OB 510

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OB 510
2010-06-08 20:45:25

Postmenopausal Gynecology
Show Answers:

  1. Define: artificial menopause
    Medical intervention (Hx, Oophorectomy, chem or radiation) eliminates hormone secrestion by ovaries.
  2. Define: complete hysterectomy
    surgical removal of uterus and ovaries
  3. Define: endometrial ablation
    Technique where uterine lining is destroyed to treat heavy uterine bleeding
  4. 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.
  5. 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)
  6. 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)
  7. Define: Menopause
    Period that marks permanent cessation of mentrual activity
  8. Define: Osteoporosis
    • Disease where bones become weak & prone to fracture.
    • MC in menopausal women >55yrs
    • Dx = bone density test
  9. Menopause is the most important risk factor for what disfiguring / debilitating disease?
  10. Define: Perimenopause
    • Period immediately preceding menopause. Still have reg/irreg menses and meno symptoms (hot flashes).
    • Duration: variable
  11. Define: Premature Menopause
    Menopause occuring before 40yrs
  12. Define: Progesterone
    • Female sex hormone secreted by ovaries
    • Prepares uterus to accept egg (relaxes uterus so it can grow during pregnancy)
  13. Oligomenorrhea
    Cycle >35 days
  14. Polymenorrhea
    Cycle <21 days
  15. Amenorrhea
    Absence of menses 5 mo or 3 cycles
  16. Menorrhagia
    • Regular cycle
    • Excessive flow & duration
  17. Metrorrhagia
    Irregular cycle
  18. Menometrorrhagia
    • Irregular cycle
    • Excessive flow & duration
  19. EV's are ALWAYS performed with postmenopausal women when there is a history of ?
  20. Why do US on postmenopausal women? (5)
    • bleeding/spotting
    • pelvic pain
    • bloating
    • palpable mass
    • family hx ovarian Ca
  21. What is the MC cause of postmenopausal bleeding?
    endometrial atrophy
  22. Normal postmenopausal endometrial thickness?

    Biopsy @ > 8mm
  23. Hyperplasia of endometrium is a precursor to?
  24. 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)
  25. What type of HRT do you take when there's been a hysterectomy?
    • Unopposed Estrogen (Premarin)
    • - increased risk for hyperplasia
    • - decreased risk heart disease
  26. If you compared Estrogen & Progesterone to growing and mowing lawn, which would be which?
    • Estrogen = fertilizer
    • Progesterone = mower
  27. What % of postmenopausal women are on HRT?
  28. 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)
  29. With HRT Continuous Estrogen&Progesterone (Premarin&Provera) what side effect risks come with progesterone?
    • depression
    • irritibility
    • bloating
    • breast tenderness
  30. 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
  31. Why is progesterone taken along with estrogen?
    To reduce risk of endometrial Ca.
  32. Progesterone produces endometrial _________________ which reduces risk of endometrial Ca.
  33. HRT is not appropriate for women @ risk of ________________.
    Breast Ca
  34. During your first year of HRT, what is there a small risk of?
    Gallbladder disease
  35. What questions should you always ask your postmenopausal patient about HRT?
    • On HRT?
    • How long?
    • Complications?
    • Changes in prescription or dosage?
  36. A postmenopausal uterus becomes small and atrophic because?
    of decline in estrogen levels
  37. Arcuate artery calcifications are a normal variant and commonly ID'd in patients with:
    • DM
    • HTN
    • Vascular disease
    • Hypercalcemia
  38. Nabothian cysts are usually what size? seen where?
    <2cm Cx
  39. Reasons for uterine enlargement?
    • fibroid
    • polyp
    • endometriosis
    • adenomyosis
    • endometrial Ca
    • uterine sarcomas
  40. 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
  41. When postmenopausal endometrial thickness is <5mm postmenopausal bleeding can be attributed to?
    endometrial atrophy
  42. An average endometrial thickness is ________________ with carcinoma than with polyps or hyperplasia.
  43. With HRT endometrium should be __________ with a smooth contour.
  44. Large amounts of endometrial fluid can mean: (3)
    • Infection
    • Malignancy
    • Hemorrhage
  45. Fluid collections may be the result of processus such as:
    • Cx Stenosis
    • Myometrioma
    • polyps
  46. What is the MC gynecological malignancy in postmenopausal age group?
    endometrial Ca 80%
  47. Pregnancy and use of pill protect against ?
    endometrial carcinoma
  48. What is normal postmenopausal ovarian volume?
    Should you see cysts?
    • 5cc
    • 8cc
    • no
  49. Which vessels would you follow to identify postmenopausal ovaries?
    internal iliacs
  50. Benign postmenopausal cyst should be what size?
    <3cm (surgical resection 5cm or larger)
  51. Name some benign ovarian masses:
    • cystadenomas
    • granulosa cell tumor
    • cystic teratoma (dermoid)
    • ovarian fibroma
  52. What is the MC cause of death d/t gynecological malignancy?
    Ov Ca
  53. Epithelial neoplasms account for 90% ovarian malignancies. These include:
    • Serous/Mucinous Cystadenocarcinomas
    • Endometroid tumors
    • Brenner tumors
  54. Risks of Tamoxifen Therapy?
    • Endometrial Ca
    • Endometrial Hyperplasia
    • Polyps
    • >5mm biopsy