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OU Module Endo Fall 2018 > Women’s Health Issues Associated with Menopause Exam 3 > Flashcards

Women’s Health Issues Associated with Menopause Exam 3 Flashcards

1
Q

Perimenopause

A
  • period immediately prior to menopause
  • inconsistent production of mature follicles
  • ovaries become resistant to FSH, LH
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2
Q

Menopause

A

permanent cessation of menses following the loss of ovarian follicular activity

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3
Q

Natural menopause

A
  • normal aging process and occurs as a result of ovarian follicle depletion
  • 12 consecutive months of amenorrhea in the absence of any other physiological cause
  • 45-55 yo
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4
Q

Induced menopause

A
  • surgical menopause
  • hysterectomy +/- bilateral oophorectomy
  • ovarian damage from other medical means
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5
Q

Postmenopause

A

time after a woman has undergone menopause

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6
Q

Hormone changes associated with menopause: Estrogen and progesterone

A
  • no longer secreted by ovaries

- source of estrogen comes from other glands and adipose tissue

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7
Q

Hormone changes associated with menopause: Androgen

A
  • ovarian stroma may become fibrotic and a poor source of sex steroids
  • do not decrease as rapid as estrogen since it’s produced by adrenal gland
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8
Q

Hormone changes associated with menopause: FSH levels

A
  • Perimenopause: FSH on day 2 or 3 of menstrual cycle > 10-12 IU/L.
  • At menopause or postmenopause, FSH increased to > 40 IU/L and estradiol concentrations decreased by >90% .
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9
Q

Clinical characteristics: Vasomotor symptoms (VMS)

A
  • perception of intense heat (hot flash) and subsequent cooling by cutaneous vasodilation (skin flushing), perspiration, and chills
  • can affect activities of daily living
  • occur first two years of menopause
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10
Q

Clinical characteristics: Psychological symptoms

A
  • insomnia
  • mood changes
  • memory loss
  • anxiety
  • depression
  • symptoms of PMS can worsen during periM but improve postM
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11
Q

Clinical characteristics: Atrophic vaginitis / genitourinary symptoms

A
  • Urogenital atrophy
  • dryness, burning, dyspareunia, loss of vaginal secretions, and vulvar pruritus
  • urethral discomfort, frequency, dysuria, stress incontinence, and increased UTIs
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12
Q

Clinical characteristics: Osteoporosis

A

low bone mass and increased fracture risk

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13
Q

Clinical Evidence for uses of Hormone Therapy

A
  • benefits for osteoporosis and heart disease
  • long term conjugated estrogen with or without medroxyprogesterone found a reduction in fracture, but an increase in breast cancer, CHD (during the first year), stroke, and DVT/PE.
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14
Q

Hormone Therapy: Estrogen

A
  • Treatment of vasomotor symptoms
  • Treatment of urogenital atrophy
  • Prevention of osteoporosis
  • Clearest benefit in healthy women < 60 years of age or within 10 years of menopause
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15
Q

Hormone Therapy: Progestins

A
  • Decreases risk of endometrial hyperplasia and endometrial adenocarcinoma in women with an intact uterus taking estrogen.
  • May also result in further reduction in vasomotor symptoms.
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16
Q

Hormone Therapy Contraindications

A
  • Breast cancer
  • History of venous thromboembolism (DVT/PE)
  • History of arterial thromboembolism (stroke, MI)
  • Liver dysfunction
  • Undiagnosed abnormal genital bleeding
17
Q

Hormone Therapy RELATIVE Contraindications

A
  • Elevated blood pressure (uncontrolled)
  • Hypertriglyceridemia (uncontrolled)
  • Hypothyroidism
  • Fluid retention
  • Severe hypocalcemia
  • Ovarian cancer (also endometrial and cervical)
18
Q

Hormone Therapy uses

A
  • Treatment of moderate to severe vasomotor symptoms
  • Treatment of moderate to severe urogenital atrophy
  • Prevention of osteoporosis
19
Q

Androgen uses

A
  • improved libido and bone mass in perimenopausal and postmenopausal women with androgen deficiency
  • used for women who have had their ovaries removed
  • used for women with sexual dysfunction
20
Q

Lifestyle modifications for Vasomotor Symptoms

A
  • Wearing layered clothing
  • Avoiding triggers
  • Exercising for as little as 1-2 hours/week has shown benefit.
  • If only mild symptoms are present, symptoms will often be alleviated by lifestyle modifications.
21
Q

Nonprescription Therapies for Vasomotor Symptoms

A
  • Black cohosh

- Soy protein

22
Q

Prescription Therapies for Vasomotor Symptoms

A
  • Bazedoxifene / conjugated estrogens (Duavee®)
  • Gabapentin (Neurontin®)
  • Medroxyprogesterone (Provera ®)
  • Serotonin (and Norepinephine) Reuptake Inhibitors
23
Q

Prescription Therapies for Vasomotor Symptoms: Duavee®

A
  • used for vasomotor symptoms
  • Bazedoxifene / conjugated estrogens
  • Should be considered as an alternative to HT (estrogen / progestin)
24
Q

Prescription Therapies for Vasomotor Symptoms: Serotonin (and Norepinephine) Reuptake Inhibitors

A
  • Paroxetine (Paxil®)
  • Fluoxetine (Prozac®)
  • Venlafaxine (Effexor®)
  • Desvenlafaxine (Prestiq®)
25
Q

VMS Treatment Approach

A
  • Mild symptoms: start with lifestyle changes, SSRI/SNRI are first line for pharmacological therapy
  • Moderate to severe symptoms: Risk vs benefit decision factoring in patients concurrent conditions and contraindications, may start hormone therapy
26
Q

Pharmacological therapy for Urogenital Symptoms

A
  • Replens
  • Selective estrogen receptor modulator SERM
  • Synthetic Steroid
27
Q

Urogenital Symptoms

A
  • Urogenital atrophy
  • vaginal dryness
  • dyspareunia
  • Urinary incontinence
  • Sexual dysfunction and decreased libido
28
Q

Pharmacological therapy for Urogenital Symptoms: Replens

A
  • Some relief of vaginal dryness can be achieved

- They can be used alone or in conjunction with HT

29
Q

Pharmacological therapy for Urogenital Symptoms: Selective estrogen receptor modulator SERM

A
  • Ospemifene (Osphena®)

- Improves moderate to severe dyspareunia associated with urogenital atrophy

30
Q

Pharmacological therapy for Urogenital Symptoms: Synthetic Steroid

A
  • Prasterone (Intrarosa®)
  • Use with caution in women with h/o breast cancer
  • Improves moderate to severe dyspareunia associated with urogenital atrophy

OU Module Endo Fall 2018 (27 decks)

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