Menopause A to Z.pdf - Medwords.com.au

MENOPAUSE A to Z
and congenital adrenal hyperplasia (adrenogenital syndrome) which affects the adrenal glands which sit on top of each
kidney and stimulates them to produce abnormal steroids in the body which affect sexual development.
If the menstrual periods cease it may be due to a failure of ovulation or pregnancy.
See also FOLLICLE STIMULATING HORMONE; LUTEINISING HORMONE; OVARY
PAGET’S DISEASE OF THE VULVA
Paget’s disease of the vulva is a rare, slow growing cancer in the skin of the vulva (lips of the vagina). It is classed
as an adenocarcinoma type of cancer, and may have spread from an adenocarcinoma elsewhere in the body. It may
also occur on the skin around the vulva. It may be mistaken for dermatitis when it first develops as it appears as an
itchy, sometimes painful red patch and usually affects women after the menopause. It is very successfully treated by
surgical excision, but the presence of any other adenocarcinoma in the body must be excluded.
See also VULVA
PALPITATIONS
Palpitations are excessively rapid and strong heartbeats that may be irregular in rhythm. They occur in everyone
with exercise, anxiety, stress, pain or a fright, but usually settle quite quickly.
Heavy smoking, caffeine in cola drinks tea or coffee, excess alcohol, food sensitivities and some food preservatives
and colourings may trigger palpitations.
Pregnant women generally have a faster heart rate, and hormonal surges may trigger brief episodes of palpitations.
Bacterial and viral infections, or any other disease that causes a fever will cause an increased heart rate while the
fever is present.
Paroxysmal atrial tachycardia (PAT) is a very common condition, particularly in women. For no apparent reason, but
sometimes because of hormonal changes during the menstrual cycle and menopause, the heart will start beating
rapidly, usually at double its normal rate. This harmless but distressing condition may last for a few seconds or several
hours before settling spontaneously.
Other causes may include a heart attack (myocardial infarct), atrial fibrillation (due to heart damage) and ectopic
beats.
Less common causes for palpitations include anaemia, infections (endocarditis, myocarditis) or inflammation of the
heart muscle, an overactive thyroid gland (hyperthyroidism), reflux oesophagitis, phaeochromocytoma (black-celled
tumour of the adrenal glands) and da Costa syndrome c(a psychiatric disturbance).
Medications such as salbutamol (Ventolin - for asthma), glyceryl trinitrate (Anginine - for heart pain), terbutaline
(Bricanyl - for asthma), aminophylline (for lung conditions) and imipramine (for depression) may have palpitations as a
side effect.
PAP SMEAR
Pap is short for Papanicolou, the name of the Greek/American doctor who developed this cervical smear test in
1932. A Pap smear is used to detect any abnormality of the cervix, including infections and erosions.
Chronic infections of the cervix of which the patient is not aware can cause infertility and other problems, and a Pap
smear can enable the doctor to diagnose these and prescribe appropriate treatment. Unquestionably, the main value of
the Pap smear has been its ability to detect precancerous conditions of the cervix and cervical cancer at an early stage
so that it can be treated. All women of any age who are sexually active should have regular Pap smear tests - generally
every two years although once every three years may be enough for women who are past menopause.
The test is quite simple. The doctor introduces a collapsible metal or plastic tube, called a speculum, into the
woman's vagina. This is painless although it may feel a bit intrusive. The speculum is shaped like a duck's bill. When
the upper and lower blades are separated, the doctor can see the cervix, and a soft plastic brush is gently inserted into
the opening of the uterus in the middle of the cervix and rotated. This lifts off a superficial layer of cells. The brush is
then wiped across a glass slide to form a smear and is sprayed with a solution to preserve the cells.
The slide is sent to a pathologist who examines the smeared cells under a microscope and sends a report to the
doctor. Sophisticated computers, that are more accurate than human technicians, are now being used in most
laboratories to scan Pap smears for abnormalities. The collecting of the cells takes only a minute or so, and the report
is usually available within a week.
The results that may be reported include:
- Normal smear - repeat in two years.
- Atypical cells - smear should be repeated in 3 to 6 months.
- CIN 1 dysplasia - colposcopy (examination of the cervix through a microscope) advised with repeat
smears frequently.
- CIN 2 dysplasia - colposcopy and punch biopsy (small sample of abnormal tissue cut out) followed by
appropriate treatment (eg. LLETZ procedure) and follow-up.
- CIN 3 carcinoma in situ - definitive treatment necessary (eg. cutting out abnormal tissue in a cone
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