NAMS Menopause Certification Study Guide with Update

NAMS Menopause Certification Study Guide with
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