Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
51 Cards in this Set
- Front
- Back
|
def of menopause per WHO
|
1 year without menses w/o pathology
permanent cessation of menstruation as a result of declining ovarian function |
|
|
def of menopausal transition per WHO
|
time before menopause
when cycles exhibit variability |
|
|
def of perimenopause per WHO (and other names)
|
AKA climacteric or transmenopause
time from onset of symptoms to 1 yr after final menstrual period |
|
|
def of premature menopause
|
premature ovarian failure w/ cessation of menses PRIOR to 40yo
|
|
|
when evaluating time since last menses, how is spotting considered?
|
counts as menses!
|
|
|
why is there no good test for menopause
|
there are constant fluctuations of estrogen levels
|
|
|
when are women likely to start having s/s of estrogen depletion after estrogen therapy stops. how is this affected by weight?
|
2-3mo
increased weight leads to increased estrogen stores so it will take heavier women longer to deplete estrogen stores. |
|
|
what are some important aspects of the past medical hx that menopausal women should be asked and why?
|
hysterectomy - determines how they will be treated with estrogen tx
clotting disd - clotting not a/w a disorder can be r/t low estrogen DES exposure - risk of cervical ca Liver disease? Cholesterol problems - r/t estrogen levels thyroid hx |
|
|
what are the risks of DES exposure
|
vaginal anomalies
cervical ca incompetant cervix |
|
|
risk factors for osteoporosis
|
age
lower back pain - suggestive of ostoeporitic effects thin - increased risk of osteoporosis at <120lbs caucasian/fair skinned smoking |
|
|
protective fc for osteoporosis
|
not obese
taking estrogen others? |
|
|
Lab tests for older women @ risk of menopause/osteoporosis
|
TSH/free T4
CMP (want calcium level, alk phos) fasting lipids CBC (anemia?) DEXA scan consider parathyroid with serum Ca++ if considering parathyroid issue consider ESR, FSH/estrodial (1yr after last menses), 24hr urine calcium (if concern for parathyroid), serum electrophoresis |
|
|
what DEXA score is diagnostic for osteoporosis
|
BMD less than/= -2.5
positive #'s are possible and are good |
|
|
how to take fosamax
|
1x/month
empty stomach, first thing in the morning with 8oz H2O MUST TAKE CALCIUM |
|
|
what is the effect of SES on age of menopause?
|
none
|
|
|
how are FSH levels helpful in dx of menopause
|
elevated FSH alone cannot dx menopause b/c of all of the fluctuations
>100 mIU/mL indicates PERMANENT failure (95% accurate) >40 mIU/mL highly SUGGESTS menopause is underway |
|
|
what causes estrogen-like activity when ingested
|
isoflavones - soy, chickpeas, legumes
whole grains, F/V resorcylic acid lactones (fungi) |
|
|
what did the WHI study look at & what were the results
|
looked at the effects of estrogen only or estrogen-progesterone supplementation in older post-menopausal women on chronic disease/cancer/clots
Combo therapy with huge increases in clots, bca, strokes, heart attacks HRT showed decreases in colorectal cancer and hip/vertebral fractures |
|
|
what is the recommendation for women who have had a hysterectomy in terms of HRT?
|
these women should stay on estrogen until 55-65yo
they do not have the adverse fx of estrogen seen in women s. hysterectomy |
|
|
when is estrogen therapy recommended
|
moderate to severe vasomotor symptoms a/w menopause
mod-severe symptoms of vaginal atrophy (use a topical!) prevention of osteoporosis |
|
|
what are the benefits of OC for perimenopausal women
|
contraception b/c of high risk of unwanted pregnancies
cycle control, predictability relief from vasomotor s/s decreased risk of ovarian/ endometrial ca (disputed) potential decreased risk of osteoporosis trans to HRT: increase in compliance treatment of depression?? |
|
|
what is the role of estrogen in depression treatment
|
may be helpful in treating postpartum depression and depression in perimenopausal women, but should be used in concert with an SSRI - there is no evidence of estrogen on its own being a substantial treatment for depression (except maybe in perimenopausal women)
|
|
|
what herbs are shown to have some effect in the treatment of menopause?
which ones have NO proven effect |
SOME EFFECT
soy isoflavones red clover isoflavones photoestrogens black cohosh NO EFFECT passion flower, st. johns wort, valerian root, sarsaparilla, evening primrose, chasteberry, dong quai, ginseng, vitamin e, kava, gingko biloba |
|
|
what is the possible risk with vit E?
|
may increase risk of clots
|
|
|
define osteoporosis
|
reduction of bone mass per unit volume
characterized by microarchitectural deterioration of bone leads to increased fragility and risk of fracture |
|
|
define osteopenia
|
low bone mass
not quite osteoporosis |
|
|
what are the 2 most important determinants of osteoporosis/ osteopenia
|
peak bone mass (mid to late adolescence)
rate of bone loss |
|
|
how much Ca++ is necessary on Fosamax
|
1200-1800 mg Ca++
|
|
|
when i sthe greatest bone loss
|
2-3 yrs p/ menopause
|
|
|
what factors effect bone remodeling
|
parathyroid hormone
vitamin D growth hormone estrogen levels any pathology that increases reabsp / decreases formation |
|
|
what is the rate of bone loss - before and after menopause
|
before menopause: o.5-1% /yr
after menopause: 1-2% for 5-10yrs |
|
|
WHAT ARE THE MODIFIABLE RISK FACTORS FOR OSTEOPOROSIS / FRX
|
age - older
gender - female race - caucasian/ asian body size: thin (<60kg/ 127lbs) loss of height >1inch maternal/FHx of hip fracture any fracture after 50yo late menarche early menopause (natural or surgical) |
|
|
WHAT ARE THE NON MODIFIABLE RISK FACTORS FOR OSTEOPOROSIS
|
smoking
ETOH (>2drinks/day) sedentary (<4hrs/day on feet) amenorrhea 2nd to anorexia/wt loss low ca / vit D increased caffeine increased protein, sodium, phosphorus poor diet (low F/V) |
|
|
Medications that increase osteoporosis risk
|
glucocorticoids - chronic/intermittent
benzos - long acting anticonvulsants heparin - long term use cyclosporine vitamin A thyroid replacment (>10yrs) lithium tamoxifen (post menopausal) TPN |
|
|
disease states that increase risk of ostoporosis
|
hyperthyroid
hyperparathyroid hypogonadism cushings disease malabsorptive states RA chronic renal/liver disease leukemia/lymphoma pagets disease prolonged immobility anorexia |
|
|
what are some possible protective factors for osteoporosis
|
estrogen exposure: early menarchy, late menopause, HRT, lactation
TZD (diuretic use) higher BMI African American Increased CA intake in childhood regular weight bearing exercise higher bone mass |
|
|
what are the effects of untreated bone loss
|
traumatic event with low BMD can result in hip, spine, wrist fracture
osteoporitic syndrome - pain/disability loss of height |
|
|
what is the gold standard test for meas bmd & what do the results mean
|
dexa
provides T score and SD from normal normal is w/in 1 SD or any positive score osteopenia (low bone mass) = -1 to -2.5 SD OSTEOPOROSIS dx by any score LESS THAN NEG 2.5 SD from the mean |
|
|
who shoudl get a DEXA scan
|
65+ - regular screening Q2-5yr
60+ - begin screening if risk factors (especially <70kg) <60 - any woman who loses >1" ht; clinical judgement / risk factors |
|
|
Treatment of osteoporosis - established benefit and possible bone benefit
|
BENEFIT:
calcium vitamin D protein POSSIBLE BENEFIT boron, copper, fluoride, magnesium, manganese omega 3 phosphorus soy isoflavones strontium (low dose) vit C, vit K, zinc |
|
|
what is the effect of progesterone creams on bmd
|
no established benefit
|
|
|
what treatments have been found to be HARMFUL to BMD
|
vit A from retinol products
high fluoride, oxalate, phosphorus, strontium |
|
|
nonpharm treatments for osteoporosis
|
CALCIUM - 1500-1800mg/day, preferably from dietary sources
AT LEAST: 1000mg/day 19-50yo; 1200mg/day >50yo with 400-800 IU vitD Vit D - 400-1000 IU exercise - weight bearing smoking cessation decrease ETOH increase F/V (mg, zinc, B6) decreased caffeine, Na, excess animal protein decrease fall risk --> hip protectors |
|
|
what type of Ca supplements to recommend
|
USP label or purified
Ca citrate can be taken w/OUT regard to food intake Ca carbonate needs to be taken with food for best absp |
|
|
How to take Ca supplements
|
500mg at a time
increase suppl 500 mg the first week and then slowly add more Ca++ |
|
|
pharmacologic treatments available for osteoporosis
|
1. bisphosphonates: fosamax and actonel
others: selective estrogen receptor modulators - raloxifene (evista) Calcitonin (salmon) - comes in nasal spray and IM injection Recombinant parathyroid hormone (teriparatide) estrogens (OCP, MHT) |
|
|
what are the FIRST CHOICE treatments for osteoporosis (Rx)
and how are they taken |
BISPHOSPHONATES
alendronate (Fosamax) risendronate (Actonel) Take FIRST THING in the AM Empty stomach Full glass of water Must be upright for the next hour, 30 min without eating Taken 1x/week (can be monthly) |
|
|
what is the effect of the bisphosphonates on osteoporosis
|
increase bone marrow density
decrease vertebral and nonvertebral fractures |
|
|
when are the bisphosphonates contraindicated
|
esophageal motility disorder
stricture achalasia severe renal insufficiency ASA & NSAIDS increase risk of GI effects, ulcers Antacids and Ca++ decrease absorption (but need to take Ca when on Fosamax!!) |
|
|
when is calcitonin used for osteoporosis treatment
|
when the patient cannot take or tolerate bisphosphonates and cannot take estrogen
|
|
|
when is raloxifene (selective estrogen receptor modulator) used for treating osteoporosis
|
post menopausal women who do not have s/s requiring estrogen and are not using OCP or HRT
also decreases LDL cholesterol and may decrease risk of breast ca |
