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25 Cards in this Set
- Front
- Back
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menopause
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1 yr with no menses
b/t 40-55 y/o -many women have clinical symptoms several yrs prior --> perimenopause |
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perimenopause
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-Begins 2-4 years prior to final menstrual period
-Changes in menstrual flow and length of cycle (due to fluctuations in estrogen) -Reflects hormonal changes which occur even when menses still present -Can have more menstrual flow (males them closer together) -Late in perimenopause may have symptoms of lower estrogen levels |
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lower estrogen may cause
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1. hot flashes
2. interrupted sleep 3. urinary symptoms 4. atrophic vaginitis 5. loss of bone density |
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hot flashes
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-40-60% have them withint 2 yrs of cessatins
-warmth in head and works way down -perspiration --> chills -hot flashes decreased as time from menses increases -30-40% have them for > 5 yrs -lack of estorgen causes a vasomotor instability |
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tx of hot flashes
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-lifestyle mod (exercise)
-estrogen -progestins -SSRI anti-depressants -gabapentin -biological agents |
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lifestyle mods
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1. avoid spicy foods, caffeine, alcohl
2. relaxation and biofeedback exercises 3. dressing in layers 4. regular exercise |
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progesterone alone
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-Side effects: (progesterone prominent hormone during second half of menstrual cycle so you see some symptoms seen in menstruation) breast discomfort, irregular vaginal bleeding, bloating, weight gain
-Oral medroxyprogesterone acetate 20mg bid or 20mg daily progesterone cream |
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SSRIs
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-decreased incidence and severity of hot flashes
-dosage often less than needed for depression -side effects: sexual dysfunction, dry mouth, nausea -fluoxetine, sertraline, velafaxine |
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gapapentin
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-gradually increase dose
side effects: dizziness, sedation, headache |
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biologic agents
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-phytoestrogens: soy, chick peas etc.
-black cohosh -evening primrose -vit E |
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effects of menopause on lower urinary tract
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-atrophic changes
-stress and urge in continence -dysuria, urgency, frequency |
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effects on the vagina
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-decreased vag elasticity, decresed rugae, shortened vaginal canal
-pale -friable or ulcerative -increased pH can lead to increased BV |
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Rx of genital/urethral symptoms
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-Systemic estrogen (controversial)
-Topical estrogen (can be very useful) (put cream where it is needed) -Daily use of low dose topical (intra-vaginal) therapy not associated with systemic levels so can use in clinical situations where systemic therapy might be contraindicated (doesn’t help with hot flashes because it is a systemic problem) |
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topical estrogens
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-vagifem suppositories, nightly for 2 weeks and then twice weekly
-cream applied with aplicator -e-string, inserted for 3 months |
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osteoporosis
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-Bone density starts to decrease at age 40
-Risk for osteoporosis increases with age -15% of women age 80+ with have hip fx -Amenorrhea from any cause decreases bone density |
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risk factors for osteoporosis
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-thin body habitus
-FH -menopause before 45 -smoking, alcohol -hyperthyroid -sedentary -low dietary Ca -DM -corticosteroids -vit d def |
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preventative measures for osteoporosis
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-wt bearing exercise
-calcium -vit d -decreased smoking, alcohol |
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screeing for osteoporosis
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-bone density scan
-All women ≥ 65 should be screened (good 10-15 yrs after beginning of menopause because in general bone changes take a long time to happen) -All women ≥ 60 should be screened if they are at increased risk |
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Rx for osteoporosis
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-estrogen therapy decreases bone resorption
-calcitonin decreases rate of bone turnover -bisphosphate decreases osteoclastic activity |
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estrogen
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-unopposed est: est w/out progest
-unopposed can only be used if pt has has a hysterectomy, because it can increase the risk for endometrial cancer |
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combination therapy
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-addition of progestins can cause HA, fatigue, bloating, menstrual cramps and bleeding
-cyclic progestins: medroxyprogesterone 10 mg 12 days/mo, rest of time just estrogen; can cause cyclical bleeding -continuous progestins: 2.5 or 5 mg daily- unpredictable light bleeding x 6 mo |
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combo therapy and heart disease and breast cancer
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-appears to increase the risk
-risk arises 5-7 yrs after therapy initiated -risk small but present, may be beneficial to put a women on estrogen for a yr or 2 to combat symptoms, no ill effects if on for only a few yrs |
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when to prescribe estrogen
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-severe symptoms, disabling
-limit to short term use -get a med hx, PE incl breast exam, Pap, mammo before prescribing |
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contraindications to estrogen therapy
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-leiomyoma
-endometriosis -hx of choleslithiasis -hx of migraine -hx of preg-related or OCP-related thrombosis |
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absolute contraindications for estrogen therapy
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-undx vag bleeding
-suspicion or hx of breast ca -" or hx of endometrial ca -active venous thrombosis -malignant melanoma |
