328 Obstetrics and Gynecology Board Review •••
❍ How much greater is the potency of vaginal conjugated estrogens than that of oral conjugate estrogens?
Four times greater.
❍ What is the most common vulvar symptom of menopause relieved with estrogen replacement?
Burning and pruritis secondary to atrophy.
❍ Pruritis is also the presenting complaint of vulvar dystrophies. What percentage of vulvar dystrophies are
squamous cell carcinomas?
5% on initial exam, another 5% may develop squamous cell carcinomas within 3–5 years after hypertrophic vulvar
dystrophy is diagnosed.
❍ What is the most common cause of postmenopausal bleeding?
Endometrial atrophy.
❍ Why does vaginitis increase during the postmenopausal years?
Due to estrogen deficiency, the vaginal pH increases from 3.5–4.5 to 6.0–8.0, predisposing to colonization of
bacterial pathogens.
❍ What cervical changes are associated with menopause?
Stenosis, atrophy, erosion, and ulcers.
❍ What changes occur in the squamocolumnar junction and transformation zone?
They migrate up into the endocervical canal.
❍ What urethral conditions can develop as a result of estrogen deficiency?
Ectropion (urethral caruncle), diverticula, and urethrocoele.
❍ What is the most common problem in menopause related to urethral changes?
Urethral syndrome, consisting of burning, frequency, hesitancy, nocturia, and urgency associated with sterile urine
cultures.
❍ How is the urethral syndrome treated?
Estrogen therapy.
❍ What urinary symptoms are associated with atrophy?
Dysuria, urgency, and recurrent urinary tract infections.
❍ Does bacteriuria increase in menopause?
Yes. The incidence of bacteriuria increases from 4% in reproductive age women to 7–10% in postmenopausal
women. This is due to thinning of the urothelium, which predisposes to ascending infections, particularly with
intercourse.