Janice is 49 years old, is married, and has two teenage children. ...

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Janice is 49 years old, is married, and has two teenage children. Over the last year, her periods tended to be irregular and heavier than usual.
 
  She also noticed intercourse was becoming more painful for her, and her interest in sex declined. She knew her mother was 51 when she reached menopause, and Janice was concerned about having the mood swings and hot flashes her mother had experienced. She phoned some of her friends to seek their advice. Some said she should try hormone therapy, while others said it was not a good idea at all. Other friends said she should use remedies like red clover tea and soy isoflavone supplements. Janice decided her best bet was to go to the local women's health care clinic to discuss her options with a nurse.
 
  Using the data collected by the Women's Health Initiative and the Nurses' Health Study, why are some women at an increased risk for CHD and others are at a decreased risk when hormone therapy is prescribed?
 
  Why are alternative methods like red clover and some plant oils being promoted for the menopausal woman? What are the changes that occur in a woman's reproductive organs when estrogen levels decline?
 
  How does estrogen affect bone growth during puberty? Why are postmenopausal women at risk for osteoporosis?

Question 2

Tracie is 39 years old and is in a casual relationship with a man. She had her first sexual relationship when she was 13 and prefers to have short-term sexual relationships with men instead of a monogamous, committed partnership.
 
  It had been several years since Tracie had a complete physical, so before going on a vacation, she decided to have one done. Tracie's Pap smear indicated CIN 3 (HSIL) dysplasia. Her physician immediately ordered a colposcopy and LEEP excision, and then asked to see Tracie for a follow-up appointment 6 months later.
 
  Why is cervical cancer considered a sexually transmitted disease?
 
  Explain what the Pap smear entails and why it is an effective tool in the detection of cervical cancer. What does Tracie's result mean?
 
  What is the transformation zone, and why is it vulnerable to the development of cervical cancer?
 
  What is the LEEP procedure, and why is it useful for the diagnosis and treatment of cervical dysplasia?

[Eazy416]

Answer to Question 1

The Woman's Health Initiative study indicated that women who began HT after 60 years of age or later than 10 years after menopause had an increased risk for CHD. It is thought that these women began HT with the preliminary development of atherosclerosis; the use of therapeutic hormones accelerated inflammatory cytokine activity that led to unstable plaque formation and the development of symptoms. When corrected for age and the time when HT was implemented, the WHI demonstrated that younger women (under 60) and women who began HT within 10 years after menopause received the cardioprotective benefits of the treatment. The Nurses' Health Study confirmed that, if started shortly after menopause, HT reduced CHD by 30. Studies consistently show, however, an increased risk of thromboembolism in women using HT, particularly within the first 2 years of treatment.

It is thought that certain plant oils that contain substances similar to steroid hormones may be used as a natural supplement when human estrogen levels decline. Soy and red clover contain phytoestrogens, which are also said to exert estrogen effects in the body when taken as supplements. Although the use of these products has increased, their effectiveness has not yet been demonstrated in clinical trials.

Declining estrogen levels have a variety of effects on the woman's reproductive organs. Subcutaneous fat declines and skin becomes less elastic, allowing the breasts to sag as tissue mass decreases. The ovaries, uterus, and cervix atrophy when not supported by estrogen. The production of cervical mucus also declines, leaving the vagina dry and prone to infection.
During puberty, estrogen is responsible for the accelerated growth of long bones and for initiating the closure of the epiphyseal plates. Estrogens also have the effect of antagonizing the actions of PTH; when estrogen declines in menopause, bone resorption accelerates. Women are therefore at an increased risk for osteoporosis after menopause.

Answer to Question 2

Cervical cancer is associated with certain HPV types, many of which are spread by sexual contact. The rate of cervical cancer is higher among women who have had sexual intercourse at an early age, have multiple sexual partners, or are in relationships with promiscuous men.

The Pap test involves the removal of a cell sample from the transitional zone and endocervix. The presence of cellular dysplasia is important as cervical cancer arises from the precursor lesions identified with the Pap smear. The CIN 3 (HSIL) indicates the presence of a high-grade squamous intraepithelial lesion and cervical cancer in situ.

The transformation zone is the area residing between the exocervix and endocervix. The exocervix is covered with stratified squamous epithelium and the endocervix by columnar epithelium. Because the transformation zone exists between these two areas, it consists of a functional squamocolumnar cellular region. Cervical cancer arises in the transformation zone because of its vulnerability during metaplasia. Genetic mutations, when the tissue is exposed to carcinogens, are more likely when the transformation zone is undergoing normal growth and cellular change.

The LEEP procedure involves the removal of cervical tissue using a thin, wire loop electrode. The electrical current allows the practitioner to cut the tissue sample and encourage coagulation at the site. The procedure can remove the entire transformational area to ensure the elimination of abnormal cells and for further histological evaluation.

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Thank you

[Eazy416]

Happy to help you