometrium --> diffusely enlarged uterus
60
35 y/o G3P3 pt w/ PMH of fibroids and endometriosis presents w/ heavy bleeding and painful periods, and pelvic pain that is unrelated to her menses. on PE you feel a diffusely enlarged, boggy, and tender uterus. US shows symmetrical uterine enlargement and "grapes" in the uterus What is the Definitive Dx + Tx method Dx?
Definitive Dx + Tx = Hysteroscopy Dx = Adenomyosis
61
Structural Causes of AUB: Adenomyosis 1. what other imaging modality used to Dx (other than US, hysteroscopy) 2. Tx (2 things) - other than hysteroscopy
Structural Causes of AUB: Adenomyosis 1. MRI = other imaging modality used to Dx (other than US, hysteroscopy) 2. Tx = NSAIDs + hormonal Therapy (other tx: hysteroscopy)
62
Structural Causes of AUB: d/o characterized by benign proliferation of smooth muscle cells of the myometrium (benign uterine tumor)
Structural Causes of AUB: Leiomyomas/Fibroids = benign proliferation of smooth muscle cells of the myometrium (benign uterine tumor)
63
Structural Causes of AUB: Why do Leiomyomas incr during pregnancy and regress after menopause
Structural Causes of AUB: Leiomyomas incr during preg and regress after menopause b/c their size depends on estrogen
64
Structural Causes of AUB: Types of Leiomyomas 1. which occurs in the myometrium 2. which a/w infertility and beneath endometrium 3. which 2 types occur on outer most layer
Structural Causes of AUB: Types of Leiomyomas 1. Intramural = in the myometrium 2. Submucosal =a/w infertility and beneath endometrium 3. Subseroal + Pedunculated = occur on outer most layer
65
37 y/o G3P3 Af Am woman h/o HTN presents c/o menorrhagia and painful periods. She also has occasional urinary frequency, constipation, dyspareunia. She admits eating lot of red meat and ETOH use. On bimanual exam you feel an enalarged, firm, irreg NT uterus w/ cobblestone protrusions Dx? Next best Dx test to do?
Dx = Leiomyoma (Fibroid) Dx test = US
66
Structural Causes of AUB: Tx of Leiomyomas 1. what is the main medical Tx given to shrink them in size before surg 2. Name of procedure that involves decr blood flow to fibroid 3. Name of procedure that destroys the endometrial lining 4. Name of procedure that preserves fertility 5. Name of procedure that is definitive tx but doesnt preserve fertility
Structural Causes of AUB: Tx of Leiomyomas 1. Lupron (GnRH agonist) = main medical Tx given to shrink them in size before surg 2. UAE = involves decr blood flow to fibroid 3. Endometrial Ablation: procedure that destroys the endometrial lining 4. Myomectomy preserves fertility 5. Hysterectomy = definitive tx but doesnt preserve fertility
67
Structural Causes of AUB: 3 complications a/w Leiomyomas in non-preg women
Structural Causes of AUB: 3 complications a/w Leiomyomas 1. Chronic iron defic anemia 2. infertility 3. SAB
68
Structural Causes of AUB: 4 complications a/w Leiomyomas in pregnancy
Structural Causes of AUB: 4 complications a/w Leiomyomas in pregnancy 1. IUGR 2. PTL 3. shoulder dystocia 4. non-vertex presentation
69
Structural Causes of AUB: proliferation of endometrial glands --> irreg size and shape
Structural Causes of AUB: Endometrial Hyperplasia = prolif of endometrial glands --> irreg size and shape note: Endometrial CA in Neoplasm section
70
Structural Causes of AUB: 2 types of Endometrial Hyperplasia - which is worse
Structural Causes of AUB: 2 types of Endometrial Hyperplasia 1. Hyperplasia w/out atypia 2. Atypical Hyperplasia/EIN (worse)
71
Postmenopausal pt presents w/ menorrhagia and vaginal d/c. Pt has be on tamoxifen for 5 yrs has PCOS and is obese. On TVUS you see an endometrial stripe that is 6 mm. What is next step in Dx? Most likely Dx?
Next step = EMB Likely Dx = Endometrial Hyperplasia
72
Structural Causes of AUB:Endometrial Hyperplasia Tx 1. what is tx for pts w/endometrial hyperplasia w/out aytpia 2. what is tx for pts w/atypical hyperplasia
Structural Causes of AUB:Endometrial Hyperplasia Tx 1. Progestin via PO/IUD = tx for pts w/endometrial hyperplasia w/out aytpia 2. TAH +/- BSO = tx for pts w/atypical hyperplasia
73
Non-Structural Causes of AUB: COEIN 1. Coagulopathy - Name 2 coagulation d/o that could cause AUB 2. I- Iatrogenic - Name 2 classes of meds that can cause AUB
Non-Structural Causes of AUB: COEIN 1. Coagulopathy - Von Willebrand Dz - ITP 2. Iatrogenic - Anticoagulants - Hormonal therapy (IUD, HRT)
74
Definition of Menopause - age __ to ___ and __ consecutive months w/out a period - loss of ovarian follicles --> loss of what hormone secretion
Definition of Menopause - age 45-55 and 12+ consecutive months w/out a period - loss of ovarian follicles --> decr/loss of estrogen secretion
75
Pathophys of Menopause Loss ovarian follicles --> loss of estrogen secretion --> has what effect on levels of FSH and LH
Pathophys of Menopause Loss ovarian follicles --> loss of estrogen secretion --> INCR levels of FSH and LH
76
Dx Menopause 1. What Lab value = best for Dx 2. Pelvic US --> thickness of endometrium and size of ovaries and uterus
Dx Menopause 1. best lab test = incr FSH 2. Pelvic US: - decr thickness of endometrium - Small/atrophied ovaries and uterus
77
52 y/o pt presents w/ hot flashes, vaginal dryness/pruritus, urinary urgency/freq/incontinence, wt gain, bloating, loss of elasticity of skin. Pt states its been 13 months since she had her last period. What would you expected labs to show? Dx?
Labs --> incr FSH and decr estradiol Dx = Menopause
78
Effects of Menopause 1. Main Sxs a/w Vasomotor System b/c estrogen = thermoregulator 2. 2 Sxs a/w urogenital System 3. 1 condition at incr risk of d/t decr estrogen --> decr BMD 4. 2 CVD conditions at risk for 5. Sx a/w Nervous System
Effects of Menopause 1. Vasomotor instability = a/w Vasomotor System (estrogen = thermoregulator) 2. recurrent UTIs + vaginal atrophy= a/w urogenital System 3. incr risk of osteoporosis d/t decr estrogen/BMD 4. 2 CVD conditions at risk for = DVTs + heart attack 5. decr cognition = a/w Nervous System
79
Menopause: Tx for hot flashes name 3 classes of meds used for hot flashes
Menopause: Tx for hot flashes 1. HRT (estrogen or combo) 2. SERMs (NOT Raloxifene) 3. SSRIs/SNRIs
80
Menopause: Tx for Osteoporosis - name 3 classes of meds used for it - other 2 things used (not drugs)
Menopause: Tx for Osteoporosis 1. HRT 2. SERMs 3. Bisphosphonates (-ate) Others = Ca + Vit D
81
Menopause Tx: one class used to Tx Vulvovaginal Atrophy
Menopause: Vulvovaginal Atrophy Tx = SERMs
82
Risks a/w HRT: Estrogen alone vs E+P together 1. incr risk of CAD 2. incr risk of BCA 3. incr risk of DVT/PE/stroke 4. incr risk of osteoporosis 5. incr risk of colorectal CA (> 50 y/o) 6. incr risk of endometrial CA
Risks a/w HRT: Estrogen alone vs E+P together 1. incr risk of CAD = E+P 2. incr risk of BCA = E+P 3. incr risk of DVT/PE/stroke = BOTH 4. incr risk of osteoporosis = neither 5. incr risk of colorectal CA (> 50 y/o) = Estrogen alone 6. incr risk of endometrial CA = Estrogen alone

Women's Health EOR (7 decks)

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