Term
| ? is the permanent cessation of menses following the loss of ovarian follicular activty; the diagnosis of menopause is primarily a clinical one and is made after a woman experiences amenorrha for ? consecutive months |
|
Definition
|
|
Term
| the loss of ovarian follicular activity leads to an increase in ?, which on laboratory examination, may help to confirm the diagnosis; many women seek medical treatment for the relief of menopausal symptoms, primarily ? |
|
Definition
| FSH (follicle stimulating hormone); hot flashes |
|
|
Term
| ? therapy has long been prescribed for relief of menopausal symptoms; it used to be thought that hormone therapy could be used to treat menopausal symptoms as well prevent ?; this has been disproved and shown that HT can actually increase risk of CHD in patients with risk factors and can also increase the likelihood of ? cancer; the current thought is that HT should only be used to reduce the frequency and severity of ? symptoms associated with menopause in women without risk factors for ? or ? |
|
Definition
| hormone; CHD; breast; vasomotor; CHD; breast cancer |
|
|
Term
| women who have undergone a total abdominal ? (surgical menopause) generally experience menopause earlier compared with women who experience natural menopause; other factors that may be associated with early menopause are ? body weight, ? menstrual cycle length, ? and ?; smokers generally experience menopause approximately ? years earlier than nonsmokers |
|
Definition
| hysterectomy; low; increased; nulliparity; smoking, 2 years |
|
|
Term
| the usual transitional period prior to menopause, known as ?, is a period when hormonal and biologic changes begin to occur; these changes may begin ? to ? years prior to menopause and eventually lead to irregular menstrual cycles, an increase in cyclic interval, and decrease in length of menses; during this time women may also experience physical symptoms similar to menopausal symptoms, primarily ? symptoms, and may require treatment |
|
Definition
| perimenopause; 2 to 8 years; vasomotor |
|
|
Term
| the hypothalamus releases ? wich causes the anterior pituitary gland to secrete ? and ? which regulate ovarian function and stimulate the ovary to produce ? steroids; all of these hormones are influenced by ? feedback system and will increase or decrease based on the levels of ? and ? |
|
Definition
| gonadotropin releasing hormone; LH and FSH; sex; negative; estadiol and progesterone |
|
|
Term
| As women age, the number of ovarian follicles ?, and the remaining follicles require higher levels of ? for maturation and ovulation; during ?, FSH concentrations rise during some menstrual cycles and fall again during subsequent menstrual cycles, leading to irregular and unpredicatable menses; during menopause, ? concentrations increase 10-15 fold, ? concentrations increase 5 fold, and levels of circulating ? decrease by over 90% |
|
Definition
| decreases; FSH; perimenopause; FSH; LH; estradiol |
|
|
Term
| HT remains the most effective treatment for ? symptoms and ? atrophy and should be considered for women experiencing these symptoms; the therapy should be continued at the ? dose for the ? duration consistent with treatment goals for each patient |
|
Definition
| vasomotor; vulvovaginal; lowest; shortest |
|
|
Term
| women suffering from vasomotor symptoms should attempt ? or ? modifications before seeking medical treatment; women who seek medical treatment usually suffer from symptoms that diminsh their quality of life such as ? hot flashes per day or week, ? disturbances, vaginal ?, or ? and HT should be considered for these patients |
|
Definition
| lifestyle or behavioral; multiple; sleep; dryness; mood swings |
|
|
Term
| in HT, women who have undergone a hysterectomy need only be prescribed ?; a progestin should be added to the estrogen only for women with an intact ? |
|
Definition
|
|
Term
| due to minimal adverse effects, it is prudent for patients to try lifestyle or behavioral modifications before before and in addition to pharmacologic therapy; the most common nonpharmacologic interentions for vasomotor symptoms are ? cessation, limit ? and ?, limit ? beverages, limit ? foods, keep cool and dress in ?, ? reduction, increase ?, and paced ? although these have not been studied in large, radomized trials |
|
Definition
| smoking, alcohol and caffeine, hot, spicy, layers, stress, exercise, respiration |
|
|
Term
| dyspareunia may result from vaginal ?; water based ? may provide relief for several hours after application while ? may provide relief for a longer period of time and potentially can prevent ? by maintainng the acidic environment of the vagina |
|
Definition
| dryness; lubricants; moisturizers; infections |
|
|
Term
| a decline in ? concentrations also may be associated with urinary ? incontinence; ? exercises are recommended as a first line intervention for stress incontinence although; these exercises strengthen the ? muscles |
|
Definition
| estrogen; stress; Kegel; pelvic floor muscles |
|
|
Term
| ? currently is indicated for the treatment of moderate to severe vasomotor symptoms and vulvovaginal atrophy associated with menopause; in addition, it is indicated for the prevention of postmenopausal ? in women with significant risk however it is recommended that ? medications receive consideration for long term use |
|
Definition
| estrogen; osteoporosis; nonestrogen |
|
|
Term
| ? or ? estogen products shold be prescribed at the ? effective dose for the ? duration possible to provide relief of vasomotor symptoms; topical products in the form of ?, ?, or ? should be prescribed for women exclusively experiencing ? |
|
Definition
| oral or transdermal; lowest; shortest; creams, tablets, rings; vulvovaginal atrophy |
|
|
Term
| ? estrogens, prepared from the ? of pregnant mares, is the most widely prescribed systemically administered estrogen product; ? estrogen preparations are also available and usually prescribed for patients who experience adverse effects, elevated ?, or liver function abnormalities while taking an oral product; this dosage form also has a lower incidence of ? than oral preparations |
|
Definition
| conjugated equine; urine; transdermal; triglycerides; venous thromboembolism |
|
|
Term
| women who have an intact uterus should be prescribed a ? in addition to estrogen in order to decrease the risk of endometrial hyperplasia and endometrial cancer; progestogens should be prescribed for at least ? to ? days of the month and often are prescribed continuously |
|
Definition
| progestogen; 12 to 14 days |
|
|
Term
| as far as adverse effects are concerned, preparations with or without progestogens display similar adverse effects and the best thing to do is to try to switch preparations partciulary the ? component or to try a different method of administration |
|
Definition
|
|
Term
| in the cyclic estrogen and progestogen method of administration, ? is administered daily and ? is administered for ? to ? days of the month; the disadvantage of this method is return of monthly ? in approximately 90% of women 1 to 2 days following the last ? dose however the withdrawal bleeding does not last as long or is not as heavy as a typical menstrual period |
|
Definition
| estrogen; progestogen; menses; progestogen |
|
|
Term
| in the continuous combined estrogen and progestogen method of administration, ? and ? are administered daily and result in ? atrophy; therefore, women do not experience a withdrawal bleed but may experience unanticipated ? bleeding or spotting during the month; this bleeding usually resolves within ? to ? monts; if bleeding persists beyond this time period, women should seek medical attention to rule out more serious conditions such as endometrial hypertophy or cancer |
|
Definition
| estrogen and progestogen; endometrial; breakthrough; 6 to 12 months |
|
|
Term
| ? doses of HT have become more popular following publication of the WHI study results; this low dose is still recommended for a ? duration |
|
Definition
|
|
Term
| ? hormones are exogenous hormones that are identical to those produced in a woman's body; they are available in topical creams, gels, and suppositories; these drugs are commercially manufactured or compounded by the pharmacist; the comercially manufactured ones are subject to regulation by the FDA but the pharmacist compounded ones are not so should be cautious with use because these formulations are not subject to the same FDA regulations |
|
Definition
|
|
Term
| HT is indicated primarily for the relief of moderate to severe ? symptoms; patients with mild vasomotor symptoms may benefit from ? therapy alone; the benefits of HT outweigh the risks in women who do not have ? or ? risk factors; after being prescribed HT, women should be reassessed every ? to ? months |
|
Definition
| vasomotor; nonpharmacologic; CHF or breast cancer; 6 to 12 months |
|
|
Term
| HT is also indicated for the treatment of ?; vulvovaginal atrophy is associated with vaginal ?, dyspareunia and also may be associated with recurrant ? infections, urethritis, and urinary urgency and frequency; ? preparations generally should be prescribed as first line therapy unless the patient is also experiencing ? symptoms |
|
Definition
| vulvovaginal atrophy; dryness; urinary tract; topical; vasomotor |
|
|
Term
| ? estrogen has demonstrated increased efficacy over ? estrogen in the treatment of vulvovaginal atrophy and generally does not require supplementation with a ? in women with an intact uterus using low doses of estradiol; women using regular or high doses of topical estrogen products do require intermittent treatment with a progestogen; estradiol in the form of a vaginal ? or ? is not significantly absorbed systemically and may be used safely in a woman with contraindications to estrogen therapy and sympptoms of vulvovaginal atropy |
|
Definition
| topical; systemic; progestogen; tablet or ring |
|
|
Term
| postmenopausal ? is a conditions that affects millions of women and is characterized by low bone mass with microarchitectural deterioration of bone tissue that can lead to fractures; fractures, especially ? fractures, are associated with a high incidence of morbidity and mortality and a decrease in quality of life; because HT should be maintained only for a short term, alternative therapies such as ? or ? should be considered as first line therapy for the prevention of postmenopausal osteoporosis, in addition to appropriate doses of ? and ? as HT should not be prescribed solely for the prevention of osteoporosis |
|
Definition
| osteoporosis; hip; bisphosphonates; raloxifene; calcium; vitamin D |
|
|
Term
| the results of various trials demonstrate that HT should not be prescribed for the prevention of ? or in patients with pre-existing CHD; for women suffering from vasomotor symptoms with a history of CHD, including CHD risk factors, alternative ? therapies should be considered; additionally, ? modifications should be implemented, and therapies to treat risk factors such as ? and ? should be prescribed |
|
Definition
| CHD; nonhormonal; lifestyle; hypertension and hyperlipidemia |
|
|
Term
| ? cancer is the most common cancer in women in the United States and there is an increased risk of breast cancer in patients taking ?; breast cancer was not increased in the ? alone arm of the WHI, and in fact, the risk was nonsignificantly lower in this group than in the placebo group; this leads to a possible link of ? to breast cancer risk however this theory needs to be studied further; because of the WHI, women with a personal history of breast cancer and possibly even a strong family history of breast cancer should avoid the use of HT and consider some alternative ? therapies for the treatment of vasomotor symptoms |
|
Definition
| breast; HT; estrogen; progestogen; nonhormonal |
|
|
Term
| the WHI also demonstrated an increased risk for ? in the HT group compared to the placebo group and this risk was also increased in the ? alone arm of the study; in summary, combined estrogen plus progestogen should not be used for the prevention of chronic diseases becuase it increases the risk of ?, ?, ? and ? however ? cancer and rates of ? were reduced with combined hormonal treatment |
|
Definition
| VTE (venous thromboembolism); estrogen; CHD, stroke, breast cancer, VTE; colorectal cancer and fractures |
|
|
Term
| HT improves overall well being and moodin in women with vasomotor symptoms, but it has not demonstrated an impovement in ? in women without vasomotor symptoms |
|
Definition
|
|
Term
| in appropriately selected women, HT should be recommended at the ? dose for the ? duration and should be ? before discontinuation in order to prevent the recurrence of ?; it is important to continually reassess a woman's ? symptoms while taking HT and to try to taper the therapy after ? year |
|
Definition
| lowest; shortest; tapered; hot flashes; vasomotor; 1 year |
|
|
Term
| limited evidence is available to guide health care providers regarding the most effective, safe, and least disruptive way to taper HT. Slowly discontinuing HT over time may be associated with less risk of symptom return. The time frame for tapering HT is unknown but can take up to ? to ? months or lonfer in some cases. Tapering HT may be done via a ? taper or a ? taper |
|
Definition
| 3 to 6 months; day taper or dose taper |
|
|
Term
| the dose taper involves decreasing the dose of ? over several weeks to months and monitoring closely for a return of symptoms. If symptoms recur, the next reduction in dose should not occur until symptoms resolve or at least stabilize on the current dose; the day taper involves decreaseing the number of days of the week that a women takes the HT dose for example, decreasing a daily dose of 0.3 mg estrogen to 0.3 mg of estrogen 5 days a week; these tapering regimens have not been studied in clinical trials and may not prove to be beneficial in individual women |
|
Definition
|
|
Term
| a variety of nonhormonal and alternative therapies have been studied for symptomatic management of vasomoter symptoms including ? (? and ?), ? products such as ? and ? and a group of miscellaneous agents such as ? and ?; evidence shows that these agents are only modestly effective and they are not necessarily safer than HT |
|
Definition
| antidepressants (SSRIs and venlafaxine); herbal; black cohosh and dong quai; gabapentin and clonidine |
|
|
Term
| SSRIs and venlafaxine are theorized to reduce the frequency of hot flashes by increasing ? in the central nervous system and decreasing ?; these drugs are useful in patients who have ? symptoms and also suffer from ? and ? |
|
Definition
| serotonin; LH; vasomotor; depression; anxiety |
|
|
Term
| the use of black cohosh should be cautious in patients with ? dysfunction and phytoestrogens found in isoflavone should not be used in patients with ? dependent cancers |
|
Definition
|
|
Term
| ? demonstrated significant reductions in severity and frequency of hot flases and ? has also demonstrated statistically significant reduction in hot flashes |
|
Definition
|
|
Term
| alternative and nonhormonal therapies are ? effective in treating vasomotor symptoms than ? but do offer another option for women experiencing menopausal symptoms who cannot or are unwilling to take HT: ? and ? have the best evidence for efficacy, however, health care providers should weigh the benefits and risks of all therapies and women should be advied to discuss their options with physicians and pharmacists |
|
Definition
| less; HT; SSRIs and clonidine |
|
|
Term
| primary ? is the absence of menses by the age of ? in the presence of normal secondary sexual development or the absence of menses by age ? in the absense of normal secondary sexual development; secondary ? is the absense of menses for ? cycles or ? months in previously menstrating women and there is a lot of overlap between the two types |
|
Definition
| amenorrhea; 16; 14; amenorrhea; 3; 6 |
|
|
Term
| ? pregnancy remains the most common cause of amenorrhea, and a ? pregnancy test should be one of the first steps in the evaluation of this disorder; the organs involved in the menstrual cycle are the ?, ?, ? pituitary, and the ? |
|
Definition
| unrecognized; urine; uterus, ovaries, anterior, hypothalamus |
|
|
Term
| ? secretion from the hypothalamus stimulates the anterior pituitary to secrete ? and ? which stimulate the release of ?; estradiol stimulates ? growth during the ? phase of the cycle |
|
Definition
| GnRH; FSH; LH; estradiol; endometrial; follicular |
|
|
Term
| nonpharmacologic therapy for amennorrhea varies depending on its underlying cause; amenorrhea secondary to ? may respond to weight gain; such patients would also benefit from ?; in young women for whom excessive ? is an underlying cause, a reduction in ? is recommended |
|
Definition
| anorexia; psychotherapy; exercise; exercise |
|
|
Term
| for most conditions associated with primary or secondary ammenorrhea, ? treatment along with a ? to minimize the risk of ? hyperplasia is utilized; the purpose of estogen therapy in this patient population is to reduce the risk of ? and improve quality of life |
|
Definition
| estrogen; progestin; endometrial; osteoporosis |
|
|
Term
| if ? is identified as the cause of amenorrhea, the use of bromocriptine, a ? agonist, results in a reduction in prolactin concentrations and the resumption of menses; amenorrhea related to anovulation may respond to the use of agents that reduce ? resistance such as ? |
|
Definition
| hyperprolactinema; dopamine; insulin; metformin |
|
|
Term
| ? have long been used to induce withdrawal bleeding in women with ? amenorrha; several factors predict the efficacy of progesterone for this purpose; these factors include estrogen concentrations greater than or equal to ? pg/ml and endometrial thickness (the greater it is , the greater the amount of withdrawal bleeding); ? progeterone induces withdrawal bleeding more so than progesterone administered ? |
|
Definition
| progestins; secondary; 35; oral; IM |
|
|
Term
| for all patients experiencing amenorrhea, owing to the negative impact this has on bone health, it is essential that a diet rich in ? and ? be followed |
|
Definition
|
|
Term
| amenorrhea in the ? population is of great importance because this is the time in the female life cycle when peak ? mass is achieved; the cause of amenorrhea and appropriate treatment must be identified promptly in this population; estrogen replacement, typically via an ?, is important; also need to ensure that patient is receiving adequte amounts of ? and ? |
|
Definition
| adolescent; bone; oral contraceptive (OC); calcium and vitamin D |
|
|
Term
| ? is a menstrual blood loss of more than 80 ml per cycle; causes of menorrhagia can be divided into ? disorders and specific ? abnormalities; ? pregnancy, ? pregnancy; and ? must be at the top of the differential diagnosis list for amy women presenting with heavy menses |
|
Definition
| menorrhagia; systemic; uterine; intrauterine, ectopic, miscarriage |
|
|
Term
| underlying ? disorders account for 3% to 13% of emergency department visits related to menorrhagia, ? disease may present initially has heavy menses in adolescents, and ? may also be associated with heavy menses; specific uterine causes of menorrhagia are more common in older ? women, and they include fibroids, adenomyosis, enodmetrial polyps, and gynecologic malignancies |
|
Definition
| bleeding; von Willebrand's disease; hypothyroidism; childbearing |
|
|
Term
| menorrhagia therapy should focus on reducing ? blood flow, improving patient's quality of life, and deferring the need for ? intervention; nonpharmacologic interventions for menorrhagia include ? interventions that are reserved for patients not responding to ? treatment and may include hysterectomy |
|
Definition
| menstrual; surgical; surgical; pharmacologic |
|
|
Term
| ? are first line treatments for menorrhagia associated with ovulatory cycles; they have the advangtage of being taken only during ?, and their use is associated with a significant reduction in menstrual ? loss; the reduction in blood loss is directly proportional to the amount of pretreatment bloods loss (if you bleed more before the treatment the reduction will be greater after taking NSAIDs) |
|
Definition
|
|
Term
| the use of ? containing greater than or equal to 35 mcg of ? is beneficial to women with menorrhagia who do not desire pregnancy; as with the use of NSAIDs, the reduction of blood loss is ? to pretreatment blood loss |
|
Definition
| oral contraceptives; estradiol; proportional |
|
|
Term
| menorragia also may be treated with the ? releasing intrauterine devices; this is a very effective treatment that consistently reduces menstrual flow by ?% or greater; ? therapy either during the ? phase of the menstrual cycle or for ? days starting on day 5 after the onset of menses results in a reduction of blood loss and this treatment is not associated with any ? benefit |
|
Definition
| levonorgestrel; 90%; progeterone; luteal; 21; contraceptive |
|
|
Term
| ? is commonly defined as crampy pelvic pain occurring with or just prior to menses; ? dysmenorrhea implies pain in the setting of normal pelvic anatomy and physiology, whereas ? dysmenorrhea is associated with underlying pelvic pathology |
|
Definition
| dysmenorrhea; primary; secondary |
|
|
Term
| risk factors for dysmenorrhea include ? age, ? menses, and ?; dysmenorrhea can lead to significant interference in attendance at ? or ? |
|
Definition
| young; heavy; nulliparity; work or school |
|
|
Term
| the most significant mechanism for primary dysmenorrhea is the release of ? and possibly ? in the menstrual fluid inducing ? contractions, reducing uterine ? flow, and causing uterine ? |
|
Definition
| prostanoids; ecosanoids; uterine; blood; hypoxia |
|
|
Term
| several nonpharmacoligic interventions exist for the management of dysmenorrhea; among these are topical ? therapy, ?, and following a low fat ? diet as all of these have been shown to reduce the intensity of the dysmenorrhea; other nonpharmacologic options that may be considered before or, in most cases, after a trial of ? intervetions include the use of transcutaneous electricals nerve stimulation (TENS), acupressure, and acupuncture |
|
Definition
| heat; exercise; vegetarian; pharmacologic |
|
|
Term
| given their impact on inhibiting prostaglandins as well as their ability to provide direct analgesia, ? are the treatment of choice for dysmenorrhea with the most common agents begin ? and ? |
|
Definition
| NSAIDs; ibuprofen; naproxen |
|
|
Term
| it has been suggested that a ? dose (twice the usual dose) of the NSAID be taken, followed by the usual recommended dose until symptoms resolve; an alternate recommendation is to begin the NSAID at the onset of menses or perhaps even the day prior and to continue treatment around the clock instead of waiting until the onset of symptoms; the use of ? has been proven inferior to the use of NSAIDs for the treament of dysmenorrhea |
|
Definition
|
|
Term
| ? help to improve dysmenorrhea by inhibiting the proliferation of ? tissue; this causes a reduction of ? that are thought to contribute to the pelvic pain experienced; these agents have other benefits such as prevention of ?, improving ?, and reducing ? cancer risk |
|
Definition
| oral contraceptives; endometrial prostaglandins; pregnancy; acne; ovarian |
|
|
Term
| the benefit of ? MPA in dysmenorrhea is related to its ability to render most patients amenorrheic within 1 year of use; since the pelvic pain of dysmenorrhea is related to the ? released during menses, in the setting of amenorrhea, the underlying cause of dysmenorrhea is removed |
|
Definition
|
|
Term
| dysmenorrhea is very common in ? females; while ? and ? are among the top choices for treatment, levonorgestrel ? is also an option in patients at low risk of sexually transmitted diseases |
|
Definition
| adolescent; NSAIDs and oral contraceptives; IUD (intrauterine device) |
|
|
Term
| ? bleeding is irregular menstrual blood flow from the uterine endometrium that ranges from light ? to heavy blood flow; anovulatory bleeding, also referred to as dysfunctional uterine bleeding, is secondary to the effects of unopposed ? and does not include bleeding owing to an anatomic lesion of the uterus; anovulatory bleeding includes PCOS, ?, ? and ? |
|
Definition
| annovulatory; spotting; estogen; hirsutism, obesisty, infertility |
|
|
Term
| ? bleeding is the most common form of noncyclic bleeding; all women of reproductive age should have a ? test when presenting with irregular menstrual bleeding; anovulatory bleeding is common at ? as well as in the ? period |
|
Definition
| anovulatory; pregnancy; menarche; perimenoposal |
|
|
Term
| ? stops the growth of the endometrium and stimulates its differentiation; in patients with anovulation a ? is not formed and the ovary does not secrete progesterone without which there is not differentiation of the endometrium |
|
Definition
| progesterone; corpus luteum |
|
|
Term
| in the treatment of anovulatory bleeding, in the short term the desired outcome is to stop acute ?; nonpharmacologic treatment options for anovulatory bleeding depend on the ? cause; in a woman of reproductive age with PCOS, ? loss may be beneficial; in women who have completed childbearing or have failed medical management, ? ablation or resection and ? are surgical options |
|
Definition
| bleeding; underlying; weight; endometrial; hysterectomy |
|
|
Term
| ? is the recommended treatment for managing acute bleeding episodes because it promotes endometrial growth and stabilization; further its use via ? regimens has been observed to avert emergency surgical procedures in nearly all treate patients; following its initial use for controlling acute bleeding episodes, it is necessary to continue therapy to prevent future occurences |
|
Definition
| estrogen; oral contraceptives; |
|
|
Term
| for women with high androgen levels and related signs such as ?, low dose OC's having less than or equal to ? mcg of ethinyl estradiol are the treatment of choice |
|
Definition
|
|
Term
| the use of insulin sensitizing agents such as ? and the thiazolidinediones ? and ? result in improved insulin sensitivity and in patients with PCOS this is associated with reduced circulating ? concentrations, increasing ovulation rates, and impovement of ? tolerance; metformin is a pregnancy category ? while pioglitazone and rosiglitazone are pregnancy category ?; ovulation is normally established about ? year after menarch |
|
Definition
| metformin; pioglitazone; rosiglitazone; androgen; glucose; B; C; 1 |
|
|
