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Define: artificial menopause
Medical intervention (Hx, Oophorectomy, chem or radiation) eliminates hormone secrestion by ovaries.
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Define: complete hysterectomy
surgical removal of uterus and ovaries
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Define: endometrial ablation
Technique where uterine lining is destroyed to treat heavy uterine bleeding
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Define: Endometrial Biopsy
Tissue sample removed from uterine lining and examined to determine if ovulation has occured, and if uterine lining is normal for that stage of the cycle. In women with irregular bleeding, it can be used to detect abnormal cells.
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Define: Estrogen
- Term for many similar steroid hormones secreted by ovaries, adrenal gland, fat cells, placenta & fetus.
- Estrogen produce obvious physical characteristics that distinguish women from men (breast, hip, thigh)
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Define: Estrogen Replacement Therapy
Body's natural production fall sharply at menopause. Supplements can offset effects of low levels (hot flashes, moodiness, increased risk cardiovascular disease, osteoporosis)
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Define: Menopause
Period that marks permanent cessation of mentrual activity
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Define: Osteoporosis
- Disease where bones become weak & prone to fracture.
- MC in menopausal women >55yrs
- Dx = bone density test
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Menopause is the most important risk factor for what disfiguring / debilitating disease?
Osteoporosis
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Define: Perimenopause
- Period immediately preceding menopause. Still have reg/irreg menses and meno symptoms (hot flashes).
- Duration: variable
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Define: Premature Menopause
Menopause occuring before 40yrs
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Define: Progesterone
- Female sex hormone secreted by ovaries
- Prepares uterus to accept egg (relaxes uterus so it can grow during pregnancy)
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Oligomenorrhea
Cycle >35 days
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Polymenorrhea
Cycle <21 days
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Amenorrhea
Absence of menses 5 mo or 3 cycles
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Menorrhagia
- Regular cycle
- Excessive flow & duration
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Metrorrhagia
Irregular cycle
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Menometrorrhagia
- Irregular cycle
- Excessive flow & duration
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EV's are ALWAYS performed with postmenopausal women when there is a history of ?
bleeding
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Why do US on postmenopausal women? (5)
- bleeding/spotting
- pelvic pain
- bloating
- palpable mass
- family hx ovarian Ca
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What is the MC cause of postmenopausal bleeding?
endometrial atrophy
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Normal postmenopausal endometrial thickness?
<5mm
Biopsy @ > 8mm
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Hyperplasia of endometrium is a precursor to?
Ca
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Name the types of HRT: (3)
- Unopposed Estrogen (usually premarin)
- Continuous Estrogen & Progesterone (Premarin(est) & Provera(prog))
- Sequential Estrogen & Progesterone (Premarin 1st 1/2 and Provera 2nd half)
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What type of HRT do you take when there's been a hysterectomy?
- Unopposed Estrogen (Premarin)
- - increased risk for hyperplasia
- - decreased risk heart disease
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If you compared Estrogen & Progesterone to growing and mowing lawn, which would be which?
- Estrogen = fertilizer
- Progesterone = mower
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What % of postmenopausal women are on HRT?
40%
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What type of HRT increases endometrial thickness by 1-1.5mm with no risk of endometrial Ca. Breakthrough bleeding possible.
Continuous Estrogen & Progesterone (Premarin&Provera)
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With HRT Continuous Estrogen&Progesterone (Premarin&Provera) what side effect risks come with progesterone?
- depression
- irritibility
- bloating
- breast tenderness
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When taking Sequential Estrogen&Progesterone (Prem1st 1/2 & Provera 2nd 1/2), what would you expect?
- Planned withdrawl bleeding @ end of month
- Increased endometrial thickness by 3mm
- Have greater monthly variation in thickness
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Why is progesterone taken along with estrogen?
To reduce risk of endometrial Ca.
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Progesterone produces endometrial _________________ which reduces risk of endometrial Ca.
atrophy
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HRT is not appropriate for women @ risk of ________________.
Breast Ca
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During your first year of HRT, what is there a small risk of?
Gallbladder disease
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What questions should you always ask your postmenopausal patient about HRT?
- On HRT?
- How long?
- Complications?
- Changes in prescription or dosage?
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A postmenopausal uterus becomes small and atrophic because?
of decline in estrogen levels
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Arcuate artery calcifications are a normal variant and commonly ID'd in patients with:
- DM
- HTN
- Vascular disease
- Hypercalcemia
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Nabothian cysts are usually what size? seen where?
<2cm Cx
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Reasons for uterine enlargement?
- fibroid
- polyp
- endometriosis
- adenomyosis
- endometrial Ca
- uterine sarcomas
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Some benefits of HRT would be:
- improves hot flashes
- vag dryness
- emotions
- dizziness & tingling
- cardiac palp
- bladder control
- muscle & joint ache
- prevent osteo
- cardiac disease
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When postmenopausal endometrial thickness is <5mm postmenopausal bleeding can be attributed to?
endometrial atrophy
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An average endometrial thickness is ________________ with carcinoma than with polyps or hyperplasia.
greater
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With HRT endometrium should be __________ with a smooth contour.
<8mm
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Large amounts of endometrial fluid can mean: (3)
- Infection
- Malignancy
- Hemorrhage
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Fluid collections may be the result of processus such as:
- Cx Stenosis
- Myometrioma
- polyps
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What is the MC gynecological malignancy in postmenopausal age group?
endometrial Ca 80%
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Pregnancy and use of pill protect against ?
endometrial carcinoma
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What is normal postmenopausal ovarian volume?
Abnormal?
Should you see cysts?
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Which vessels would you follow to identify postmenopausal ovaries?
internal iliacs
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Benign postmenopausal cyst should be what size?
<3cm (surgical resection 5cm or larger)
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Name some benign ovarian masses:
- cystadenomas
- granulosa cell tumor
- cystic teratoma (dermoid)
- ovarian fibroma
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What is the MC cause of death d/t gynecological malignancy?
Ov Ca
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Epithelial neoplasms account for 90% ovarian malignancies. These include:
- Serous/Mucinous Cystadenocarcinomas
- Endometroid tumors
- Brenner tumors
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Risks of Tamoxifen Therapy?
- Endometrial Ca
- Endometrial Hyperplasia
- Polyps
- >5mm biopsy
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