GYN CHAPER 4
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- WHAT HAPPENS TO THE OVARIES WITH MENOPAUSE?
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1.)THEY GRADUALLY BECOME UNRESPONSIVE TO THE GONADOTROPINS AS A WOMAN AGES AND THEY STOP PRODUCING PROGESTERONE, ESTRADIOL AND SIGNIFICANT LEVELS OF ESTROGEN.
2.)THE OVARIES ALSO ATROPHY AND DECREASE IN SIZE WITH DISAPPEARANCE OF FOLLICLES. - WHAT HAPPENS TO THE MENSES WITH MENOPAUSE?
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1.)MENSES BECOMES IRREGUAR AND GENERALLY CEASES BTWN 45-55YRS OF AGE.
2.)THE ENDO, UTERUS AND VAGINA GRADUALLY BECOME ATROPHIC. - POSTMENOPAUSAL BLEEDING MAY BE DUE TO WHAT?
- ATROPHIC ENDOMETRIUM
- WHAT ARE THE NORMAL SONOGRAPHIC FINDINGS IN A POSTMENOPAUSAL WOMAN? NAME 7:
- 1.)UTERINE AND CERVICAL PROPORTIONS ARE MAINTAINED
- WHAT IS HORMONE REPLACEMENT THERAPY(HRT)?
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THE ADMINISTRATION OF ESTROGEN AND PROGESTERONE WHICH MAY HELP ALLEVIATE SOME OF THE SYMPTOMS ASSOC. WITH MENOPAUSE.
IT ALSO HELPS PREVENT SEVERE OSTEOPOROSIS. - UNOPPOSED ESTROGEN IS ASSOC. W/ INCREASED RISK OF WHAT?
- HYPERPLASIA AND ENDOMETRIAL CARCINOMA
- WHAT 2 WAYS ARE HORMONES DELIVERED TO POSTMENOPAUSAL WOMAN?
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1.)TAKING CYCLING(SEQUENTIAL) DOESES OF ESTROGEN AND PROGESTERONE WHICH WILL CAUSE THE ENDO TO THICKEN DURING THE ESTROGEN PHASE AND THIN DURING PROGESTERONE PHASE.
2.)CONTINUOUS COMBINES DOSES OF ESTROGEN AND PROGESTERONE. IN THESE WOMAN THE ENDO DOES NOT CYCLE BETWEEN THICK AND THIN PHASES. - HAVE THE CUTOFFS OF NORMAL ENDO THICKNESS AND THRESHOLD BEEN ESTABLISHED FOR WOMEN ON HRT THAT REPRESENT WITH POSTMENOPAUSAL BLEEDING?
- NOT AT THIS TIME.
- WHAT SHOULD THE ENDO MEASURE ON A PT ON UNOPPOSED ESTROGEN ONLY?
- UP TO 8MM
- WHAT SHOULD THE ENDO MEASURE ON A PT CYCLING(SEQUENTIAL)HRT?
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*10-12MM IN ESTROGEN PHASE AND DECREASES DURING PROGESTERONE PHASE.
*U/S SHOULD BE FERFORMED AFTER PROGESTERONE WITHDRAWL, THAT IS, AFTER BLEEDING. - WHAT SHOULD THE ENDO MEASURE ON A PT WITH CONTINUOUS COMBINED HRT?
- LESS THAN 8MM
- WHAT IS POSTMENOPAUSAL VAGINAL BLEEDING?
- ANY BLEEDING FROM THE GENITAL TRACT OF AN OLDER WOMAN THAT OCCURS MORE THAN 6MO AFTER HER LAST MENSTRUAL PERIOD.
- NAME 5 CAUSES OF POSTMENOPAUSAL VAGINAL BLEEDING:
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1.)EXOGENOUS ESTROGEN ADMINISTRATION-MOST COMMON CAUSE.
2.)ENDOMETRIAL ATROPHY-MOST COMMON CAUSE WITHOUT HRT
3.)CERVICAL CARCINOMA
4.)ENDOMETRIAL CARCINOMA
5.)ESTROGEN PRODUCING FUNCTIONAL TUMOR OF THE OVARY. (RARE) - WHAT IS TAMOXIFEN?
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A NONSTEROIDAL ANTIESTROGEN USED IN AS A CHEMOTHERAPEUTIC AGENT IN PATIENTS WITH CERTAIN TYPES OF BREAST CANCER.
*IN SOME PATIENTS IT MAY CAUSE CHANGES IN THE ENDO AND THUS INCREASE THEIR RISK FOR ENDO CARCINOMA.
*U/S IS RECOMMENDED FOR WOMEN ON TOMOXIFEN WHO PRESENT WITH VAGINAL BLEEDING. - WHAT ARE THE SONOGRAPHIC FINDINGS OF THE ENDO ON A PT WHO IS ON TAMOXIFEN WHO PRESENTS WITH BLEEDING? OR WHAT MAY BE SEEN?
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1.)SUBENDOMETRIAL CYSTS-CYSTIC AREAS IDENTIFIED IN THE ENDOMETRIAL-MYOMETRIAL JUNCTION.
2.)ENDOMETRIAL HYPERPLASIA
3.)ENDOMETRIAL CARCINOMA