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What is the cuase of menopause?
Depletion of oocytes, less ovarian production of estradiol, progesterone and testosterone
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What vaginal changes occur with menopause?
Reduced secretions, thinned lining and increased pH of >6
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What uterine changes happen at menopause?
Decreased uterine size
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What group may go through menopause 2 years earlier and suffer from more hot flashes?
Smokers
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What groups may be artificially stimulated to undergo menopause?
Chemotherapy/Radiation patients
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When is a normal time range to undergo menopause?
40-60 years
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What are non-pharmacological treatments for menopause?
Healthy eating, regular exercise, no smoking, relaxation, cold showers, adequate sleep, yoga and acupuncture
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What is the MOA of progesterone in the treatment of Menopause side effects?
Replaces reduced endogenous progesterone
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What is the NMCD effectiveness and safety rating for Progesterone replacement in the treatment of menopause symptoms?
Possibly effective, insufficient evidence for safety of OTC topicals
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What are the consequences of use for Progesterone replacement in the treatment of menopause symptoms?
Vaginal spotting
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What patients are at risk when using Progesterone replacement in the treatment of menopause symptoms?
Disease made worse by fluid retention, Depression and Cardiovascular disease
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What is the NMCD effectiveness and safety rating for Black Cohosh in the treatment of menopause symptoms?
Possibly safe (short-term) and possibly effective
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What is the MOA of Black Cohosh in the treatment of menopause symptoms?
Estrogen like, but overall unknown
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What are the consequences of use for Black Cohosh in the treatment of menopause symptoms?
GI upset, rash, HA, weight gain, cramping, breast tenderness, vaginal spotting, HEPATOTOXICITY
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What populations are at risk when using Black Cohosh in the treatment of menopause symptoms?
Kidney transplant, liver disease, hormone sensitive cancers/breast cancer, Protein S deficient
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What are the safety and effectiveness rating of Soy in the treatment of menopause symptoms?
Likely/possibly safe and possibly effective
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What is the MOA for Soy in the treatment of menopause symptoms?
Estrogenic effects, similar structure to estradiol and selective estrogen receptor modulator
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What are the consequences of use for Soy in the treatment of menopause symptoms?
GI upset, insomnia
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Is Soy in the treatment of menopause symptoms usually well tolerated?
Yes
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What populations are at risk for Soy in the treatment of menopause symptoms?
Allergic rhinitis or asthma, breast cancer, endometrial cancer and kidney stones
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Why are kidney stones contraindicated with Soy in the treatment of menopause symptoms?
Soy has a high oxalate content that can contribute to kidney stones
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What are the safety and efficacy ratings for Eicosapentaenoic Acid in the treatment of menopause symptoms?
Likely safe, and possibly effective
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What is the MOA of Eicosapentaenoic Acid in the treatment of menopause symptoms?
Antidepressant effect, largely unknown
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What are the consequences of use with Eicosapentaenoic Acid in the treatment of menopause symptoms?
GI discomfort, increase bleeding, decreased NK cell activity, fish burps
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What populations are at risk when using Eicosapentaenoic Acid in the treatment of menopause symptoms?
Hypertensive, patients with bleeding disorders
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What are the safety and effectiveness ratings for St. John’s Wart in the treatment of menopause symptoms?
Likley safe and possibly effective
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What is the MOA of St. John’s Wart in the treatment of menopause symptoms?
Serotonergic effects (antidepressant)
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What are the consequences of use for St. John’s Wart in the treatment of menopause symptoms?
Stimulatory effects, diarrhea, dry mouth, dizziness, HA
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(True/False) St. John’s Wart is a potent inducer of CYP450.
True
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What populations are at risk when using St. John’s Wart in the treatment of menopause symptoms?
Psychiatric conditions, surgery/anesthesia, those taking drugs metabolized by CYP enzymes
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What herbal remedies for Menopause are possible INeffective?
Dong quai, Ginseng, Evening primrose, wild yam
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What is Vaginits?
Inflammation of the vagina
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What are the signs and symptoms of Vaginitis?
Discharge, pain, itching and sometimes infection
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What is the relationship or difference between Vaginitis and Vaginosis?
Vaginitis is inflammation of the vagina, while Vaginosis is a bacterial infection of the vagina
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Define Atrophic vaginitis:
thinning drying and inflammation of the vaginal walls
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What proportion of post-menopausal women have atrophic vaginitis?
40%
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What is the pathophysiology of Atrophic vaginitis?
Caused by declining estrogen levels
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What are the signs and symptoms of atrophic vaginitis?
Discharge, Dryness, Itching, Lubrication, painful intercourse, mild bleeding after intercourse, urinary issues
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What groups are at risk for atrophic vaginitis?
Postmenopausal women, smokers, un-sexually active, no vaginal births
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What are the treatments for atrophic vaginitis?
Vaginal Lubricants
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What are useful vaginal lubricants for Atrophic Vaginitis?
Glycerin, Hydroxymethylcellulose, Mineral oil, Chlorhexadine, Gluconate, propylene glycol, Vitamin E and Aloe vera
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Is Vaseline a good treatment for Atrophic Vaginits?
No, gloopy, hard to remove and can break down latex
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What are common ingredients for douching?
Water/vinegar, betadine and acetic acid
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