HY lecture notes:
Pseudocyesis –> belief that one is pregnant when she is not (psych). Random, but just be aware of the term.
Annoying epidemiology stuff:
With respect to cancer risk, if you give OCPs –> you decrease the risk of ovarian by 50%, decrease endometrial, increase cervical (not directly, but because of decreased condom use –> increased HPV transmission); no change for breast.
Hormone-replacement therapy (HRT) –> the only approved indication is severe vasomotor symptoms (hot flashes, atrophic vaginitis, urge incontinence); HRT is not indicated for preserving bone density, even in high-risk patients.
Estrogen increases fibrinogen and factor VIII activation –> increased cerebrovascular (stroke) + cardiovascular events (MI) events + increases risk of breast cancer.
HRT –> given as cyclic estrogen + progesterone.
Any increase in the absolute amount of estrogen a woman experiences during her life, independent of the progesterone that’s added to HRT, increases her risk of breast cancer.
The only reason progesterone is given with estrogen is to decrease endometrial cancer risk. If given without progesterone –> endometrial hyperplasia + cancer risk. Only time estrogen is given alone without progesterone is if the woman has a Hx of hysterectomy.
Once again, HRT is only given to women for severe vasomotor symptoms.
If they tell you a woman started on HRT three months ago has a new simple cyst seen on mammogram, you must FNA the cyst.
So in summary, in terms of cancer risk:
OCPs: ↓↓ Ovarian, ↓ Endometrial, ↑ Cervical, no change Breast
HRT: ↑ Breast
Abnormal periods are normal in perimenopausal women and post-menarche girls. For the former, if they tell you a 52-year-old woman has abnormal periods but there’s no breakthrough bleeding (metrorrhagia), even if she’s a smoker, endometrial cancer is less likely –> answer = reassurance on NBME 8 for 2CK; if metrorrhagia, do endometrial biopsy.
Hx of anovulation/PCOS is big risk factor for endometrial cancer due to Hx of unopposed estrogen. Diabetes mellitus type II increases the risk of endometrial cancer indirectly –> insulin resistance –> abnormal GnRH pulsation –> increased LH/FSH ratio –> LH spike occurs before the follicle has matured –> Graafian follicle doesn’t rupture –> follicular cyst (if lots –> PCOS).
LH causes theca interna cells to secrete androgens.
FSH causes granulosa cells to secrete aromatase.
High LH/FSH means androgen ratio is high –> hirsutism.
PCOS is diagnosed when you have 11 cysts visible bilaterally on ultrasound (Amsterdam criteria) + hirsutism.
Women can have anovulatory cycles without full-blown PCOS. Once again, mechanism is insulin resistance, although high BMI is not mandatory for occurrence.
