23 - 2y Amenorrhoea & Menopause

Question 1

define menopause?

Answer 1

woman’s last ever period

Question 2

average age of menopause?

Answer 2

51 years

Question 3

when does perimenopause occur?

Answer 3

~ 5 years before

Question 4

define premature menopause?

Answer 4

40 years or less

Question 5

describe 2 things which happen in menopause?

Answer 5

ovarian insufficiency - oestradiol falls

FSH rises

Question 6

what happens to FSH levels in perimenopause?

Answer 6

they fluctuate

Question 7

describe 3 scenarios when menopausal transition may be sudden?

Answer 7

following -

oophorectomy

chemotherapy

radiotherapy

Question 8

describe 2 vasomotor symptoms of menopause and how long they last?

Answer 8

hot flushes & night sweats

usually last 2-5 yrs- but may be 10 years+

Question 9

describe 5 other symptoms of menopause?

Answer 9

Vaginal dryness / soreness

Low libido

Muscle and joint aches

Mood changes

poor memory

Question 10

what is a severe and hard to detect change which can occur with menopause?

Answer 10

osteoporosis

Question 11

what is osteoporosis?

Answer 11

reduced bone mass -

DEXA scan shows bone density described as T score

Question 12

what is a possible result of osteoporosis?

Answer 12

fractured hip / vertebra

Question 13

give 4 RFs for developing osteoporosis?

Answer 13

thin

caucasian

smoking

high EtOH

Question 14

give 4 ways to prevent and treat osteoporosis?

Answer 14

wt bearing exercise

adequate calcium & Vit D

HRT

calcitonin

Question 15

give 3 examples of local vaginal HRT?

Answer 15

oestrogen pessary/ring/cream

Question 16

how long does local HRT need to be used to be effective?

Answer 16

longterm

Question 17

what is a benefit of systemic oestrogen transdermal/ oral HRT?

Answer 17

less risk of Venous thromboembolism

Question 18

when should combined oestorgen and progesterone HRT be used?

Answer 18

if there may still be some ovary function to avoid irregular bleeding

Question 19

3 contraindications for systemic HRT?

Answer 19

Current Hormone dependent cancer breast/endometrium

Current active liver disease

Un-investigated abnormal bleeding

Question 20

which lubricants should be used for vaginal dryness?

Answer 20

Non hormonal lubricants -

Replens or Pre sex ‘Sylk’

Question 21

in terms of treating depression for those with menopause, which medications should NOT be used?

Answer 21

clonidine

SSRI SNRI

Question 22

give 3 benefits for using HRT?

Answer 22

control vasomotor symptoms

local genital symptoms controlled

reduces risk of osteoporosis

Question 23

3 risks with using HRT?

Answer 23

breast Ca if combined HRT

ovarian Ca

venous thrombosis if oral route

Question 24

association with HRT and risks of CVS?

Answer 24

no increase of CVS risks if HRT is started before 60 years

Question 25

if HRT is being used to control night-sweats and hot flushes, how often should it be reviewed?

Answer 25

annually

Question 26

what is the first line for osteoporosis prevention?

Answer 26

bisphosphonates

Question 27

what is first line for vaginal symptoms?

Answer 27

vaginal oestrogen

Question 28

what is andropause?

Answer 28

condition characterised by Testosterone falling by 1% a year after 30 yrs

Question 29

what, other than testosterone, falls with andropause?

Answer 29

DHEAS

Question 30

andropause's effect on fertility?

Answer 30

fertility remains

Question 31

define 1y amenorrhoea?

Answer 31

never had a period

Question 32

define 2y amenorrhoea?

Answer 32

has had periods in past but none for 6 months

Question 33

give 5 causes of 2y amenorrhoea?

Answer 33

Pregnancy / Breast feeding Premature ovarian insufficiency PCOS contraception-related Asherman's syndrome

Question 34

give 7 endocrine causes for 2y amenorrhoea?

Answer 34

Thyroid disease Cushing's syndrome raised Prolactin (prolactinoma) hypothalamic causes (stress) androgen secreting tumour Sheehan's Syndrome (pituitary failure) congenital adrenal hyperplasia

Question 35

7 components of examination for 2y amenorrhoea?

Answer 35

BP BMI enlarged clitoris deep voice acne hisutism Cushingoid

Question 36

4 tests for 2y amenorrhoea?

Answer 36

urine pregnancy test dipstick for GLC bloods pelvic ultrasound

Question 37

name 7 things the FBC will be measuring?

Answer 37

FSH oestadiol (to rule out menopause) prolactin thryroid function testosterone 17 hydroxy progesterone

Question 38

3 treatments for 2y amenorrhoea?

Answer 38

treat specific cause aim for BMI >20 and <30 for ovulation emotional support

Question 39

what should be offered as treatment if found to have premature ovarian insufficiency?

Answer 39

HRT until turn 50 years old

Question 40

how to diagnose PCOS?

Answer 40

need 2/3 of the following - oligo/amenorrhoea androgenic symptoms: excess hair/acne Polycystic ovarian morphology on scan

Question 41

risks associated with PCOS?

Answer 41

diabetes and cardiovascular disease regardless of BMI and body shape

Question 42

Does PCOS cause weight gain/ pain?

Answer 42

No - but weight gain can worsen PCOS

Question 43

treatment for PCOS?

Answer 43

weight loss & exercise - BMI of 20-25 antiandrogen combined hormonal contrception - spironolactone alfornithine cream to reduce facial hair support and information - e.g. support group

Question 44

role of metformin for PCOS patients?

Answer 44

encourages ovulation but no consistent evidence of benefit for androgenic symptoms or helping weight loss