NAMS MENOPAUSE CERTIFICATION STUDY GUIDE WITH COMPLETE SOLUTIONS| LATEST 2024/2025

NAMS MENOPAUSE CERTIFICATION STUDY GUIDE WITH COMPLETE SOLUTIONS| LATEST 2024/2025 “Climacteric phase - CORRECT ANSWER The period of endrocrinologic, somatic, and transitory psychologic changes that occur around the time of menopause." "Early menopause - CORRECT ANSWER LMP before age 45" "Late menopause - CORRECT ANSWER LMP after age 54" "Late reporoductive years -3b and -3a. What happens with menstrual cycles, FSH, AMH, AFC, inhibin? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER produced by granulosa cells used to test damage to ovarian follicle reserve. If AMH is low, the woman has a low ovarian reserve. not recommended as a screening tool to predict fertility. Peaks at around 25 years old. So before age 25, this test is not helpful. It is influenced by exogenous hormones. Lower in hormonal contraception users, but increases after d/cing." "AFC - CORRECT ANSWER Antral follicle count Number of follicles that are detectable with ultrasound. They are sensitive to FSH and considered to represent the availability poo of follicles." "Late menopause transition (-1) FSH level on random draw - CORRECT ANSWER 25 or higher" "Black women have higher or lower FSH levels? - CORRECT ANSWER Higher" "Chinese and Japanese women have higher or lower estradiol levels compared to white, black and hispanic women? - CORRECT ANSWER lower" "Menopause transition-changes in SHBG and testosterone? ratio? - CORRECT ANSWER SHBG decreases Testosterone/SHBG ratio increases by 80%." "What region of the adrenal gland secretes the androgens? - CORRECT ANSWER zona reticularis" "what are considered the 'adrenal androgens'? - CORRECT ANSWER DHEA, DHEAS, Androstenedione." "Aldosterone secretion from the zona reticularis in the adrenal gland is regulated by 3 main factors. - CORRECT ANSWER Angiotensin II, potassium concentration, adrenocorticotropic hormone secreted by the anterior pituitary." "treatment of POI - CORRECT 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." "Women who have had a BSO experience an abrupt and persistent decline in what hormone? - CORRECT ANSWER circulating androgen levels" "HSDD and FSAD were combined into a single dysrunction called - CORRECT ANSWER female sexual interest/arousal disorder" "HSDD treatments - CORRECT ANSWER flibanserin and bremelanotide" "FGAD treatments (genital arousal disorder) - CORRECT ANSWER L-arginine, topical alprostadil, wellbutrin, oxytosin. phosphodiesterase inhibitors-lacking in efficacy Eros therapy device $300- vaccum-like the penis pump" "FOD (orgasmic disorder) treatments - CORRECT ANSWER directed masturbation is most researched behavioral treatment." "Migraine headache and pregnancy - CORRECT ANSWER typically migraines improve-estrogen levels stabilize" "Migraine without aura after menopause - CORRECT ANSWER usually decrease with natural menopause" "menstrual migraine after menopause - CORRECT ANSWER should resolve completely" "When to consider preventative medication for migraines - CORRECT ANSWER 2 times per week or severe and effecting QOL" "Triptans are contraindicated in what? - CORRECT ANSWER patients with cardiovascular disease, as are NSAIDs" "Menstrual migraine treatment - CORRECT ANSWER NSAID or triptan 2 days before expected to get your period, and take for 5-7 days." "cdc and who guidelines for migraine treatment - CORRECT 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? - CORRECT ANSWER it can take several months." "what is th emost common form of arthritis? - CORRECT ANSWER osteoarthritis" "what areas of th ebrain have th emost estrogen receptors? - CORRECT ANSWER hippocampus and prefrontal cortex" "what is the most common thyroid disorder in women? - CORRECT ANSWER hashimoto thyroiditis" "if a patient on levothyroxine is started on estrogen, when do you recheck and what can you anticipate happening? - CORRECT 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? - CORRECT ANSWER when the TSH level is higher than 10." "are hot or cold thyroid nodules typically most likely to be malignant? - CORRECT ANSWER cold nodules" "What t score defines osteopenia - CORRECT ANSWER -1.5 to -2.5" "what t score defines osteoporosis - CORRECT ANSWER less than -2.5" "what z score defines osteoporosis before menopause? - CORRECT ANSWER z score less than 2.0 and a history of a fragility fracture" "Who is at highest risk of osteoporosis? - CORRECT ANSWER white and hispanic populations" "What amount of women require long term care after hip fracture? What amount of women have long term loss of mobility after hip fracture? - CORRECT ANSWER 1 in 4 women (25%) require long term care 1 in 2 woemn (50%) have long term loss of mobility" "Asians have ____BMD than white people? - CORRECT ANSWER lower" "Black women have ____BMD than white people? - CORRECT ANSWER higher" "Over 3 servings of alcohol daily and risk for fracture? - CORRECT ANSWER 38% for osteoporotic fracture and 68% for hip fracture" "What 4 ethnic specific versions of FRAX are there? - CORRECT ANSWER white, asiain, black, hispanic" "Dairy free diet amount of calicum. How much do they need to supplement? - CORRECT ANSWER dairy free diet-300mg calcium daily. Needs 800-1200mg" "Tibolone and osteoporosis where is it approved? why wasn't it submitted for approval in the US and canada? - CORRECT ANSWER approved in mexico decreased risk of vertebral and nonvertebral fracture increased risk of stroke" "Why was estrogen not approved for osteoporosis? - CORRECT ANSWER decreased risk of vertebral and hip fracture in low fracture risk population, but estrogen has not been shown to decrease fracture risk in women with osteoporosis. More prevention than treatment." "Black box warning for PTH receptor agonists? - CORRECT ANSWER osteosarcoma" "caution using PTH receptor agonists in what condition? - CORRECT ANSWER hypercalcemia" "when would you use PTH receptor agonists? - CORRECT ANSWER someone incredibly high risk for vertebral fracture" "raloxifene helps with what kind of fractures? - CORRECT ANSWER vertebral fractures" "raloxifene risk factors - CORRECT ANSWER increased risk of death from stroke in high risk patients, estrogen like risk of VTE, worsens hot flashes" "atypical femur risk in women on bisphosphonate? - CORRECT ANSWER 1 in 1000 after 2-3 years." "Salmon calcitonin and osteoporosis? - CORRECT ANSWER small increase in spine BMD. daily SQ injections or nasal." what is the gold standard for treatment of hot flashes - CORRECT ANSWER hormone therapy" "does hormone therapy cause breast cancer - CORRECT ANSWER no" "lack of estrogen in the vaginal and urethral area causes an increase in what complications - CORRECT ANSWER UTI" "Hormone therapy is effective at the prevention of what - CORRECT ANSWER osteoporosis" "If a women has a family history of breast cancer is this a contraindication for starting hormone therapy - CORRECT ANSWER no" "does menopause affect lipid levels - CORRECT ANSWER yes" "Should you discourage the use of hormone therapy in postmenopausal women - CORRECT ANSWER no" "defined as the span of time from puberty to perimenopause - CORRECT ANSWER premenopause" "defined as the span of time that begins with the onset of menstrual cycle changes and other menopause s/s and extend through menopause to 1 year after menopause - CORRECT ANSWER perimenopause" "is progesterone measurable during postmenopause - CORRECT ANSWER no" "after menopause estrogen levels are available from what other sources - CORRECT ANSWER - ovaries - adrenal glands - liver - fat cells" "after menopause estrogen is available from other sources such as the ovaries in what forms - CORRECT ANSWER - androstenedione - testosterone" "after menopause estrogen is available from other sources such as the adrenal glands in what from - CORRECT ANSWER - androstenedione" "estrogen is converted in the liver and fat cells to what form - CORRECT ANSWER estrone" "high levels of LH after menopause cause cells in the ovary to produce what two hormones - CORRECT ANSWER - androestenedione - testosterone" "what 3 estrogens circulate in the body - CORRECT ANSWER 1. 17 beta estradiol 2. estrone 3. estriol" "what is the most biologically active form of estrogen that circulates in the body - CORRECT ANSWER 17 beta estradiol" "very short acting estrogen that is the least biologically active estrogen in circulation - CORRECT ANSWER estriol" "during peri menopause a woman may experience atrophic changes such as - CORRECT ANSWER vaginal itching, dryness, irritation, bleeding with intercourse, dyspareunia" "during peri menopause a woman will under go atrophic changes causing the PH to what and lactobacilli to what - CORRECT ANSWER PH increases lactobacilli decreases" "most women experience menstrual cycle changes aprox how many years before menopause occurs - CORRECT ANSWER 4-8 years" "if a pt experiences vaso motor s/s early in peri menopause will their s/s tend to last longer or be shorter - CORRECT ANSWER last longer" "if a pt dosent begin to experience vasomotor s/s until the onset of post menopause will they experience these symptoms longer or shorter - CORRECT ANSWER shoert" "what risk factors increase a woman's risk for experiencing vasomotor s/s - CORRECT ANSWER - younger age - AA - Smoking - Depression/anxiety - stress" "what study looked at vasomotor symptoms - CORRECT ANSWER Study of Womens Health Across the Nation SWAN" "during menopause a woman more likely to c/o bloating and weight gain especially in what area - CORRECT ANSWER waist area" "what is recommended for the treatment of decreased libidio due to menopause - CORRECT ANSWER vaginal estrogen" "bone mineral density is directly correlated to what - CORRECT ANSWER number of teeth" "what are some early signs of estrogen loss - CORRECT ANSWER - hot flashes - insomnia - irritability - mood disturbance" "what are some physical changes of estrogen loss - CORRECT ANSWER - vaginal atrophy - stress incont - skin atrophy" "what are some late s/s of estrogen loss - CORRECT ANSWER - osteoporosis - cardiovascular disease - DM - Maculare degeneration - colon cancer" "can HT decrease some of the late s/s experienced due to estrogen loss - CORRECT ANSWER yes" "when should you start a woman on estrogen therapy to reduce atheroscleorisis - CORRECT ANSWER when a woman first entersmenopause" "if you start HT therapy late when atheroscleorsis has already occurred what happens - CORRECT ANSWER increased risks for the plaques and necrotic cores to break off" "if you start HT early it decreases a woman risk for what comorbidities - CORRECT ANSWER atherosclerosis and plaque buidlup" "early users of HT had a significantly lower prevalencee of what - CORRECT ANSWER CAD" "what is a greater risk for the development breast cancer in comparison to HT use - CORRECT ANSWER obesity" "what is the most effective tx for menopausal s/s including vasomotor s/s and vaginal atrophy - CORRECT ANSWER HT" "what is the preferred tx for women with s/s of vaginal dryness or dyspareunia - CORRECT ANSWER local estrogen therapy" "what is an acceptable option for the treatment of healthy women aged 59 or within 10 years of menopause bothered by moderate to severe menopausal s/s - CORRECT ANSWER systemic HT" "systemic HT is acceptable treatment for what age group of women - CORRECT ANSWER up to age 59 or within 10 years of menopause" "what factors should be considered when deciding to treat a menopausal woman - CORRECT ANSWER - quality of life - age - time since menopause - risk of blood clots - HD - Stroke - Breast cancer" "is the risk for developing breast cancer statistically significant with the use of HT - CORRECT ANSWER no 1%" "there is an increased risk for developing breast cancer when EPT is used continuously for how long - CORRECT ANSWER 5 years" "is there an increased risk for the development of breast cancer with the continuous use of estrogen for 5 years - CORRECT ANSWER no" "true or false the risk for developing breast cancer decreases when HT is D/C'd - CORRECT ANSWER true" "there is an increased risk for stroke, PE and VTE when using HT but the risk is low in what age group - CORRECT ANSWER 50-59" "true or false the lowest dose of HT should be used for the shortest amount of time to manage menopausal symptoms - CORRECT ANSWER true" "what is the recommended duration of treatment with EPT for menopausal s/s - CORRECT ANSWER 5 years" "Which treatment can safely be used longer when treating menopausal symptoms ET or EPT - CORRECT ANSWER ET" "some insurers deny coverage for HT for woman older than what age - CORRECT ANSWER 65 years" "what HT are on the beers list - CORRECT ANSWER oral and transdermal estrogen with or without progestin" "HT reduces the risk of what type of cancer - CORRECT ANSWER colon and endometrial" "HT reduces the risk of what types of fractures - CORRECT ANSWER hip and veretbral" "true or false for younger women undergoing HT close to the time of menopause the benefits outweigh the risks - CORRECT ANSWER true" "what is the gold standard in the tx of vasomotor s/s r/t menopause - CORRECT ANSWER HT" "what type of HT is proven to reduce the risk of colon cancer - CORRECT ANSWER only EPT" "what do oral HT preparations reach their peak concentratiosn - CORRECT ANSWER 4-6 hours" "what effect does smoking have on HT - CORRECT ANSWER decreases estrogen level so may need to prescribe higher dose" "what lab values may oral estrogen therapies effect - CORRECT ANSWER - increase CRP - Increase cholesterol" "if a pt has night sweats when would you encourage them to take their oral estrogen thearapy - CORRECT ANSWER after dinner. peak concentrations 4-6h" "if a pt has hot flashes throughout the day when would you encourage them to take their oral estrogen therapy - CORRECT ANSWER in the morning peak concentration 4-6h" "how does estrogen effect cholesterol levels - CORRECT ANSWER - decrease ldl - increase hdl - increase TG" "the risk for VTE is greatest with what form of estrogen therapy - CORRECT ANSWER oral" "is the usual prescribed HT a lower or higher does of estrogens in comparison to BC pills - CORRECT ANSWER low dose" "will HT prevent pregnancy - CORRECT ANSWER no" "what are the types of estrogens - CORRECT ANSWER - estrones - estraidols - esterified estrogens - synthetic conjugated estrogens" "(CEE) or conjugated equine estrogen is what form of estrogen - CORRECT ANSWER estrones" "what is conjugated equine estrogen (CEE) derived from - CORRECT ANSWER pregnant mares urine" "where is conjugated equine estrogen (CEE) stored once administered - CORRECT ANSWER stored in fat. potent and long lasting" "what is the recommended starting dose for the estrone conjugated equine estrogen (CEE) - CORRECT ANSWER 0.3mg" "which form of estrogen that you can prescribe is bioidentical - CORRECT ANSWER estradiols" "estradiols and bioidentical to what naturally occurring hormorn - CORRECT ANSWER 17B-estradiol" "what is the oral from of estradiol that you can prescribe - CORRECT ANSWER Estrace (micronized estradiol)" "what is the recommended starting does for micronized estradiol (estrace) PO - CORRECT ANSWER 0.5mg" "what are some of the names of the transdermal estardiols that you can prescribe - CORRECT ANSWER -estraderm - vivelle - climara" "what is the vaginal estradiol that you can presribe - CORRECT ANSWER estring" "how may estradiol affect cholesterol levels - CORRECT ANSWER low dose and transdermal estradiol maintain or decrease levels of TG" "what is the oral form of esterified estrogen - CORRECT ANSWER estradiol esters" "do estradiol esters increase plasma TG - CORRECT ANSWER no" "do esterified estrogens such as estradiol esters increase a pts risk for VTE - CORRECT ANSWER no" "is it safe to presribe esterified estrogens such as estradiol esters to a diabetic woman or one with hypertriglyceridemia - CORRECT ANSWER yes" "what is the oral form of esterified estrogens - estradiol esters called - CORRECT ANSWER Menest - no animal precurcors" "who is esterified estrogens - estradiol esters (menest) not recommend for - CORRECT ANSWER pt with osteoporosis" "can esterified estrogens - estradiol esters (menest) be prescribed to aide in the prevention of osteoporosis - CORRECT ANSWER no" "are synthetic conjugated estrogens approved for osteoporosis or prevention - CORRECT ANSWER no" "what are the names of some of the synthetic conjugated estrogens that you may prescribe - CORRECT ANSWER - cenestin - enjuvia" "synthetic conjugated estrogens are synthesized from what - CORRECT ANSWER soy and yam plants" "what is the principle estrogen in synthetic conjugated estrogens - CORRECT ANSWER estadiol" "duavee is a combination of what 2 meds - CORRECT ANSWER estrogen (premeran) and bazedoxifene" "how does duavee work on the bones - CORRECT ANSWER estrogen agonist effect on the bones - builds bone" "duavee provides an alternative to what HT - CORRECT ANSWER progestin. only one pill" "what are the drawbacks to Duavee - CORRECT ANSWER price tier 3 not covered" "is duavee approved for use in the prevention of osteoporosis - CORRECT ANSWER yes" "is duavee approved for the treatment of vasomotor symptoms - CORRECT ANSWER yes" "duavee can only be used if the woman still has what - CORRECT ANSWER her uterus" "what are some of the side effects of duavee - CORRECT ANSWER - muscle spasm - nausea - diarrhea - dyspepsia - upper abd pain - oropharyngeal pain - dizziness - neck pain" "what are some of the drug interactions you should be aware of if prescribing duavee - CORRECT ANSWER - CYP3A4 inhibitors such as: - mycin ATBs - azole ATBS - grapefruit juice" "if prescribing duavee you should instruct the pt not to take with what fluid and why - CORRECT ANSWER grapefruit juice - increases estrogen exposure" "Use of duavee is contraindicated in women with active or a history of? - CORRECT ANSWER - blood clots - liver problems - breast/uterine CA" "what are the types of progestins used in HT during menopause - CORRECT ANSWER - medroxyprogesterone acetate (MPA) - Norethindrone (NETA)" "what is the most common type of progestin used in HT during menopause - CORRECT ANSWER Medroxyprogesterone acetate (MPA)" "what is the most commonly prescribed medroxyprogesterone acetate (MPA)? - CORRECT ANSWER Provera also found in prempro and premphase" "what effects do pregstins like MPA's have on cholesterol - CORRECT ANSWER negate estrogens benefits to lipid profiles" "in comparison to other progestins does medroxyprogesterone acetate (MPA) have more or less androgenic activity - CORRECT ANSWER less" "if a pt c/o mood changes or depression when on a bc pill you should change to one containing what - CORRECT ANSWER norethindrone or NETA" "Norethindrone or NETA is developed from what - CORRECT ANSWER testosterone molecule" "Norethindrone or NETA's cause less of what side effects - CORRECT ANSWER - spotting/bleeding - depression - mood changes" "what medications contain norethindrone or NETA - CORRECT ANSWER - FemHRT - Activella - Combipatch" "what are the different types of progesterones - CORRECT ANSWER - Prometrium - Drospirenone - Norgestimate - Levonorgestrel" "what is the FDA approved bio identical form of progesterone called - CORRECT ANSWER Prometrium" "Prometrium is synthesized from what - CORRECT ANSWER yam plants" "what must you be sure to ask about before prescribing prometrium and why - CORRECT ANSWER - food allergies - contains peanut oil" "if a pt does not tolerate synthetic progestins what may you consider - CORRECT ANSWER prometrium (progesterone)" "premetrium has been shown to reduce a woman risk for what - CORRECT ANSWER CVD" "what is the recommended dose for prometrium - CORRECT ANSWER 200 mg QHS x12 days every 28 days with food" "what are some of the side effects of prometrium - CORRECT ANSWER - somnolence - breast tenderness - constipation -HA - dizziness - abd pain - joint pain" "when and how should you instruct your pt to take prometrium - CORRECT ANSWER at night with food." "what is the major side effect of prometrium - CORRECT ANSWER drowsiness" "this HT is primarily used in women who undergo surgical menopause for s/s decreased libido, fatigue and changes in cognition or memory or moodiness - CORRECT ANSWER Androgen: - methyletestosterone (Estratest, Estratest HS)" "what is a good option for HT for someone who has had their ovaries removed - CORRECT ANSWER Androgen methyltestosterone (estratest, estratest HS)" "what effect do androgens have on cholesterol - CORRECT ANSWER - decrease HDL - decrease TG, LDL and total cholesterol" "if a pt c/o of HA and breast tenderness secondary to estrogen what other HT may reduce these s/s - CORRECT ANSWER Androgens Methyltestosterone (estratest)" "HT is indicated for moderate to severe menopausal s/s such as how many hot flashes per day - CORRECT ANSWER 6-8 hot flashes per day" "Is HT indicated if a pt reports hot flashes that are bothersome and disrupt sleep but they can not quantify them to 6 or more per day - CORRECT ANSWER yes" "What are some s/s of vaginal atrophy - CORRECT ANSWER pale, minimal discharge, errythemia, bleeding after intercourse, painful intercourse" "Is HT indicated for vulvar or vaginal atrophy - CORRECT ANSWER yes" "is HT indicated to prevent osteoporosis in women at high risk for fracture - CORRECT ANSWER yes" "prevention of osteoporosis means that they have what - CORRECT ANSWER osteopenia" "HT Is indicated for what 3 things - CORRECT ANSWER - Tx menopausal s/s - Tx vaginal atrophy - Prevent osteoporosis" "continuous estrogen only therapy is indicated for woman with a history of what - CORRECT ANSWER hysterectomy with or without oophorectomy" "what are some of the risk associated with continuous estrogen only therapy - CORRECT ANSWER - endometrial hyperplasia - cancer" "if a pt does not have a uterus do they need progestin as well as estrogen therapy - CORRECT ANSWER no just estrogen" "no uterus = - CORRECT ANSWER no progestin" "have a uterus = - CORRECT ANSWER estrogen and progestin (except Duavee)" "what is the advantage to prescribing continuous combined estrogen progestin therapy - CORRECT ANSWER - lower progestin dose" "use of daily progestin causes endometrial atrophy which has what positive side effect - CORRECT ANSWER minimal spotting" "a pt taking a continuous combined EPT can expect amenorrhea within what time period - CORRECT ANSWER minimal spotting first 6 months then amenorrhea within 1 year" "what is the brand name of cyclic combined EPT - CORRECT ANSWER premphase" "what are some of the disadvantages of cyclic combined EPT HT - CORRECT ANSWER - withdrawal bleeding - inconvenient" "cyclic combined EPT HT is made up of estrogen that the pt takes for how many days and progestin for how many days - CORRECT ANSWER estrogen daily x28D with Progestin for last 10-14 days of estrogen tx" "if a pt has no uterus what type of HT would you prescribe - CORRECT ANSWER estrogen only" "if a women has a uterus what is the goal of HT therapy - CORRECT ANSWER avoid vaginal bleeding or make it predictable" "transdermal preparations or estrogen batches contain what type of estrogen - CORRECT ANSWER 17B-estradiol" "true or false transdermal estrogen patches are less likely to cause peaks in serum concentration - CORRECT ANSWER true" "transdermal estrogen patches have what effect on insulin - CORRECT ANSWER insulin sensitivity improved" "do transdermal estrogen patches increase CRP or triglycerides - CORRECT ANSWER no" "what effect do transdermal estrogen patches have on cholesterol - CORRECT ANSWER HDL increases but less than with oral HT" "when does the peak concentration of transdermal estrogen patches occur - CORRECT ANSWER 2-8 hours" "if a pt has high triglycerides what type of estrogen would you prescribe - CORRECT ANSWER estrogen patch does not elevate TG" "if a pt has gallbladder disease what type of estrogen would you prescribe - CORRECT ANSWER estrogen patch" "if a pt has DM what type of estrogen would you prescribe - CORRECT ANSWER estrogen patch increases sensitivity to insulin" "if w pt has daily mood swings what type of estrogen would you supply - CORRECT ANSWER estrogen patch" "if a pt is a smoker what type of estrogen would you prescribe - CORRECT ANSWER estrogen patch - decreased risk for clot" "if a pt has problems taking pills or experiences n/v secondary to oral estrogen what type of estrogen would you prescribe - CORRECT ANSWER estrogen patch" "if a pts night sweats are unrelieved by oral estrogen what type of estrogen would you switch them to - CORRECT ANSWER estrogen patch" "what are some first line indications for use of estrogen patch - CORRECT ANSWER - high TG - Gallbladder dx - DM - Migraines - mood swings - smoker - n/v on pill - unable to take pill - night sweats not relieved by pill" "what type of estrogen do estrogen gels contain - CORRECT ANSWER 17B-estradiol" "do gel forms of estrogen deliver a steady state - CORRECT ANSWER yes" "is the onset of a gel estrogen slow or rapid - CORRECT ANSWER rapid" "what are some of the brand names for gel estrogens - CORRECT ANSWER - elestrin - divagel - estrogel - estrasorb" "pt using a gel form of estrogen should be instructed to avoid contact with others for how long - CORRECT ANSWER 1 hour after applciation" "pts using a gel form of estrogen should be instructed to avoid what other topical agent and why - CORRECT ANSWER sunscreen increases estrogen absorption" "if you prescribe estrogel how should you instruct your pt to apply it - CORRECT ANSWER 1 pump to arm from wrist to shoulder" "if you prescribe estrasorb how should you instruct your pt to apply it - CORRECT ANSWER 2 foil packets to each thing and calf rubbed in for 3 minutes" "what is the brand name of a estrogen spray - CORRECT ANSWER evamist" "if you prescribe evamist how would you instruct your pt to use it - CORRECT ANSWER 1 spray to inner forearm up to 3 times a day in different spots let dry for 2 minutes" "estrogen spray evamist contains what form of estrogen - CORRECT ANSWER estradiol" "does the estrogen spray evamist have a slow or fast absorption rate - CORRECT ANSWER slow" "is skin irritation common with the use of estrogen gels or sprays - CORRECT ANSWER no. maybe itching" "pts using evamist should be instructed to avoid contact with others for how long - CORRECT ANSWER 30 mintues" "what are some side effects of evamist estrogen spray - CORRECT ANSWER HA breast tenderness nasopharyngitis nipple pain back pain nausea arthralgia" "is femring a local or systemic estrogen - CORRECT ANSWER systemic" "femring is FDA approved for what uses - CORRECT ANSWER - menopausal s/s - atrophic vaginitis" "femring is inserted into the vagina and changed every how many days - CORRECT ANSWER 90 days" "femring is ideal for a woman who has had what - CORRECT ANSWER hysterectomy" "if femring is used in a woman with an intact uterus what must you also prescribe - CORRECT ANSWER progestin pill" "when starting an estrogen you should always start with a low dose if the response is suboptimal you may modify it by? - CORRECT ANSWER - increasing dose - changing preparation - change delivery route - consider estrogen-androgen combo" "when starting an estrogen therapy how long should you wait before evaluating response and considering making changes - CORRECT ANSWER at least 12 weeks (3months)" "if you start a woman on estrogen on hot flashes when you can you tell they can expect some relief - CORRECT ANSWER with 2-3 weeks with optimal relief in 12 weeks" "what is the only FDA approved SSRI for the treatment of vasomotor s/s - CORRECT ANSWER brisdelle" "if brisdelle is not covered by a pts insurance what may you consider as an alternative - CORRECT ANSWER paroxetine 10 mg" "when taking bristdelle what type of relief from hot flashes can a pt expect - CORRECT ANSWER 1-2 fewer/day" "what are some side effects of brisdelle - CORRECT ANSWER - HA - Fatigue - N/V" "Does bristled cause weight gain or sexual dysfunction - CORRECT ANSWER no" "what are some risks to taking brisdelle - CORRECT ANSWER - reduces effectiveness of tamoxifen - increased bleeding - serotonin syndrome" "What SSRIs may you consider prescribing to treat hot flashes - CORRECT ANSWER -Escitalopram (lexapro) - Citalopram - Fluoxetine - Sertraline" "how is escitalopram lexapro dosed for tx of hot flashes - CORRECT ANSWER 10 mg daily increase to 20 mg after 4 weeks" "if you prescribe a pt escitalopram (lexapro) for the tx of hot flashes what type of reduction can they expect - CORRECT ANSWER about 50%" "there is an increased risk of bleeding if escitalopram (lexapro) is taken with what - CORRECT ANSWER - ASA - NSAIDS - Warfarin - anticoagulants" "Can escitalopram (lexapro) be given with tamoxifen - CORRECT ANSWER yes" "escitalopram (lexapro) should be used with caution if the pt has recent h/o of what - CORRECT ANSWER MI, unstable heart disease, hepatic or renal impairment" "How is citalopram dosed for hot flashes - CORRECT ANSWER 10 - 20 mg" "if prescribing citalopram for hot flashes how much of a reduction in s/s can your pt expect - CORRECT ANSWER 50%" "true or false there are few side effects from citalopram and it is safe to use in the elderly - CORRECT ANSWER true" "can you use citalopram with tamoxifen - CORRECT ANSWER yes" "are SSRI considered first line therapy for the treatment of hot flashes - CORRECT ANSWER no" "what SSRI's may you be least likely to consider for the tx of hot flashes - CORRECT ANSWER fluoxetine sertraline" "what SNRI's may be used in the treatment of hot flashes - CORRECT ANSWER - Venlafaxine - Desvenlafaxine (prestiq)" "what are some of the side effects of venlafaxine - CORRECT ANSWER - Dry mouth - Constipation - Nausea" "Venlafaxine and desvenlasfaxine should be used with caution in women who also have what disease - CORRECT ANSWER HTN - may increase bp" "why should you use venlafaxine and desvenlafazine cautiously in women with HTN - CORRECT ANSWER may increase bp" "can venlafaxine be used with tamoxifen - CORRECT ANSWER yes" "in addition to a 50% reduction in hot flashes what other benefits does the SNRI venlafaxine have - CORRECT ANSWER - improved sleep" "what is pattis favorite SNRI for breast cancer pts - CORRECT ANSWER venlafaxine" "which SSRI or SNRI has been proven to cause the greatest reduction in hot flashes for pts - CORRECT ANSWER Desvenlafaxine (prestiq) 60-66%" "what are some side effects of venlafaxine - CORRECT ANSWER - nausea - dizziness - ha" "is desvenlafaxine a good choice for tamoxifen users - CORRECT ANSWER yes" "list some OTC botanical and isoflavones people may try to reduce their menopausal s/s - CORRECT ANSWER - soy isoflavones - red clover - black cohosh - evening primrose oil - chasteberry -dong quai -ginseng -vitamin e" "has there been proven any benefit to taking botanicals or isoflavones to reduce s/s menopause - CORRECT ANSWER no" "Remifmin is the OTC version of what herb - CORRECT ANSWER black cohosh" "Vitex is the OTC verison of what herb - CORRECT ANSWER Chasteberry" "woman should be instructed to avoid isoflavones if they have what other disease - CORRECT ANSWER thyroid disorders" "Black cohosh should be avoided with what other meds - CORRECT ANSWER antihypertensives anticoags" "what is an adverse effect to taking black cohosh - CORRECT ANSWER liver failure" "if a woman is taking black cohosh for 6 months what labs should you obtain - CORRECT ANSWER LFTS liver failure" "do progesterone containing skin creams protect the endometrium - CORRECT ANSWER no" "is salivary testing to determine hormone levels recommended - CORRECT ANSWER no" "is the use of custom compounded hormones recommended - CORRECT ANSWER no" "what are the FDA approved bio identical hormones - CORRECT ANSWER - oral esterase (estrace) - 17-beta estradiol on patch, gel, spray, ring (estring) - Prometrium" "what are some of the benefits of using a local vaginal estrogen therapy - CORRECT ANSWER - minimize systemic exposure - reduce urge incont - reduce UTI" "what is the only vaginal preparation of a local estrogen therapy that acts systemically - CORRECT ANSWER Femring" "is femring a local or systemic treatment - CORRECT ANSWER systemic" "Femring is approved for the treatment of what - CORRECT ANSWER - menopausal s/s - vaginal atrophy" "if prescribing Femring to a pt with a uterus what must you also prescribe - CORRECT ANSWER Progestin" "what is considered for line therapy for the tx of decreased libido, dyspareunia, volvovaginal s/s - CORRECT ANSWER Vaginal Preparation - Local estrogen therapies" "recurrent UTI associated with vaginal atrophy is defined as how many UTIs in what time frame - CORRECT ANSWER 3x/12months or 2x/6months" "what are your treatment options for atrophic vaginitis - CORRECT ANSWER - esterase cream - premarin cream - estring - vagifem - femring - Ospemifene (osphena)" "would you use Femring for the tx of atrophic vaginitis alone - CORRECT ANSWER no but may use to tx atrophic vaginitis if also having menopausal s/s" "if prescribing femring what will you also need if a uterus is present - CORRECT ANSWER progestin" "with estrogen cream therapies for the treatment of atrophic vaginitis a pt can expect to experience relief in what time frame - CORRECT ANSWER 2 weeks" "a pt should avoid sexual contact for what time period after applying local estrogen cream - CORRECT ANSWER 12 hours" "what drug category does ospemifene or osphena fall under - CORRECT ANSWER selective estrogen receptor modulator (SERM) estrogen agonist/antagonist" "Orphan makes vaginal tissue thicker and less fragile but may lead to what complication - CORRECT ANSWER endometrial hyperplasia" "Ospemifene (Osphena) is indicated for the treatment of what 2 conditions - CORRECT ANSWER - Atrophic vaginitis - Dyspareunia" "Ospemifene (osphena) can lead to endometrial hyperplasia what s/s should you monitor for which may indicate this complication - CORRECT ANSWER uterine bleeding" "why is ospemifene (Osphena) not first line therapy for atrophic vaginitis - CORRECT ANSWER systemic treatment for local problem" "what is the black box warning associated with ospemifene (osphena) - CORRECT ANSWER increased risk for endometrial cancer" "if a pt has an increased risk for endometrial cancer such as obesity, HTN, DM and is taking ospemifene (osphena) for dyspareunia what med should you also prescribe and why - CORRECT ANSWER Progestin. Increased risk for endometrial cancer" "what are some side effects of ospemifene (osphena) - CORRECT ANSWER -hot flashes - vaginal d/c - muscle spasms - excessive sweating" "would you prescribe ospemifene (osphena) to a women c/o of dyspareunia who is also c/o hot flahses - CORRECT ANSWER no - most common side effect is hot flashes" "what drugs is ospemifene (osphena) known to interact with - CORRECT ANSWER - azole ATB's - Rifampin - other SERMS - Estrogen therapy" "Use of ospemifene (osphena) is contraindicated in what pts - CORRECT ANSWER - undiagnosed vaginal bleeding - pregnancy - estrogen dependent neoplasia - active/hx VTA - HX stroke, HD, MI - Liver problems" "what are some non hormonal options for the treatment of atrophic vaginitis - CORRECT ANSWER -moisturizers -lubricants" "what are the 2 basic lubricant formulations - CORRECT ANSWER water silicone" "lubricants are used primarily for what - CORRECT ANSWER dyspareunia" "what is the only FDA approved treatment for female low libido or hypoactive sexual desire disorder - CORRECT ANSWER Flibanserin (Addyi)" "how long does flibanserin (addyi) take to work - CORRECT ANSWER 4-8 weeks" "flibranserin (addyi) is contraindicated in what - CORRECT ANSWER liver disease ETOH use" "can NP's prescribe flibanserin (addyi) for low libido - CORRECT ANSWER only if take online course" "what must a pt sign before being given flibanserin (addyi) - CORRECT ANSWER statement that says they will not drink ETOH" "there is a decreased risk for dvt with use of what preparation of estrogens - CORRECT ANSWER transdermals and gels" "before starting HT what risk factors should you work your pt up for - CORRECT ANSWER -CVA -CHD -VTE -Osteoporosis -Breast CA" "before starting HT your pt should of had a mammogram within what time frame - CORRECT ANSWER previous 12 months" "should HT be used for primary or secondary prevention of heart disease - CORRECT ANSWER no" "is a 64y female with menopause at age 52y eligible for HT for her c/o hot flashes - CORRECT ANSWER no - current age over 60. menopause 10 years ago" "would you prescribe fenlafaxine to a pt with a hx of htn - CORRECT ANSWER no" "Femring is ideal for a pt who has had a hysterectomy and also c/o what - CORRECT ANSWER - hot flashes - night sweats - vaginal dryness" "Primary ovarian insufficiency - CORRECT ANSWER Menopause that occurs before age 40" "Early menopause transition (stage -2) - CORRECT ANSWER Persistent difference of 7 days or more in the length of consecutive cycles." "Late menopause transition (stage -1) - CORRECT ANSWER 60 or more consecutive days of amenorrhea" "Luteal out of phase event (LOOP) - CORRECT 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 - CORRECT 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 - CORRECT ANSWER These ethnic groups have lower estradiol levels then white, black and hispanic women." "stage +2 - CORRECT ANSWER late menopause stage: 5-8 years after FMP. Somatic aging predominates. Increased genitourinary symptoms." "Stages +1a, +1b, +1c - CORRECT ANSWER early post menopause: 2 years after FMP. FSH rises, estradiol decreases. VMS predominate." "Elevated FSH, LH - CORRECT ANSWER Endocrine labs after menopause" "AMH, inhibin B - CORRECT ANSWER These hormones work during reproductive years to not deplete follicle pool too quickly." "Phases during menopause transition and PMS symptoms - CORRECT ANSWER Menstrual cycle shortenes, follicular phase compresses, women spend more time in luteal phase.. meaning more premenstrual symptoms and more frequent menstrual periods." "How to respond if a patient requests FSH lab? - CORRECT ANSWER many pitfalls, variable depending on the day of the cycle you draw the lab, normal or low FSH is not helpful." "The potentially superior marker of menopause, a lab. - CORRECT ANSWER AMH" "DHEA (dehydroepiandrosterone) - CORRECT 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 - CORRECT ANSWER Vagina, vulva, urethra, trigone of the bladder" "Effects of estrogen on tissue - CORRECT ANSWER maintain blood flow, the collagen, and HA within the epithelial surfaces. Supports microbiome and protects tissue from pathogens." "Vaginal changes with menopause - CORRECT ANSWER Thinning, loss of elasticity, loss or absence or rugae." "Vagina and urethra in menopause - CORRECT ANSWER vagina narrows, urethra moves closer to the introitus." "Stress urinary incontinence - CORRECT ANSWER Vaginal estrogen and urinary incontinence: what type does it help with?" "Treatment for FPHL - CORRECT ANSWER Minoxidil, spironolactone, finasteride, estrogen therapy" "Testosterone/SHGB ratio is called what? - CORRECT ANSWER The free androgen index" "What stage are VMS more likely? - CORRECT ANSWER +1b (generally last 2 years)" "What hormone is generally higher in obese women? - CORRECT ANSWER Estrone-via aromatization." "The postmenopausal ovary continues to produce what two hormones? - CORRECT ANSWER testosterone and androstenedione" "Surgical menopause causes women to have lower levels of what hormone? - CORRECT 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? - CORRECT 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? - CORRECT ANSWER Luteal-more PMS symptoms, more frequent menstrual periods." "HPO axis theory and the menopause transition - CORRECT 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? - CORRECT ANSWER progesterone" "What part of the pituitary gland secretes adrenocorticotropic hormone? - CORRECT ANSWER Anterior pituitary. The posterior only secretes vasopressin and oxytosin." "Cortisol and HRT - CORRECT ANSWER 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." "Do cortisol levels associate with VMS severity? - CORRECT ANSWER No, cortisol levels have NOT been associated with more severe VMS." "Local DHEA has been proven to help with what? - CORRECT ANSWER vaginal pain and dyspareunia" "How to DX POI? - CORRECT 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 - CORRECT ANSWER prolactin FSH estradiol TSH pregnancy test" "Hair loss. Difference between FPHL and telogen effluvium? - CORRECT 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." "FPHL pattern - CORRECT ANSWER thinning at the crown of the head and widening of the hair part" "Treating FPHL - CORRECT ANSWER MINOXIDIL spironolactone finasteride" "What ethnicity has the least likely chance of having bad hot flashes? - CORRECT ANSWER Japanese" "What ethnicity is the most likely to have bad hot flashes? - CORRECT ANSWER black more frequent, longer duration." "Median length of hot flashes - CORRECT ANSWER 10 years, early menopause transition women have them the longest." "Theories about etiology of hot flashes (6) - CORRECT ANSWER lower ovarian estradiol 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 - CORRECT 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 - CORRECT ANSWER squamous cell carcinoma" "Vulvar disorder commonly misdiagnosed as eczema or dermatitis? - CORRECT 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 - CORRECT ANSWER 100mL" "systemic and vaginal estrogen will not help with this type of urinary incontinence? - CORRECT ANSWER will NOT help with stress incontinence." "Which topical vaginal estrogen has the highest dose? - CORRECT ANSWER the vaginal rings FEMRING IS THE HIGHEST" "Most common cause of vulvovaginitis? - CORRECT ANSWER BV" "post menopause burning and diffuse yellow/brown discharge and dyspareunia that does not respond to local ET? - CORRECT ANSWER desquamative inflammatory vaginitis. treat different with clindamycin or hydrocortisone+ET" "What hormones are associated with sexual desire in women? - CORRECT ANSWER circulating androgens" "Does systemic ET cause fibroids to resume growth? - CORRECT ANSWER Rarely. They often shrink after menopause." "What is true about cognition and menopause? - CORRECT ANSWER Difficulty concentrating and remembering are common." "What is true about cognition and surgical menopause - CORRECT 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? - CORRECT 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 - CORRECT 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? - CORRECT 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? - CORRECT ANSWER 1. Observational studies imply it 2. Clinical trial of transdermal estradiol during the early postmenopause stage is associated with reductions in AD pathology. 3. 18 year cumulative follow up data from WHI found that women randomized to ET had significantly lower risk of dying from AD or dementia compared with women randomized to receive placebo." "how does HRT impact gallbladder disease? - CORRECT ANSWER increases risk of gallstones with oral HRT, lower risk with transdermal." "when did they start screening blood for hep c? - CORRECT ANSWER 1992, so women who have received blood products or organ transplants prior to 1992 may have acquired heptatitis c" "why do we screen for hep C? - CORRECT ANSWER most infections become chronic and most are asymptomatic until liver damage is detected years later. Our treatments are improving so if we catch this earlier in people, outcomes will be better" "all adults born from what year to what year should recieve one time hep c testing? - CORRECT ANSWER 1945 to 1965" "routine screening of all adults for hepatitis c. is it reocmmended? - CORRECT ANSWER routine screening for all adults is not recommended, however baby boomers are at the highest risk. infection rates are 5x other birth cohorts." "what hpv is high risk? - CORRECT ANSWER 16 and 18" "by age 50 what percentage of US women will have acquired a genital HPV infection? - CORRECT ANSWER 80%-HPV is very common, but it is the high risk ones to worry about" "what is the most commonly sexually transmitted infection in the US? - CORRECT ANSWER HPV" "What percentage of bone loss do women have from the menopause transition? - CORRECT ANSWER 10-12% on average, about 1 t score" "when does the time frame known as perimenopause begin - CORRECT ANSWER when a pt begins experiencing menstrual cycle changes and other menopause related s/s" "who long does the perimenopause period usually last - CORRECT ANSWER 6-10 years" "perimenopause begins with the changing of the menstraul cycle and menopause s/s and continues until when - CORRECT ANSWER through menopause and 1 year after menopause" "what is another name for the peri menopause period - CORRECT ANSWER menopause transitions (MT)" "defined as the the final menstrual period which can be confirmed after going 12 consecutive months without a period - CORRECT ANSWER menopause" "when can you diagnose menopause - CORRECT ANSWER after 12 consecutive months without a period" "defined as the span of time after menopause - CORRECT ANSWER post menopause" "what does NAMS stand for - CORRECT ANSWER north america menopause society" "what is the average age of menopause - CORRECT ANSWER 51 range 45-55" "during menopause what levels decrease - CORRECT ANSWER - decrease in ovarian follicular activity - decrease in estrogen and progesterone" "during menopause what levels rise - CORRECT ANSWER - FSH increase 10-20 times - LH levels rise 3 times" "what are some factors that affect the age of menopuase - CORRECT ANSWER - heredity - age of menarche - smoking - altitude - nutrition - high vmi - non contraceptive hormone use like lupron - hx osteoporosis - hx autoimmune dx - hx chemo/radiation" "if a pt has a late menarch what can you tell them about when they may go into menopause - CORRECT ANSWER early" "if a pt has an early menarch what can you tell them about when they may go into menopause - CORRECT ANSWER late" "during perimenopause a woman may begin to experience disturbances in her menstrual pattern which may include - CORRECT ANSWER - dysfunctional uterine bleeding - irregular bleeding - variation in length of cycles" "during perimenopause a woman may begin to not variations in the length of her cycles usually - CORRECT ANSWER shortened" "what are the 3 main s/s of perimenopause - CORRECT ANSWER - disturbance in menstrual pattern - vasomotor insability - atrophic conditions" "what is that most commonly reported vasomotor s/s experienced during peri menopause - CORRECT ANSWER hot flashes" "untreated vasomotor s/s are associated with what poor outcomes - CORRECT ANSWER - loss of sleep - loss of memory - lethargy - fatigue" "what other conditions may you want to rule out if a woman presents with only c/o hot flahes - CORRECT ANSWER - TB - myelo proliferative disease - SE of SSRI - Sleep apnea - GERD - ETOH abuse - nocturnal hypoglycemia" "what are some psychologic discomforts associated with going through menopause - CORRECT ANSWER - insomnia - mood swings - irritability - anxiety - depression - memory loss - general malaise" "does HT improve the feelings of anxiety and depression that may be experienced during menopause - CORRECT ANSWER yes especially if started within 3 years of menopause" "during menopause women experience a decrease in Ph and and increase in lactobacilli putting them at increased risk for what - CORRECT ANSWER UTI" "what may you prescribe to prevent UTIs in menopausal women - CORRECT ANSWER local estrogen" "does oral estrogen decrease the risk of UTI in menopausal women - CORRECT ANSWER No. only local estrogen" "what type of HT has been proven to relieve some of the psychological discomforts associated with menopause - CORRECT ANSWER Estrogen patches" "what skin changes may a woman experience during menopause - CORRECT ANSWER dry hyperpigmentation age spots" "what breast changes may a woman experience during menopause - CORRECT ANSWER loss of adipose tissue" "what hair pattern changes may a woman experience during menopause - CORRECT ANSWER loss of axillary and pubic hair. Growth of hair on face and chin" "what changes may a woman going through menopause note in her mouth - CORRECT ANSWER dry mouth" "during menopause what may happen to a womans lipid levels - CORRECT ANSWER HDL decreases LDL, TG, Total cholesterol all increase" "what are the criteria that need to be met to diagnose menopause - CORRECT ANSWER 1. amenorrhea for 12 months 40y 2. 40y - elevated FSH30 3. 40y FSH 30 LH40 estradiol 15-30" "to diagnose menopause a woman of what age must have not had a period for how long - CORRECT ANSWER amenorrhea for 12 months +/- s/s if 40 yo" "to diagnose menopause a woman must be greater than what age with an FSH level of what - CORRECT ANSWER 40 years old with a consistently elevated level of FSH 30" "to diagnose menopause a woman less than what age must have FSH, LH and estradiol levels of what - CORRECT ANSWER 40 years old FSH 30, LH 40, Estradiol15-30" "is a single random level of FSH, LH or estradiol a reliable indicator of menopause - CORRECT ANSWER no" "do you need to draw labs to diagnose menopause - CORRECT ANSWER no" "when you can you assume induced menopause has occured - CORRECT ANSWER after bilateral oophorectomy or ablation of ovarian function" "what are some management options for menopause - CORRECT ANSWER - HT - SSRI and SNRI - Nutrition - Weight bearing exercise - Education - Herbs - Hypnosis" "have weight bearing exercises been proven effective a decreasing a menopausal womans risk for osteoporosis - CORRECT ANSWER no but does maintain the bone mass that they have" "are herbs fda approved or proven effective at treating the s/s menopause - CORRECT ANSWER no" "does exercise decrease the number of hot flashes - CORRECT ANSWER no" "what supplements should you encourage a menopausal woman take - CORRECT ANSWER calcium and vitamin d" "why did the womens health initiatives (WHI) lead to a decrease in the use of HT - CORRECT ANSWER concern for breast CA risk and CV risk" "what was the WHI study designed to look at - CORRECT ANSWER effects of estrogen on CV health and slowing progession of cognitive decline" "did the WHI study evaluate the impact of HT on PM women - CORRECT ANSWER no these women were excluded from the study" "did the WHI study assess the efficacy of established HT - CORRECT ANSWER no" "the WHI study looked primarily at what age gropu pf women - CORRECT ANSWER 60-79yo post menopausal women" "what are some absolute contraindications of HT - CORRECT ANSWER - undiagnosed vaginal bleeding - known or suspected pregnancy - known, suspected or hx of breast ca - known/suspected estrogen-dependent neoplasia - severe liver disease if giving PO HT - Active/hx DVT, PE, clotting - Active/hx stroke, MI" "should you treat undiagnosed vaginal bleeding with HT - CORRECT ANSWER no" "if someone is pregnant should you prescribe HT - CORRECT ANSWER no" "if a pt has known suspected or a hx of breast cancer is it adviseable to prescribe HT - CORRECT ANSWER no" "when should you not prescribe PO HT - CORRECT ANSWER if known liver disease" "is smoking a contraindication for the use of HT - CORRECT ANSWER no" "is a family history of breast CA a contraindication to HT - CORRECT ANSWER no" "where is oral estrogen metabolized - CORRECT ANSWER liver" "is use of HT contraindicated in a pt with a h/o migraines - CORRECT ANSWER relative contraindication as may exacerbate migraines" "if a pt has hypertriglyceridemia should you prescribe HT - CORRECT ANSWER patch or esterified estrogens" "what type of HT should you prescribe to someone with a hx of uterine fibroids or endometriosis - CORRECT ANSWER low dose" "if someone has a an active or history of a DVT, PE or clotting disorder is it ok to prescribe HT - CORRECT ANSWER no" "if apt has an active or within the past year has had a stroke or an MI is it ok to prescribe a HT - CORRECT ANSWER no" "what are some common side effects of estrogen use - CORRECT ANSWER - breast tenderness - nausea - HA" "what are some common s/e of progestin use - CORRECT ANSWER - withdrawal bleeding - bloating - HA - mood changes"