1. Elaine E. Jolly, O.C., M.D., F.R.C.S.(C.) Medical Director Shirley E. Greenberg Women’s Health Centre Professor of Obstetrics and Gynaecology University of Ottawa GYNECOLOGIC ISSUES IN THE LATE POST MENOPAUSAL WOMAN

2. GYNECOLOGIC ISSUES in the “Geripause” Introduction Introduction Life Threatening Disorders: Cancers Life Threatening Disorders: Cancers Most Common Gynecologic problems Most Common Gynecologic problems Summary Summary

3. Physiology of the “Geripause” Decreased Estrogen Causes Progressive Atrophy   Thinning of vulvar tissue   Thinning, greying, loss of pubic hair   Diminution of labia minora   Presence of petechia   Vaginal walls are atrophic and pale   Shortening and narrowing of vagina   Atrophy of cervix / cervical stenosis   Decreased uterine size   Atrophic endometrium   Fibrous myometrium   Ovarian senescense

4. Gynecologic Examination in the Elderly Female   Abdominal/inguinal exam   Vulvar/perineal inspection   Inspection of Vagina/Vault   Cervix (stenosis), Pap Smear (brush)   Bimanual exam (uterus/adnexa)   Pelvirectal exam Gently, slowly, sensitively Be innovative and accommodating Respect patient’s modesty Warm hands – warm instruments

5. Gynecologic Issues Life Threatening Disorders Life Threatening Disorders Quality of Life Issues Quality of Life Issues

6. Life Threatening Disorders Ovarian Cancer Ovarian Cancer Uterine Cancer Uterine Cancer Cervical Cancer Cervical Cancer Vulvar Cancer Vulvar Cancer