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18 Cards in this Set
- Front
- Back
Menopause
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-permanent amenorrhea in a previous cycling woman
-natural menopause: caused by teh exhaustion of the ovaries |
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Perimenopause
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period immediately prior to teh menopause and the first year after the LMP
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Circulating estrogen
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-mostly produced by the ovary
-E1: estrone; produced by fat cells -E2: estradiol -E3Estriol |
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Premature Menopause
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cessation of menstrual periods before 40 years of age
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Dx of Menopause
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-1 year after LMP
-FSH levels are usaully greater than 40 |
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Vasomotor symptoms of Menopause
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-hot flashes followed by chill are most common
-due to sudden change in hypothalamic control of temperature regulation -more common: AA women; obesity |
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Tx of Vasomotor sx
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-low dose estrogen
-Estrogen alternatives: gabapentin, Venlafaxine, paroxetine, clonidine, megestrol acetate |
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Urogenital Sx of Menopause
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-due to decline in estrogen: mucosa thins and collagen support is lost
-glycogen content declnes and lactobacilli are less prominent increasing pH -atrophic vaginitis is common |
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Osteoporosis
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-bone loss begins in premenopausal years and accelerates in early postmenopause
-risk factors: poor intake of Ca and Vit D, sedentary lifestyle, low body weight, caucasian, smoking, prolonged amenorrhea (athletes) |
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Tx of Osteoporosis with hormone replacement
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-only while tx continues
-decrease use of HT for tx and prevention |
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Bisphosphonates for tx of Osteoporosis
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-most commonly used tx
-potent inhibitors of bone resorption -Alendronate (Fosamax) -Risedronate (Actonel) -Ibandronate (Boniva); monthly -Zolendronic acid (Zometa) IV for malignant bone dz |
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Other Classes for tx of Osteoporosis
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-SERM (selective estrogen receptor modulators): Raloxifene
-Human Parathyroid hormone (Forteo): stimulates osteoblastic activity |
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Menopausal Hormone Therapies
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-ET in a woman without a uterus
-CHT: with uterus to decrease risk of endometrial CA |
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Risks/Benefits of HT
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-not cardioprotective
-increase risk of breast cancer -increase risk in dx of Alzheimer's -2-point decline in MMSE score |
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Androgens
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-Exogenous testosterone has a benefical efffect on bone density and libido
-lacking long term safety data |
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Selective Estrogen Receptor Modulators (SERMs)
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-Tamoxifen
-Raloxifene -Toremifene |
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Tamoxifen
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-breast CA prevention in high-risk women
-risk for DVT -estrogenic effect on endometrium: endometrial hyperplasia, AUB, increased risk of endometrial CA -hot flashes and increase stroke risk |
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Raloxifene
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-tx of osteoporosis
-less effective than estrogen or alendronate -may replace Tamoxifen b/c less adverse events |