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36 Cards in this Set
- Front
- Back
What are the 3 classic signs of perimenopause?
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-Irregular menses
-Hot flashes -Feelings of inadequecy |
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What is the age span most women go through the climacteric?
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40-51
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What test would you run to confirm the diagnosis of perimenopause/climacteric?
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Serum FSH and LH
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What can be given to treat hot flashes?
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Estrogen/progestin
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What will NOT work to treat hot flashes?
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Raloxifene the SERM
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Why do menses cease in menopause?
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Due to follicular atresia
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What is Perimenopause, aka the climacteric?
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The 2-4 years preceding and after the menopause
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What is Premature ovarian failure?
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Cessation of menses and ovarian function BEFORE the age of 40
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What should be suspected if Premature ovarian failure occurs before age 30??
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-Karyotypic abnormalities
-Autoimmune disease |
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So what is the mean age of Perimenopause onset?
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47
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What hormone change occurs first in menopause; FSH rise, or estrogen loss? WHY?
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FSH rise - because Inhibin release from the ovary is lost.
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What are the 2 main reasons for giving HRT in menopause?
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-Prevent hot flashes
-Maintain bone density |
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What has the WHIS reported a slightly increased risk of with continuous Est/Prog HRT?
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-Breast cancer
-Heart disease -Pulm embolism -Stroke |
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But 2 things that Est/Prog HRT protects against are:
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-Fractures
-Colon cancer |
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What is the timeframe for which the risk of adverse events is increased by Est/Prog HRT?
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6 months
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So how should Est/Prog HRT be given for preventing hot flashes?
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For the shortest amount of time possible.
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What can be given to reduce vasomotor hot flashes in women that don't want or can't have estrogen?
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Clonidine - antihypertensive
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What does the SERM Raloxifene help with in menopause?
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Prevents BONE DENSITY loss, but not hot flashes!
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What are the 4 cornerstones of maintaining bone mass in menopause?
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-Vit D
-Calcium supplement -Estrogen/HRT -Weight bearing exercise |
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Do serum FSH levels change when estrogen HRT is given in menopause? Why/why not?
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No - because it's the INHIBIN that determines serum FSH
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What test is done for Bone Mineral Density testing?
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DEXA
Dual Energy Xray Absorptiometry |
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When should BMD screening begin?
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AGe 65, or earlier if at increased risk and present with a fracture
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Best guess as to cause of a 51 yo woman with oligomenorrhea and hot flushes:
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Ovarian failure
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What could cause Galactorrhea and Hyperprolactinemia in a 22 yo nonpregnant woman?
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Hypothalamic dysfunction due to Hypothyroidism
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How does hypothyroidism lead to Galactorrhea?
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Lack of NFB leads to increased TSH which stimulates Prolactin release.
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How does hypothyroidism lead to hypoestrogenic amenorrhea?
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Prolactin inhibits GnRH release, so no FSH/LH
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Why are women with PCOS amenorrheic?
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Because of EXCESS estrogen
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4 common findings in women with PCOS:
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-Obese
-Hirsute -Insulin resistant -Anovulatory |
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What will induce vaginal bleeding in women with PCOS?
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Progestin
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What is the reason for delayed puberty with infantile breasts and amenorrhea in Turners pts?
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Lack of estrogen due to ovarian failure - they're just streaks!
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How is excess exercise related to amenorrhea?
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Hypothalamic dysfunction
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Woman complicated by postpartum hemorrhage; unable to breastfeed; now is amenorrheic and she did not have a D/C:
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Sheehan's syndrome
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So what is the MAIN indication for HRT in the climacteric?
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Significant vasomotor symptoms - hot flashes
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What is the most common location of an osteoporosis-associated fracture?
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In the THORACIC spine - compression fracture.
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The 4 cornerstones of preventing osteoporosis are:
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-Vit D
-Calcium -HRT with estrogen -Weight bearing exercise |
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The 2 things we're mostly worried about with longterm HRT:
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-Breast cancer
-Cardiovasc disease |