NAMS Certification
Physiology of VMS - ✅✅ --thermoregulatory center altered by increase in
KNDy neurons
-activation of NK3R causes hot flashes
-blockade of NK3R reduces/eliminates hot flashes
-may also be affected by: serotonin, epinephrine, and norepinephrine;
parasympathetic nerve activity
Off label rx for VMS - ✅✅--SSRIs
-SNRIs
-Gabapentinoids
-Clonidine
-Oxybutynin
Studies on Fractional Co2 Laser for GSM - ✅✅
--not FDA approved
-vaginal symptoms and sexual function scores increased significantly at 3
mon; noted continued improvement at 1y
Ospemifene (Osphena) indications and MOA - ✅✅ --for treatment of
dyspareunia
-decreases vaginal pH
-improves vaginal dryness
-shifts vaginal maturational index to superficial cells
-estrogen agonist/antagonist
Ospemifene (Osphena) adverse effects - ✅✅ --increase in uterine polyps
-proliferative endometrium
-slight increased risk of hemorrhagic stroke and VTE
-can increase VMS
treatment of urge incontinence - ✅✅--behavioral modifications
-overactivity of the detrusor muscle
-antimuscarinics: *oxybutynin*
-nerve stimulation
-botox
pelvic floor muscles - superficial - ✅✅--transverse perineal
-bulbospongiosus,
-ischiocavernosus
,pelvic floor muscles - deep - ✅✅--pubococcygeus
-iliococcygeus
-obturator internus
-coccygeus
What is low-tone pelvic floor dysfunction? - ✅✅
--weak, underactive and
hypotonic muscles that cannot maintain adequate contraction
What is high-tone Pelvic Floor Dysfunction? - ✅✅--weak pelvic floor
muscles cannot attain or maintain adequate relaxation
-muscles are overactive, hypertonic, spastic, shortened
What are the symptoms of low-tone PFD? - ✅✅--heaviness
-pressure
-pelvic organ prolapse
-incontinence
-altered sexual sensation
What are the symptoms of high-tone PFD? - ✅✅--urinary retention
-frequency
-urgency
-dysuria
-fecal retention/constipation
-penetrative dyspareunia and/or vaginismus
Vaginal dilators for PFD - ✅✅ --Choose size that does not cause pain
-Show how to insert with a mirror
-Apply lubricant to dilator, insert dilator as far as is comfortable, leave dilator in
place
for 5-10 min 1-2 times daily
-Use each for 4 wk before progressing to a size similar to partner size
HRT and cognition - natural menopause - ✅✅-In RCT, HRT has little or no
overall effect on short or long-term cognition
HRT and cognition - surgical menopause - ✅✅-HRT may be beneficial in
improving verbal memory in the short term
, ✅✅
In the SWANN survey, which groups of women were most likely to experience
sleep disturbance? - --late perimenopause (45%)
-surgical menopause (47%)
non-menopausal causes of chronic myalgia - ✅✅--fibromyalgia
-arthritis
-statins
-biphosphonates
✅✅-1. Does pt have joint-based pain?
3 simple questions to dx arthritis -
-single/multiple
-symmetrical
-episodic/progressive
-with activity
2. Is there early morning stiffness?
3. Can I see joint swelling?
-redness in joints
-tenderness in joints
-MCP joint swelling
Most common sites of osteoarthritis - ✅✅-knee, hip, hand
✅✅-peak age of onset: women age 35-55
onset of rheumatoid arthritis -
most common cause of hypothyroidism - ✅✅-Hashimoto's thyroiditis
Gallbladder disease and HT - ✅✅--prescribe HT with caution in women with
gallstones or h/o gallbladder disease
-suggested that oral estrogen has a a greater risk of gallbladder disease vs
transdermal
-CHCs and HT increase risk of cholelithiasis, cholecystitis, and
cholecystectomy
✅✅-All patients born between 1945 and 1965
who to screen for hepatitis C -
Primary syphillis symptoms - ✅✅-single, painless chancre for 3-6 weeks
Secondary syphilis symptoms - ✅✅--Rash on palms/soles
-Mucous membrane lesions
-Lymphadenopathy
, -Malaise
-Fever
latent (tertiary) syphilis symptoms -✅✅--Brain damage, dementia and
mental health problems
-Heart disease
-Movement disorders and muscle problems
-Nerve damage
-Seizures
-Tumors, usually on the bones and skin
-Vision problems
prevalence of osteoporosis - ✅✅ --of 10 million adults with osteoporosis, 8
million are women
-prior low-trauma/fragility fracture is a diagnosis of osteoporosis regardless of
DEXA result
*excludes fingers, toes, face, skull or pathologic traumatic fractures
When do women reach peak bone mass? - ✅✅-age 20
What accounts for 50-85% of variance in BMD? - ✅✅-genetics
What is the difference between T-score and Z-score? - ✅✅-Z-scores are for
premenopausal women; match age/sex/race-based criteria
T-scores are for postmenopausal women
Criteria to dx osteopenia -✅✅-T-score -1.0 to -2.5
Criteria to dx osteoporosis - ✅✅-T-score less than -2.5
Criteria for normal bone density per WHO - ✅✅-T-score above -1.0
What race has the highest bone density? - ✅✅-Black women
✅✅
What conditions qualify a patient for pharmacologic therapy for osteoporosis?
- --osteoporosis on T-score (<2.5%)
-10-yr FRAX risk overall > 20%
-10-yr FRAX risk for hip > 3%
-h/o low trauma fracture
Physiology of VMS - ✅✅ --thermoregulatory center altered by increase in
KNDy neurons
-activation of NK3R causes hot flashes
-blockade of NK3R reduces/eliminates hot flashes
-may also be affected by: serotonin, epinephrine, and norepinephrine;
parasympathetic nerve activity
Off label rx for VMS - ✅✅--SSRIs
-SNRIs
-Gabapentinoids
-Clonidine
-Oxybutynin
Studies on Fractional Co2 Laser for GSM - ✅✅
--not FDA approved
-vaginal symptoms and sexual function scores increased significantly at 3
mon; noted continued improvement at 1y
Ospemifene (Osphena) indications and MOA - ✅✅ --for treatment of
dyspareunia
-decreases vaginal pH
-improves vaginal dryness
-shifts vaginal maturational index to superficial cells
-estrogen agonist/antagonist
Ospemifene (Osphena) adverse effects - ✅✅ --increase in uterine polyps
-proliferative endometrium
-slight increased risk of hemorrhagic stroke and VTE
-can increase VMS
treatment of urge incontinence - ✅✅--behavioral modifications
-overactivity of the detrusor muscle
-antimuscarinics: *oxybutynin*
-nerve stimulation
-botox
pelvic floor muscles - superficial - ✅✅--transverse perineal
-bulbospongiosus,
-ischiocavernosus
,pelvic floor muscles - deep - ✅✅--pubococcygeus
-iliococcygeus
-obturator internus
-coccygeus
What is low-tone pelvic floor dysfunction? - ✅✅
--weak, underactive and
hypotonic muscles that cannot maintain adequate contraction
What is high-tone Pelvic Floor Dysfunction? - ✅✅--weak pelvic floor
muscles cannot attain or maintain adequate relaxation
-muscles are overactive, hypertonic, spastic, shortened
What are the symptoms of low-tone PFD? - ✅✅--heaviness
-pressure
-pelvic organ prolapse
-incontinence
-altered sexual sensation
What are the symptoms of high-tone PFD? - ✅✅--urinary retention
-frequency
-urgency
-dysuria
-fecal retention/constipation
-penetrative dyspareunia and/or vaginismus
Vaginal dilators for PFD - ✅✅ --Choose size that does not cause pain
-Show how to insert with a mirror
-Apply lubricant to dilator, insert dilator as far as is comfortable, leave dilator in
place
for 5-10 min 1-2 times daily
-Use each for 4 wk before progressing to a size similar to partner size
HRT and cognition - natural menopause - ✅✅-In RCT, HRT has little or no
overall effect on short or long-term cognition
HRT and cognition - surgical menopause - ✅✅-HRT may be beneficial in
improving verbal memory in the short term
, ✅✅
In the SWANN survey, which groups of women were most likely to experience
sleep disturbance? - --late perimenopause (45%)
-surgical menopause (47%)
non-menopausal causes of chronic myalgia - ✅✅--fibromyalgia
-arthritis
-statins
-biphosphonates
✅✅-1. Does pt have joint-based pain?
3 simple questions to dx arthritis -
-single/multiple
-symmetrical
-episodic/progressive
-with activity
2. Is there early morning stiffness?
3. Can I see joint swelling?
-redness in joints
-tenderness in joints
-MCP joint swelling
Most common sites of osteoarthritis - ✅✅-knee, hip, hand
✅✅-peak age of onset: women age 35-55
onset of rheumatoid arthritis -
most common cause of hypothyroidism - ✅✅-Hashimoto's thyroiditis
Gallbladder disease and HT - ✅✅--prescribe HT with caution in women with
gallstones or h/o gallbladder disease
-suggested that oral estrogen has a a greater risk of gallbladder disease vs
transdermal
-CHCs and HT increase risk of cholelithiasis, cholecystitis, and
cholecystectomy
✅✅-All patients born between 1945 and 1965
who to screen for hepatitis C -
Primary syphillis symptoms - ✅✅-single, painless chancre for 3-6 weeks
Secondary syphilis symptoms - ✅✅--Rash on palms/soles
-Mucous membrane lesions
-Lymphadenopathy
, -Malaise
-Fever
latent (tertiary) syphilis symptoms -✅✅--Brain damage, dementia and
mental health problems
-Heart disease
-Movement disorders and muscle problems
-Nerve damage
-Seizures
-Tumors, usually on the bones and skin
-Vision problems
prevalence of osteoporosis - ✅✅ --of 10 million adults with osteoporosis, 8
million are women
-prior low-trauma/fragility fracture is a diagnosis of osteoporosis regardless of
DEXA result
*excludes fingers, toes, face, skull or pathologic traumatic fractures
When do women reach peak bone mass? - ✅✅-age 20
What accounts for 50-85% of variance in BMD? - ✅✅-genetics
What is the difference between T-score and Z-score? - ✅✅-Z-scores are for
premenopausal women; match age/sex/race-based criteria
T-scores are for postmenopausal women
Criteria to dx osteopenia -✅✅-T-score -1.0 to -2.5
Criteria to dx osteoporosis - ✅✅-T-score less than -2.5
Criteria for normal bone density per WHO - ✅✅-T-score above -1.0
What race has the highest bone density? - ✅✅-Black women
✅✅
What conditions qualify a patient for pharmacologic therapy for osteoporosis?
- --osteoporosis on T-score (<2.5%)
-10-yr FRAX risk overall > 20%
-10-yr FRAX risk for hip > 3%
-h/o low trauma fracture
