NAMS Menopause Certification Study Guide with complete solutions-Physiology of VMS - -thermoregulatory center altered by increase in KNDy neurons
-activation of NK3R causes hot flashes
-blockade of NK3R reduces/elimina
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NAMS Menopause Certification Study Guide with complete solutions-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
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
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