week 6 Menopause, Breast Conditions,
and Osteoporosis
According to recent studies, which of the following is not a protective factor against
developing breast cancer? - ANS-vitamin intake
benefits of breast ultrasound - ANS-Differentiate cysts vs. solid masses
Used to guide fine needle aspiration of breast cysts
Breast cancer screening should assess for the following - ANS-Masses, pain, and skin
changes
Ca and Vit D recommendations - ANS-Women over the age of 50 should be advised to
get 1200 mg calcium and 800-1000 IU vitamin D daily
The National Osteoporosis Foundation Recommends:
●Women age 50 and younger : get 1,000 mg calcium daily, 400-800 IU vitamin D
●Men aged 50-70 should take 1000 mg calcium per day, over 71- 1200 mg/day
●Men under 50 400-800 IU vitamin D, over 50 800-1000 IU vitamin D
can mammogram differentiate between malignant, benign or cystic lesions? - ANS-no
can only identify distortion of normal tissue
diagnostics for breast lumps - ANS-●Order mammogram and/or ultrasound
○Ultrasound can distinguish if mass is cystic or solid
○Mammogram detects non palpable abnormalities and microcalcifications
Management Varies by age:
❖Under age 30: Order breast ultrasound alone
❖30 years or older: order a diagnostic MMG and ultrasound
do age timing and hormones matter for HT? - ANS-YES
,duration of Tx - ANS-In post menopausal women some experts suggest:
●Stop Bisphosphonates after 5 years if:
○no Fracture HX or low risk for fracture
○hip BMD is greater than -2.5: Consider drug Holiday and reassess in 2-3 years
●Continue medications over 5 years if:
○HX of fracture before or during treatment
○BMD is -2.5 or less or high risk for fracture
***Reassess every 2yr-3yrs****
Fatigue and hot flashes are often associated with perimenopause/menopause but can
also be symptoms of: - ANS-diabetes
how do you diagnose FSAD or HSSD - ANS-To make diagnosis certain criteria must be
met: Complete lack of or significant reduction in sexual interest or sexual arousal
associated with 3 or more of 6 symptoms for at least 6 months
Absence or Reduction in:
●Interest in sex
●Fantasies or erotic thoughts
●Desire to initiate sex
●Sense of excitement or pleasure during sex
●Response to sexual cues
●Decreased sensation in genitals or elsewhere during sex
how do you Dx menopause? - ANS-∙Thorough history and PE- confirm absence of
menses x 12 months
∙Skip the LABS- FSH/LH levels are erratic and fluctuate for the first 5 years. Labs can
help to rule out other ddx
∙Still need to consider other causes of AUB
how do you manage FSAD and HSDD? - ANS-●CBT: Cognitive Behavior therapy:
mindfulness training
● FDA approved medication:
○ Flibanserin: activates dopamine, sometimes called the Female Viagra drug: but does
not work on blood flow like Viagra , main side effect can be syncope especially if
combined with ETOH
○Bremelanotide: comes in autoinjector- PRN use, main side effect is nausea
●Off label Drugs:
, ○ Bupropion : NDRI/ Norepinephrine -dopamine reuptake inhibitor, if given with SSRI
can help treat SSRI induced FSD including desire
○Testosterone: 3-6 month trial
how do you manage persistent mastitis? - ANS-obtain biopsy to r/o inflammatory breast
disease
how do you screen for osteoporosis - ANS-Measure Bone Mineral Density with DEXA
scan Q 2 yrs
(dual energy xray absorptiometry)
● DEXA of the hip (femoral neck) and spine (lumbar) is the preferred method for
diagnosing osteoporosis
● DEXA generates a T-score and a Z-score to help guide management
In pregnancy, which hormones work in combination to produce and eject milk? -
ANS-prolactin and oxytocin
is liver dysfunction usually a direct result of menopause? - ANS-no
management of breast cysts - ANS-Obtain breast ultrasound to help to differentiate
between solid masses and fluid filled cysts
●US and diagnostic mammo in women 30+
●US only in women under age 30
●Diagnosis is confirmed with fine needle aspiration (FNA) which is also therapeutic
because you can drain and collapse the cyst
○repeat US in 2-4 months
management of fibrocystic breast changes - ANS-Management:
●Aspiration of larger, painful cysts.
●Using OCPs will sometimes decrease the risk of developing fibrocystic changes.
●Provide reassurance: there is no association with the development of breast cancer.
Menopause is the permanent cessation of menstruation and - ANS-ovulation
menopause occurs in response to changes in the_____ - ANS-HPO axis
modifiable risk factors for osteoporosis - ANS-●Poor diet- low calcium, high salt, eating
disorder
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