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NAMS MENOPAUSE
CERTIFICATION
Explains why some perimenopausal women have elevated estrogen level sometimes...In the early menopause transition, elevated FSH levels are adequate to recruit a second follicle which results in a follicular phase-like rise in estradiol secretion superimposed on the mid-to-late luteal phase of the ongoing
ovulatory cycle. - --100% CORRECT ANSWER---Luteal out of phase
event (LOOP) Obese women are more likely to have anovulatory cycles with high estradiol levels. They are also more likely to have lower premenopause yet higher postmenopause estradiol levels compared with women of normal weight. (why they are at
higher risk of endometrial cancer) - --100% CORRECT ANSWER---
Obese women and estradiol levels during menopause These ethnic groups have lower estradiol levels then white,
black and hispanic women. - --100% CORRECT ANSWER---Chinese
and Japanese women
late menopause stage: 5-8 years after FMP. Somatic aging
predominates. Increased genitourinary symptoms. - --100%
CORRECT ANSWER---stage +
early post menopause: 2 years after FMP. FSH rises, estradiol
decreases. VMS predominate. - --100% CORRECT ANSWER---
Stages +1a, +1b, +1c
Endocrine labs after menopause - --100% CORRECT ANSWER---
Elevated FSH, LH These hormones work during reproductive years to not deplete
follicle pool too quickly. - --100% CORRECT ANSWER---AMH,
inhibin B Menstrual cycle variable, persistent >7 day difference between
difference in length of consecutive cycles. - --100% CORRECT
ANSWER---Phases during menopause transition and PMS
symptoms
vagina narrows, urethra moves closer to the introitus. - --100%
CORRECT ANSWER---Vagina and urethra in menopause
Vaginal estrogen and urinary incontinence: what type does it
help with? - --100% CORRECT ANSWER---Stress urinary
incontinence
Minoxidil, spironolactone, finasteride, estrogen therapy - --
100% CORRECT ANSWER---Treatment for FPHL
- 3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low. The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause.
- --100% CORRECT ANSWER---Climacteric phase
LMP before age 45 - --100% CORRECT ANSWER---Early
menopause
LMP after age 54 - --100% CORRECT ANSWER---Late menopause
Menopause that occurs before age 40 - --100% CORRECT
ANSWER---Primary ovarian insufficiency
Persistent difference of 7 days or more in the length of
consecutive cycles. - --100% CORRECT ANSWER---Early
menopause transition (stage - 2)
60 or more consecutive days of amenorrhea - --100% CORRECT
ANSWER---Late menopause transition (stage - 1)
- 3a: subtle menstrual changes, variable FSH, AMH low, AFC low,
inhibin low. - --100% CORRECT ANSWER---Late reporoductive
years - 3b and - 3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? Cycle day #3. Elevated estradiol can suppress FSH giving a
falsely normal FSH level. - --100% CORRECT ANSWER---When it is
appropriate to check an FSH during the cycle if you check it? and why? produced by granulosa cells
25 or higher - --100% CORRECT ANSWER---Late menopause
transition (-1) FSH level on random draw
Higher - --100% CORRECT ANSWER---Black women have higher or
lower FSH levels?
lower - --100% CORRECT ANSWER---Chinese and Japanese women
have higher or lower estradiol levels compared to white, black and hispanic women? SHBG decreases
Testosterone/SHBG ratio increases by 80%. - --100% CORRECT
ANSWER---Menopause transition-changes in SHBG and
testosterone? ratio?
The free androgen index - --100% CORRECT ANSWER---
Testosterone/SHGB ratio is called what?
+1b (generally last 2 years) - --100% CORRECT ANSWER---What
stage are VMS more likely?
Estrone-via aromatization. - --100% CORRECT ANSWER---What
hormone is generally higher in obese women?
testosterone and androstenedione - --100% CORRECT ANSWER---
The postmenopausal ovary continues to produce what two hormones?
testosterone. 40-50% lower than in women w/ intact ovaries. -
--100% CORRECT ANSWER---Surgical menopause causes women
to have lower levels of what hormone? inhibin and AMH decrease therefore, follicle growth is not restrained, this allows for the
growth of the remaining, diminished follicle pool. - --100%
CORRECT ANSWER---Driving piece of menopause is ovarian
follicles depleting. What does this do to the inhibin B and AMH? Luteal-more PMS symptoms, more frequent menstrual periods.
- --100% CORRECT ANSWER---In the menopause transition, women spend more time in what phase?
Most serum cortisol circulates bound to cortisol binding globulin. Oral estrogen increases the cortisol binding globulin, which increases total cortisol concentration. Oral tamoxifen acts similarly. Transdermal does not increase it, so it has a minimal effect on
serum cortisol concentration. - --100% CORRECT ANSWER---
Cortisol and HRT No, cortisol levels have NOT been associated with more severe
VMS. - --100% CORRECT ANSWER---Do cortisol levels associate
with VMS severity?
vaginal pain and dyspareunia - --100% CORRECT ANSWER---Local
DHEA has been proven to help with what? Menstrual disturbance-oligomenorrhea or amenorrhea for at least 4 months.
AND
elevated FSH over 25 on two occasions at least 4 weeks apart. -
--100% CORRECT ANSWER---How to DX POI?
prolactin FSH estradiol TSH
pregnancy test - --100% CORRECT ANSWER---Anyone <40years old
who misses 3+ consecutive cycles gets these labs 100 microgram estradiol patch 1.25 mg CEE 2mg oral estradiol If intact uterus-progesterone for 12 days of the month. Physiologic is better than continuous hormonal contractption, but if menorrhagia-IUD plus estrogen patch, or if really not
10 years, early menopause transition women have them the
longest. - --100% CORRECT ANSWER---Median length of hot
flashes lower ovarian estradiol thermoregulation zone is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation
endothelial dysfunction. - --100% CORRECT ANSWER---Theories
about etiology of hot flashes (6) low grade is not precancerous high grade is precancerous-GYN ONC differentiated-wide local excision-high risk of invasive
carcinoma. - -- 10 0% CORRECT ANSWER---VIN
low grade-what to do high grade-what to do differentiated VIN-what to do
squamous cell carcinoma - --100% CORRECT ANSWER---most
common type of vulvar cancer paget's disease will not improve on steroids screen for co-existing breast, GI or GU cancer. They are present
20 - 30% of the time. - --100% CORRECT ANSWER---Vulvar disorder
commonly misdiagnosed as eczema or dermatitis?
<100mL - --100% CORRECT ANSWER---Normal PVR
will NOT help with stress incontinence. - --100% CORRECT
ANSWER---systemic and vaginal estrogen will not help with this
type of urinary incontinence? the vaginal rings
FEMRING IS THE HIGHEST - --100% CORRECT ANSWER---Which
topical vaginal estrogen has the highest dose?
L-arginine, topical alprostadil, wellbutrin, oxytosin. phosphodiesterase inhibitors-lacking in efficacy
Eros therapy device $300- vaccum-like the penis pump - --100%
CORRECT ANSWER---FGAD treatments (genital arousal disorder)
directed masturbation is most researched behavioral
treatment. - --100% CORRECT ANSWER---FOD (orgasmic disorder)
treatments
Rarely. They often shrink after menopause. - --100% CORRECT
ANSWER---Does systemic ET cause fibroids to resume growth?
Difficulty concentrating and remembering are common. - --
100% CORRECT ANSWER---What is true about cognition and
menopause? memory for verbal information can be compromised immediately after surgical menopause, especially if it is before
the typical age of mesopause. - --100% CORRECT ANSWER---What
is true about cognition and surgical menopause
Mediterranean diet with olive oil and tai chi exercise helps with global cognition Mediterranean diet with olive oil and isoflavone supplements
helps with memory. - --100% CORRECT ANSWER---Meta analysis
of RCTs have shown small benefit of what diet/exercise for global cognition and memory?
small or no overall effect on cognition - --100% CORRECT
ANSWER---effect of HRT on cognition
EPT replacement was shown to double the risk of developing dementia. There was no significant increased risk in ET alone. this is why HRT is not recommended after 65 for primary
prevention of dementia - --100% CORRECT ANSWER---What HRT
can increase your risk for dementia based on the WHIMS study in 65+ year old healthy women?
- Observational studies imply it
patients with cardiovascular disease, as are NSAIDs - --100%
CORRECT ANSWER---Triptans are contraindicated in what?
NSAID or triptan 2 days before expected to get your period, and
take for 5-7 days. - --100% CORRECT ANSWER---Menstrual
migraine treatment migraine with aura-advise to not use combined hormone contraception
caution in women with migraine without aura - --100% CORRECT
ANSWER---cdc and who guidelines for migraine treatment
it can take several months. - --100% CORRECT ANSWER---How
long can it take for arthralgia from vitamin d deficiency or hypothyroidism to fully resolve?
osteoarthritis - --100% CORRECT ANSWER---what is th emost
common form of arthritis?
hippocampus and prefrontal cortex - --100% CORRECT ANSWER---
what areas of th ebrain have th emost estrogen receptors?
hashimoto thyroiditis - --100% CORRECT ANSWER---what is the
most common thyroid disorder in women? recheck 6-8 weeks later. anticipate that the dose of levothyroxine may need to be increased. oral estrogens increase thyroid binding globulin which in turn
reduces the levels of free T4. - --100% CORRECT ANSWER---if a
patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening?
when the TSH level is higher than 10. - --100% CORRECT ANSWER-
--when is treatment of subclinical hypothyroidism
recommended?
cold nodules - --100% CORRECT ANSWER---are hot or cold thyroid
nodules typically most likely to be malignant?
