Menopause

Question 1

What is perimenopause

Answer 1

Menstrual cycle irregularity, precede final menstrual period marked by increased cycle variation and vasomotor symptoms, sleep disturbances, and gu symptoms, hot flash
Lasts 4-8 years and can be longer
Fertility decline but pregnancy is still possible,
Clinical diagnosis

Question 2

Menopause diagnosed after how many months of amennorhea

Answer 2

Diagnosed after 12 months of amenorrhea with no other cause

Question 3

What is depleted in menopause

What rises due to loss of negative feedback at the hypothalmic pituatary axis

Answer 3

Estrogen and progesterone
Rise in fsh, and rise in LH
Loss of steroidospgenesi

Question 4

Common symptoms during menopause

Answer 4

Hot flashes, decreased sexual desire, forgetfulness, bone loss is accelerated

Question 5

Menopause effects

Answer 5

Ovarian follicle depletion
Decline in ovarian steroidogenesis
Loss of negative feedback LH, and fsh increased

Question 6

Menopause cause loss of estrogen what symptoms occur due to this

Answer 6

Bone loss, osteoporosis, cv risk, urogenital atrophy

Question 7

Perimenopause symptoms

Answer 7

Hot flashes, night sweats, brain fog, joint pain, weight gain, poor memory, increased anxiety

Question 8

Red flag menopause symptoms on exam

Answer 8

Palpable ovary is a red flag

Question 9

Most common perimenopause symptom

Answer 9

Hot flashes

Question 10

Hot flash tx

Answer 10

Behavioral, lowering room temp, use fan,
If severe use estrogen, and oral contraceptives, SSRI/SNRI

Question 11

Exam finding in menopause

Answer 11

Atrophy labia majora.
Thin vaginal epithelium, atrophic vaginitis,
Ovaries non palpable

Question 12

Atrophic vaginitis signs

Answer 12

May be dry, spotting, and dyspareunia,
Exam shows, pale surface and shiny and thinning

Question 13

Atrophic vaginitis tx

Answer 13

1- moisturize, with lubricant, and vitamin e oil
2- estrogen cream, nightly 2 weeks
If estrogen ring leave for 3 months

Question 14

Menopause major risks due to estrogen deficiency

Answer 14

Osteoporosis, increased fracture risk , fragility fractures mostly of the vertebrae,
Cardiovascular disease risk is increased
Mood, depression and anxiety

Question 16

Tx for menopause, non hormonal, behavioral, and hormone therapy

Answer 16

Non hormonal,
SSRI, Gabapentin
, (veozah to help with vasomotor symptom of hot flashes but increased risk for Hepatotoxicity)

Behavioral
Cbt, wt loss,

Hormone therapy, good for patients with moderate to severe symptoms less than age 60

Question 17

HRT initiated less than __ years from onset of menopause and in women less than

Answer 17

10

women less than 60 years of age

Question 18

HRT shown to reduce _______, _________,_____

Answer 18

Coronary artery disease, osteoporosis and colon cancer

Question 19

Most effective tx for vasomotor and gu symptoms

Answer 19

HRT

Question 20

HRT reduce what loss?

Answer 20

Bone

Question 21

HRT is contraindicated in a women with a history of ________

Answer 21

Breast cancer

Question 22

HRT doseage start at the ____ doseage and use what ____ and ______

Answer 22

Start at lowest dose, for the shortest duration
Use estrogen and progesterone

Question 23

What HRT is good for VTE pt

Answer 23

Gel or patch. Transdermal
Bypass the liver and less risk for clotting.

Question 24

Pt with hot flash and intact uterus tx involves

Answer 24

Estradiol patch, or gel (transdermal if VTE risk)
and add progesterone, 100 mg

Question 25

When is testosterone used

Answer 25

Hypoactive sex drive disorder

Question 26

Side effects of testosterone

Answer 26

Oily skin, acne, Adam’s apple

Question 27

When is vaginal estrogen used

Answer 27

For mod to severe GU symptoms. Estradiol tablet, or estradiol ring Not vasomotor symptoms