Download NAMS MENOPAUSE CERTIFICATION EXAM and more Exams Nursing in PDF only on Docsity!
NAMS MENOPAUSE CERTIFICATION EXAM
Climacteric phase - ANSWER - The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause. Early menopause - ANSWER - LMP before age 45 Late menopause - ANSWER - LMP after age 54 Primary ovarian insufficiency - ANSWER - Menopause that occurs before age 40 Early menopause transition (stage - 2) - ANSWER - Persistent difference of 7 days or more in the length of consecutive cycles. Late menopause transition (stage - 1) - ANSWER - 60 or more consecutive days of amenorrhea
Luteal out of phase event (LOOP) - ANSWER - 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. Obese women and estradiol levels during menopause - ANSWER - 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) Chinese and Japanese women - ANSWER - These ethnic groups have lower estradiol levels then white, black and hispanic women. stage +2 - ANSWER - late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms.
DHEA (dehydroepiandrosterone) - ANSWER - Adrenal androgens: precursor hromones produced by the adrenal gland that are enzymatically converted to active androgens or estrogens in peripheral tissues. Location of estrogen receptors - ANSWER - Vagina, vulva, urethra, trigone of the bladder Effects of estrogen on tissue - ANSWER - maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome and protects tissue from pathogens. Vaginal changes with menopause - ANSWER - Thinning, loss of elasticity, loss or absence or rugae. Vagina and urethra in menopause - ANSWER - vagina narrows, urethra moves closer to the introitus. Stress urinary incontinence - ANSWER - Vaginal estrogen and urinary incontinence: what type does it help with?
Treatment for FPHL - ANSWER - Minoxidil, spironolactone, finasteride, estrogen therapy Late reporoductive years - 3b and - 3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? - ANSWER --3b: menstrual cycles normal, FSH normal, AMH low, AFC low, inhibin low.
- 3a: subtle menstrual changes, variable FSH, AMH low, AFC low, inhibin low. When it is appropriate to check an FSH during the cycle if you check it? and why? - ANSWER - Cycle day #3. Elevated estradiol can suppress FSH giving a falsely normal FSH level. AMH produced by... used to test... Is it a screening tool for fertility? When does it peak? - ANSWER - produced by granulosa cells
Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? - ANSWER - lower Menopause transition-changes in SHBG and testosterone? ratio? - ANSWER - SHBG decreases Testosterone/SHBG ratio increases by 80%. Testosterone/SHGB ratio is called what? - ANSWER - The free androgen index What stage are VMS more likely? - ANSWER - +1b (generally last 2 years) What hormone is generally higher in obese women? - ANSWER
- Estrone-via aromatization. The postmenopausal ovary continues to produce what two hormones? - ANSWER - testosterone and androstenedione
Surgical menopause causes women to have lower levels of what hormone? - ANSWER - testosterone. 40-50% lower than in women w/ intact ovaries. Driving piece of menopause is ovarian follicles depleting. What does this do to the inhibin B and AMH? - ANSWER - inhibin and AMH decrease therefore, follicle growth is not restrained, this allows for the growth of the remaining, diminished follicle pool. In the menopause transition, women spend more time in what phase? - ANSWER - Luteal-more PMS symptoms, more frequent menstrual periods. HPO axis theory and the menopause transition - ANSWER - It is felt that the HPO axis may become less sensitive to estrogen, so even with good follicle growth and estradiol secretion, LH surges can fail which can lead to more cycle irregularity. In the first year after the FMP, there is no production of what hormone? - ANSWER - progesterone
Oral tamoxifen acts similarly. Transdermal does not increase it, so it has a minimal effect on serum cortisol concentration. Do cortisol levels associate with VMS severity? - ANSWER - No, cortisol levels have NOT been associated with more severe VMS. Local DHEA has been proven to help with what? - ANSWER - vaginal pain and dyspareunia How to DX POI? - ANSWER - Menstrual disturbance- oligomenorrhea or amenorrhea for at least 4 months. AND elevated FSH over 25 on two occasions at least 4 weeks apart.
Anyone <40years old who misses 3+ consecutive cycles gets these labs - ANSWER - prolactin FSH estradiol TSH pregnancy test treatment of POI - ANSWER - 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 wanting to risk pregnancy, continuous HRT can be used. Hair loss. Difference between FPHL and telogen effluvium? - ANSWER - FPHL is gradual, telogen effluvium is sudden and usually precipitated by a life stressor, chronic illness, beta blockers or anticoagulants-usually more patchy hair loss.
thermoregulation zone is narrowed neurokinins-regulate GnRH secretion. KNDy new meds serotonin cortisol and HPI axis dysregulation endothelial dysfunction. VIN low grade-what to do high grade-what to do differentiated VIN-what to do - ANSWER - low grade is not precancerous high grade is precancerous-GYN ONC differentiated-wide local excision-high risk of invasive carcinoma. most common type of vulvar cancer - ANSWER - squamous cell carcinoma Vulvar disorder commonly misdiagnosed as eczema or dermatitis? - ANSWER - 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. Normal PVR - ANSWER - <100mL systemic and vaginal estrogen will not help with this type of urinary incontinence? - ANSWER - will NOT help with stress incontinence. Which topical vaginal estrogen has the highest dose? - ANSWER
- the vaginal rings FEMRING IS THE HIGHEST Most common cause of vulvovaginitis? - ANSWER - BV post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET? - ANSWER -
FOD (orgasmic disorder) treatments - ANSWER - directed masturbation is most researched behavioral treatment. Does systemic ET cause fibroids to resume growth? - ANSWER - Rarely. They often shrink after menopause. What is true about cognition and menopause? - ANSWER - Difficulty concentrating and remembering are common. What is true about cognition and surgical menopause - ANSWER - memory for verbal information can be compromised immediately after surgical menopause, especially if it is before the typical age of mesopause. Meta analysis of RCTs have shown small benefit of what diet/exercise for global cognition and memory? - ANSWER - Mediterranean diet with olive oil and tai chi exercise helps with global cognition Mediterranean diet with olive oil and isoflavone supplements helps with memory.
effect of HRT on cognition - ANSWER - small or no overall effect on cognition What HRT can increase your risk for dementia based on the WHIMS study in 65+ year old healthy women? - ANSWER - 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 3 reasons supporting the idea that HRT in early menopause may decrease a woman's chance of developing alzheimer's disease?
- ANSWER - 1. Observational studies imply it
- Clinical trial of transdermal estradiol during the early postmenopause stage is associated with reductions in AD pathology.
- 18 year cumulative follow up data from WHI found that women randomized to ET had significantly lower risk of dying
cdc and who guidelines for migraine treatment - ANSWER - migraine with aura-advise to not use combined hormone contraception caution in women with migraine without aura How long can it take for arthralgia from vitamin d deficiency or hypothyroidism to fully resolve? - ANSWER - it can take several months. what is th emost common form of arthritis? - ANSWER - osteoarthritis what areas of th ebrain have th emost estrogen receptors? - ANSWER - hippocampus and prefrontal cortex what is the most common thyroid disorder in women? - ANSWER - hashimoto thyroiditis
if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? - ANSWER
- 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. when is treatment of subclinical hypothyroidism recommended? - ANSWER - when the TSH level is higher than
are hot or cold thyroid nodules typically most likely to be malignant? - ANSWER - cold nodules how does HRT impact gallbladder disease? - ANSWER - increases risk of gallstones with oral HRT, lower risk with transdermal.
