NAMS Menopause Certification Study Guide with complete solutions

NAMS Menopause Certification Study Guide with complete solutions-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