330 Obstetrics and Gynecology Board Review •••
❍ What effect do “night sweats” (hot flashes at night) have?
Interruption of sleep patterns and thus a decline in sleep quality and length.
❍ How does estrogen exert its effects on improving “quality of life” in postmenopausal women?
Alleviation of hot flashes and improved quality of sleep leading to improved mood, memory, and quality of life.
❍ What alternatives to estrogen are partially effective in treating hot flashes?
Clonidine, medroxyprogesterone acetate, methyldopa, SSRIs, gabapentin, and black cohosh.
❍ What alternatives to estrogen are ineffective in treating hot flashes?
Bellergal, propranolol, vitamin E, and soy extracts.
❍ What alternatives to estrogen are currently recommended for the treatment of hot flashes?
Transdermal clonidine 100 μg weekly, Effexor 37.5 to 75 mg qd, and black cohosh.
❍ Are there any safety data on black cohosh?
Yes. For use up to 6 months.
POSTMENOPAUSAL BLEEDING AND ENDOMETRIAL CANCER
❍ What is the first diagnostic test recommended for postmenopausal bleeding if the uterus is normal?
Endometrial biopsy.
❍ In the perimenopausal period, after exclusion of gynecological causes of dysfunctional uterine bleeding
(DUB), what endocrine gland should be evaluated?
The thyroid gland.
❍ What endometrial thickness on ultrasound requires biopsy in postmenopausal women?
4 mm.
❍ How do you treat simple hyperplasia in perimenopause?
Monthly oral progestin therapy, repeat biopsy in 6 months, if hyperplasia persists, D&C.
❍ How effective is monthly progestin therapy in treating simple hyperplasia?
95% to 98% of the time.
❍ What is the incidence of endometrial hyperplasia after 1 year of unopposed estrogen (conjugated estrogen
0.625 mg or its equivalent)?
20% incidence of hyperplasia, predominantly simple hyperplasia.
❍ When DUB in perimenopause is diagnosed, what are the treatment options?
Observation, oral contraceptives, and progestational agents.