NAMS Certificationhttps://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
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
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
, NAMS Certificationhttps://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
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
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
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
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
, NAMS Certificationhttps://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
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
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
https://www.stuvia.com/user/filwe1099salmin
