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WHNP Menopause_Infertility_Miscellaneous.
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WHNP Menopause_Infertility_Miscellaneous.
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WHNPMenopause/Infertility/Miscellaneous
6 months - ANS-How long does a couple have to try to conceive before being referred if
over the age of 35?
Adenomyosis - ANS-Deposit and growth of endometrial tissue within the myometrium
Most common in multiparous women between the ages of 35-50 years
Uterus often slightly ENLARGED and GLOBULAR
Heavy menstrual bleeding
Similar treatment as endometriosis
Bisphosphonate MOA - ANS-Inhibits osteoclasts
Bisphosphonates (alendronate, zoledronic acid) - ANS-Medications that reduce bone
resorption by decreases osteoclast activity
Make sure to take with 8oz plain water prior to food
May be associated with GI ulcerations
Hydrate well!!!!
Calcium supplementation - ANS->1200 mg/d
Contraindications to HT - ANS-Unexplained vaginal bleeding
Liver disease
HIGH risk for stroke
PMH for breast cancer, DVT, CHD, MI, CVA, endometrial cancer
Cystocele - ANS-Herniation of posterior bladder all into anterior vagina
Most common
DEXA - ANS-Gold standard approach for measuring bone density
Endometriosis - ANS-Classic presentation
Fixed retroverted uterus with nodules on ligaments
Enerocele - ANS-Post hysterectomy enterocele and vaginal vault prolapse
Intestine into vaginal vault
Requires surgery to fix
, Estrone - ANS-estrogen of menopause
Functional incontinence - ANS-Associated with inability to get to the toilet or lack of
awareness of needing to void
Usually person with mobility issues or altered cognition
Gamete intrafallopian tube transfer (GIFT) - ANS--Oocytes are matured and aspirated
from the ovary, sperm are washed and both placed into fallopian tube where fertilization
takes place (in vivo)
-Good when there is no tubal damage
HT - ANS--Indicated for moderate to severe menopausal symptoms, including hot
flashes...is the primary indication for systemic estrogen therapy/EPT
-Data does not support use of progestin only or testosterone
HT effects - ANS--Bone health improves
-May reduce risk of coronary heart disease
-Could cause increase in ischemic stroke or clots
-Could increase risk for breast cancer if used >3-5 years
-Dementia risk increased in women >65 yo
HT prescribing - ANS-ET and EPT should be prescribed for shortest amount of time
(start low and go slow)
Hysterosalpingography - ANS-a radiographic examination of the uterus and fallopian
tubes
Hysteroscopy - ANS-visualization of the endometrium through a scope to detect uterine
abnormalities
In vitro fertilization - ANS--Process of aspiration of mature oocytes (controlled by
hyperstimulation) that are artificially fertilized and then re-implanted in the uterus
-Good for tubal issues, but now widely used when conventional treatments fail
intracytoplasmic sperm injection (ICSI) - ANS--procedure in which a single sperm is
injected into an egg
-Utilizes early steps of IVF
-After development into the morula stage, the zygote is transferred to the endometrial
cavity
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