PCOS and Menopause- Lalande Flashcards Preview

M2 Endo/Repro > PCOS and Menopause- Lalande > Flashcards

Flashcards in PCOS and Menopause- Lalande Deck (14):
1

 

 

What are some consquences of the hyperandrogenism seen in PCOS?

 

Hisutism

Acne

Alopecia

Deepened Voice

Increased Muscle Mass

Clitoromegaly

2

 

What is the Ferriman-Gallwey Hirsutism scoring system?

 

What areas are scored?

 

A system for qualifying hair growth from 1-4

 

  1. Above the lip
  2. Chin
  3. Chest
  4. Navel/Stomach
  5. Pubic
  6. Arms
  7. Thighs
  8. Back
  9. Butt

3

 

What is believed to cause PCOS?

 

 

 

 

Change in Gonadotropin secretion

Steroidogenesis problems (leading to insulin resistance)

4

 

 

What dermatological findings might you see in a patient with PCOS?

 

Increased Hair growth

Acanthosis Nigricans

Skin tags

 

5

 

What symptoms are seen in PCOS that contribute to insulin resistance?

 

  • Central Obesity
  • Hyperinsulinemia (listed as a symptom....)
  • Low SHBG
  • Elevated Triglycerides
  • Low HDL
  • Non-alcoholic steatohepatitis

6

 

How is PCOS treated?

  • Anovulation
    • progesterone to decrease endometrial cancer risk
    • BC pills to regulate menses
  • Hyperandrogenism
    • BC pills to increase SHBG
    • Spironolactone as androgen receptor antagonist
  • Obesity
    • Weight loss
    • Sleep apnea screening
    • Diabetes management/prevention
    • Lipid/CV disease risk managment
  • Anxiety/Depression screening

 

7

 

How is menopause "diagnosed"?

 

When does it typically occur?

 

Amenorrhea for 12 consecutive months

 

between 40-60, average age is 51

 

PS ONLY WOMEN HAVE MENOPAUSE

8

 

What is perimenopause?

 

What is premature menopause?

 

The period surrounding menopause, lasting a few years prior to menopause to one year post menopause; this period may have symptoms similar to those seen in menopause

 

Menopause that occurs before age 40

 

 

9

 

What occurs in FSH leading up to and after menopause?

 

What is seen in AMH (anti-mullerian hormone)?

 

FSH levels are highly variable and spike immediately prior to menopause.  They are variable after menopause but stabilize eventually.  

 

AMH is extremely low around menopause (AMH is an estimate of oocyte reserves)

10

 

What symptoms might be seen in menopause?

  • Vasomotor symptoms (hot flashes, chills, etc)
  • Vaginal dryness
  • Urinary Incontinence
  • Osteoporosis
  • Skin changes

11

 

Is hormone therapy recommended for post-menopausal women?

 

For what?  What prescription?

 

Yes, in women less than 10 years past menopause with few risk factors EG smoking, breast cancer Hx, diabetes

 

Used to treat symptoms, not prevent disease due to decreased estrogen. Estrogen only is preferred, but women with a uterus must also get progesterone.  

12

 

What is Bazedoxifene?

 

What is is used for?

 

a SERM

 

Combined with estrogen to treat vaginal symptoms and prevent osteoporosis, but does not have bleeding like seen with progesterone

13

 

Why would menopausal hormone therapy be counterindicated in a symptomatic woman? 

 

  • Unexplained vaginal bleeding
  • Hx of stroke
  • MI/ Ischemia
  • Hx of Breast cancer
  • Hx of Endometrial cancer
  • Hx of Pulmonary emboli
  • Liver Disease
  • Gall bladder disease
  • Diabetes
  • Migraines with Aura

14

 

What are some dosing strategies for hormone replacement therapy in post-menopausal women?

 

  • Give in topical form to avoid liver metabolism
  • Give lowest possible dose
  • Try to give for short durations
  • Consider giving alternative medications
    • SERMs
    • SSRI/SNRI
    • Gabapentin
    • Clonidine

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