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Obs & Gynae 3 Flashcards

1
Q

Give 4 principles of care to consider when investigating + managing infertility.

A
  1. See both partners together
  2. Explanation + written advice
  3. Psychological effects of fertility problems
    - relationship difficulties
    - support groups
    - counselling
  4. Seen by specialist team
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2
Q

What initial advice should be given to couples trying to conceive?

A
  • Inform effect of age
  • Preconception advice: folic acid, smoking cessation
  • Refer after 1 year -> early referral if female over 35yrs, or if there is a known / suspected problem.
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3
Q

List some reproductive disorders associated with obesity.

A
  • PCOS
  • Infertility
  • Miscarriage
  • Obstetric complications
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4
Q

What investigations might you request when investigating a couple for infertility?

A
  • Ovulation / ovarian function
  • Semen quality
  • Tubal potency (+ uterus_
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5
Q

Which 3 hormones are measured in ‘Ovarian Reserve Testing’?

A
  • FSH
  • AFC (Antral Follicle Count)
  • Antimullerian Hormone (AMH)
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6
Q

What is the diagnostic criteria for PCOS?

A

Rotterdam Criteria: 2 out of 3

  • Anovulation / oligo/amenorrhoea
  • PCOS on scan (TVS)
  • Raised androgens: clinical or biochemical -> exclude adrenal cause
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7
Q

What treatment measures may be used for PCOS?

A
  • Normalise weight
  • Clomifene (or Tamoxifen)
    (but may increase risk of ovarian cancer if used for more than 12 months)
  • Metformin
    > less effective than clomifene alone
    > less effective in obese
    > may help if clomifene resistant
    > GI side effects
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8
Q

Tubal disease may be a cause of infertility. What are the causes of tubal disease?

A
  • Infections: Chlamydia, Gonorrhoea
  • Endometriosis
  • Surgical: adhesions, sterilisation
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9
Q

Does medical treatment of endometriosis improve the chances of pregnancy?

A

Medical treatment of minimal or mild endometriosis does not improve chances of pregnancy.

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10
Q

What are the risks of IVF?

A
  • Multiple pregnancy
  • Miscarriage
  • Ectopic
  • ? Fetal abnormality
  • Ovarian hyperstimulation syndrome
  • Egg collection = risky
  • Longer term: ? Ovarian Ca.
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11
Q

List some patient factors affecting the success of IVF.

A
  • Age
  • Cause of infertility
  • Previous pregnancies
  • Duration of infertility
  • Number of previous attempts
  • Specific medical conditions
  • Environmental factors
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12
Q

Increased maternal age confers increased risk on the pregnancy. Give examples of why the pregnancy is higher risk.

A

Increased risks of:

  • Hypertension
  • Diabetes
  • IUGR
  • Operative Delivery
  • Thromboembolism
  • Maternal death
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13
Q

What is the role of uterine abnormalities in pregnancy?

A
  • Associations with infertility / miscarriage
  • Exact role is not clear
  • Abnormalities:
    > adhesions
    > polyps
    > fibroids
    > septate uterus
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14
Q

With regards to IVF, the chance of pregnancy decreases with 4 factors. Name these 4 factors.

A
  1. Maternal age
  2. Successive cycles
  3. Obesity
  4. Environmental factors (smoking, alcohol, caffeine)
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15
Q

At what age does breast cancer screening take place?

A

Females, aged 50 - 70 years

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16
Q

How often are women above 50yrs invited for breast screening?

A

3 yearly

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17
Q

What assessment is carried out in the fast track breast cancer clinics?

A

Triple Assessment:

  • Physical Examination
  • Mammogram (USS)
  • Biopsy
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18
Q

What scoring system is used for each of the investigations for breast cancer, and what should you look for in the scores?

A

P = Physical Exam (1-5)
M = Mammogram (1-5)
B = Biopsy (1-5)
* Look for concordance in the results.

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19
Q

Which nodes should you check when conducting a physical examination for breast cancer?

A
  • Axillary
  • Supra-clavicular
  • Sub-clavicular
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20
Q

List some pre-existing medical disorders in pregnancy.

A
  • Asthma
  • Epilepsy
  • Hypertension
  • Diabetes
  • Thyroid disease
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21
Q

List some pregnancy-specific medical disorders seen in pregnancy.

A
  • Pre-eclampsia / Eclampsia
  • Thromboembolism
  • Gestational Diabetes Mellitus (GDM)
  • Obstetric Cholestasis
  • Acute Fatty Liver Disease
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22
Q

What are the key issues regarding management of medical disorders in pregnancy?

A
  • Be familiar with normal physiological changes of pregnancy
  • Preconception assessment
  • What is the effect of pregnancy on the Medical condition?
  • What is the effect of the medical condition on the pregnant woman and her baby? (incl. impact of maternal medication).
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23
Q

Describe some steps which might be taken prior to conception to maximise the chance of a healthy pregnancy in a woman who has a disease.

A
  • Optimise disease control
  • Rationalise drug therapy to minimise effects on baby -> alter medication to drugs ‘safe’ in pregnancy
  • Advise on risks to mum + baby
  • Agree a plan of care -> MDT
  • Effective contraception until ready to conceive.
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24
Q

What effect might pregnancy have on a pre-existing condition?

A
  • May cause condition to worsen eg. mitral stenosis

- Some conditions improve in pregnancy eg. Rheumatoid Arthritis.

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25
Q

What effect might a pre-existing medical condition have on the health of baby + mum?

A
  • Increased risk of pregnancy complications eg. HTN -> pre-eclampsia
  • May have detrimental effects on the baby either:
    i) directly: eg. teratogenic drug effects
    ii) indirectly: eg. premature delivery
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26
Q

What considerations should be made for the delivery of a pregnancy where mum has a pre-existing conditions?

A
  • ‘Safest’ mode of delivery
  • Neonatal support
  • Anaesthetic expertise
  • HDU / ITU facilities
  • Ongoing care postpartum -> maternal condition may initially deteriorate.
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27
Q

i. Which type of anaemia is most common in pregnancy? ii. Why?
iii. What are the implications of this anaemia for the baby?

A

i. Iron deficiency anaemia, followed by folate deficiency anaemia
ii. Pregnancy is associated with a 2-3 fold increase in requirement for iron and a 10-20 fold increase in folate requirements
iii. Iron deficiency is associated with low birthweight and preterm delivery.

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28
Q

Describe the physiological respiratory changes seen in pregnancy.

A
  • Increased metabolic rate + increased oxygen consumption
  • Increased minute ventilation due to increase in tidal volume
  • Arterial pO2 increases; pCO2 decreases
  • Mild compensated respiratory alkalosis is normal in pregnancy.
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29
Q

Pregnancy may exacerbate asthma. With regards to trimesters, when is this most likely to occur?

A

Risk of asthma exacerbation is most likely in the 3rd trimester

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30
Q

What are the effects of asthma on the foetus during pregnancy?

A
  • Risk of fetal growth restriction due to inadequate placental perfusion
  • Premature delivery: usually due to deterioration in maternal condition
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31
Q

Which drugs can be used for Asthma in pregnancy?

A
  • Short acting b2 agonist
  • Long acting b2 agonist
  • Inhaled steroids
  • Theophyllines
  • Steroid tablets (in severe asthma)
  • Leukotriene antagonist can be used
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32
Q

What are the physiological changes experienced by the cardiac system during pregnancy?

A

Cardiac output rises by 40% (mainly due to increased stroke volume)

CO = SV x HR

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33
Q

What considerations should you have when managing cardiac disease in a pregnant woman?

A
  • Prediction + prevention of heart failure
  • Anticoagulation -> if mechanical heart valves
  • Drug therapy: may need to alter / add medication
  • Monitor fetal growth and well being -> scan
  • Timing and mode of delivery
  • Postpartum complications -> cardiac failure
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34
Q

How does Obstetric Cholestasis present?

A
  • Usually in 3rd trimester
  • itchy palms of hands + soles of feet
    • NO RASH *
  • Abnormal LFTs:
    Raised AST, ALT + Bile acid
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35
Q

If a woman presents with obstetric cholestasis, what are the risks to the baby? What does this risk relate to?

A

Risk: stillbirth, premature labour

Relates to: the level of bile acid (higher bile acid = increased risk)

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36
Q

What is the treatment for Obstetric Cholestasis?

What is the effect of this treatment?

A
  • Ursodeoxycolic acid
  • Appears to be associated with improved biochemical abnormalities (bile acid level + LFTs)
  • treatment has not been shown to reduce fetal complications.
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37
Q

When does Obstetric Cholestasis tend to resolve?

A

After delivery.

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38
Q

Hyperthyroidism is uncommon during pregnancy and usually improves after the 1st trimester.
What are the - i) maternal; and ii) fetal / neonatal - risks (during pregnancy) of hyperthyroidism?

A

Maternal: Thyroid crisis with cardiac failure

Fetal / Neonatal: Thyrotoxicosis due to transfer of thyroid stimulating antibodies

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39
Q

Give an example of an anti-thyroid drugs. What complication may this drug cause?

A

Propylthiouracil: May cause maternal liver failure

Carbimazole: Causes fetal abnormalities

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40
Q

If a pregnant woman is hypothyroid + this is not treated, what is she at risk of?

A
  • Early fetal loss

- Impaired neurodevelopment of baby

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41
Q

What treatment should a hypothyroid woman be given?

A
  • Adequate replacement of thyroxine (esp. in the 1st trimester)
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42
Q

What is the pathophysiology of Type 1 diabetes?

A

Autoimmune destruction of beta cells of islets of Langerhans in the pancreas.

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43
Q

What is the pathophysiology of Type 2 diabetes?

A
  • Characterised by insulin resistance
  • Genetic component is stronger than for type 1
  • Incidence increases with age and degree of obesity
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44
Q

What is the pathophysiology of gestational diabetes?

A
  • Carbohydrate intolerance first recognised in pregnancy

- Risk of developing Type 2 Diabetes within 10 - 15 years.

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45
Q

How should you manage Diabetes pre-conception?

A
  • HbA1c < 48mmol / l
  • Folic acid 5mg
  • Stop ACEi + Statins
  • Retinal screening
  • Renal function and microalbuminuria
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46
Q

What are the maternal complications of diabetes?

A
  • DKA
  • Hypoglycaemia (common)
  • Progression of retinopathy
  • Pre-eclampsia
  • Premature labour
47
Q

What are the fetal complications of diabetes?

A
  • Miscarriage
  • Macrosomia + shoulder dystocia
  • Fetal abnormality
  • Stillbirth
  • Neonatal hypoglycaemia, respiratory distress, hypocalcaemia, polycycaemia
48
Q

What can the fetal complications of diabetes largely be attributed to?

A
  • Maternal hyperglycaemia

- Excessive glucose transfer across the placenta and secondary fetal hyperinsulinaemia

49
Q

Which medications for diabetic control are safe to use in pregnancy?

A
  • Insulin: basal bolus regime
  • Metformin
  • Glibenclamide
    (All other hypoglycaemics are contraindicated)
  • Statins + ACEi are contraindicated
50
Q

What is the change in renal output in a healthy pregnant woman?

A

50% increase in renal blood flow and GFR in a pregnancy with healthy kidneys.

Serum creatinine, Urate and Albumin.

51
Q

Why are pregnant women more susceptible to acute pyelonephritis?

A

Pelvicaliceal system + ureters dilate, predisposing to ascending infection and acute pyelonephritis.

52
Q

What are the maternal complications of chronic renal disease during pregnancy?

A
  • Severe hypertension
  • Deterioration in renal function
  • Pre-eclampsia
  • Caesarean section
53
Q

What are the fetal complications of chronic renal disease during pregnancy?

A
  • Premature delivery
  • Growth restriction
  • Still birth
  • Abnormalities due to maternal drug therapy
54
Q

What things should you consider in your risk assessment of a woman’s pre-pregnancy renal status?

A
  • MDT care
  • Close monitoring of renal function + BP during pregnancy
  • Regular assessment of fetal growth and wellbeing
55
Q

What are risks of epilepsy for the mother?

A
  • Increase in seizure frequency
  • Sudden Unexpected Death in Epilepsy (SUDEP)
    > more common in patients who do not take their prescribed anticonvulsants
56
Q

What are the risks of epilepsy for the foetus?

A
  • Fetal abnormality
    > all anticonvulsants are associated with a risk of fetal abnormalities (esp. Sodium Valproate)
  • Inheritance of epilepsy
  • Risk of fetal hypoxia associated with maternal seizures
57
Q

Describe the management of epilepsy in pregnancy.

A
  • Preconception assessment: high folic acid
  • Once pregnant: offer screening for fetal anomalies
  • Control seizures
  • Plan for delivery: pain relief, avoid prolonged labour
  • Postpartum support
58
Q

What factors increase a woman’s risk of thromboembolism during / post pregnancy?

A
  • Maternal age
  • BMI
  • Operative delivery
  • Haematological changes in pregnancy predispose to VTE
59
Q

You suspect a pregnant woman has a VTE. What investigation should you do for:

i) DVT?
ii) PE?

A

i) DVT: Doppler Ultrasound

ii) PE: VQ scan (Ventilation / Perfusion scan) or CTPA

60
Q

A pregnant woman has a VTE.

i) What is the treatment of choice?
ii) Why is Warfarin not used as a therapy?

A

i) Treatment of choice: LMWH

ii) Warfarin crosses the placenta, and may cause fetal abnormalities and intracranial bleeding.

61
Q

FGM definition

A

“All procedures involving partial or total removal of female external genitalia or other injury to the female organs for non-medical reasons. It involves damaging and removing normal, healthy female genital tissue, and hence interferes with the natural function of girls’ and women’s bodies”

62
Q

WHO categories FGM into 4 main types. What are these?

A

1: Clitoridectomy: partial / total removal of the clitoris
2. Excision: partial / total removal of the clitoris + labia minora ± excision of labia majora
3. Infibulation: narrowing of vaginal orifice, with creation of a covering seal by cutting + appositioning the labia minora ± labia majora with or without excision of the clitoris.
4: All other harmful procedures to female genitalia for non-medical purposes.

63
Q

Why does FGM occur?

A
  • Preserves a girl’s chastity / virginity
  • Part of being a woman
  • Upholds family honour
  • Cleanses + purifies the girl
  • Fulfils a perceived religious requirement
  • Gives the girl social acceptance, especially for marriage
64
Q

What is the UK prevalence of FGM?

A

103,000 women aged 15 - 49 are living with FGM in England + Wales

65
Q

Where are the FGM ‘hotspots’ in the UK?

A
  • London
  • Cardiff
  • Manchester
  • Sheffield
  • Birmingham
  • Milton Keynes
66
Q

What is the law with regards to FGM?

A

FGM Act, 2003:

  • Offence to perform FGM in England, Wales, NI
  • Assist in the carrying out of FGM
  • Assist a non-UK person to carry out FGM outside the UK or a UK national or permanent UK resident
  • Under the Children’s Act 1989, local authorities can apply to the court for various orders to prevent a child being taken abroad for mutilation.
67
Q

List 8 gynaecological complications of FGM.

A
  1. Dyspareunia
  2. Sexual dysfunction with anorgasmia
  3. Chronic pain
  4. Keloid scar formation
  5. Dysmenorrhoea
  6. Urinary outflow obstruction / recurrent UTIs
  7. PTSD
  8. Difficulty conceiving
68
Q

List some obstetric complications of FGM.

A
  • Fear of childbirth
  • Increased likelihood of C-section, PPH, episiotomy, severe vaginal lacerations
  • Extended hospital stay

Difficulties:

  • performing vaginal examinations in labour
  • applying fetal scalp electrodes
  • performing fetal blood sampling
  • catheterising the bladder
69
Q

What are our responsibilities as doctors regarding FGM?

A
  • Report all cases of FGM in the medical notes

- Ensure that families know that FGM is illegal.

70
Q

What are the 4 most common problems in paediatric gynaecology?

A
  • Amenorrhoea
  • Precocious puberty
  • Delayed puberty
  • Menstrual disorders
71
Q

What is a ‘normal’ menarche?

A
  • Age 11-14
  • Preceded by development of secondary sexual characteristics
  • Peak height velocity
  • Initial cycles anovulatory: pain free and often long gaps between
  • Bleeds last 3 - 7 days, 21 - 45 day gaps
72
Q

What is primary amenorrhoea?

What are the possible causes?

A
  • No menses by age 16 in the presence of secondary sexual characteristics
  • No menses by age 13 in the absence of secondary sexual characteristics

Possible causes:

  1. Hypothalamic-Pituitary-Ovarian Axis:
    - Turner’s
    - Premature Ovarian Failure
    - Swyer syndrome
  2. Anatomical
  3. Enzyme/Receptor:
    - Congenital Adrenal Hyperplasia
73
Q

What is ‘secondary amenorrhoea’?

What are the possible causes?

A

Cessation after onset of menses.

Possible causes:

  • Weight loss
  • Excessive exercise
  • PCOS
74
Q

What is ‘oligomenorrhoea’?

A

Menses more than 35 days apart.

75
Q

What is ‘precocious puberty’?

A
  • Appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal
  • Puberty before age 8 (girls); 9 (boys)
  • Secretion of high-amplitude pulses of GnRH by the hypothalamus
76
Q

What is the aetiology of ‘Central’ Precocious puberty?

A
  • Gonadotrophin-dependent: maturation of the entire HPG axis
    > spectrum of physical and hormonal changes of puberty
    > may be associated with CNS abnormalities: trauma, tumours, hydrocephalus
77
Q

What is the aetiology of ‘pseudo puberty’ with regards to precocious puberty?

A
  • Gonadotrophin-independent

Possible causes:

  • Congenital adrenal hyperplasia
  • Adrenal tumours / ovarian tumours
  • McCune-Albright syndrome
78
Q

A girl presents in clinic with suspected delayed puberty. What investigations should you consider?

A 
Baseline: 
- FBC 
- CRP 
- U+Es 
- LFTs 
to exclude anaemia, IBD, renal and liver disease

Bone profile:

  • Alk phosp
  • Coeliac antibodies
  • TSH + Free T4
79
Q

How might endometriosis present?

A
  • Pain
  • Increased CA125
  • ?infertility
80
Q

Describe the pain associated with endometriosis

A
  • Cyclical pain
  • Dysmenorrhoea
  • Dyspareunia
81
Q

In which patient group would you expect to see presentations of endometriosis?

A
  • Younger women

- Low parity

82
Q

What are the 2 main methods for reducing pain associated with endometriosis?

A
  1. Abolish cyclicity -> OCP, GnRH agonists

2. Glandular atrophy: Oral progestogens, Depo-Provera, Mirena

83
Q

What risks might be associated with GnRH use?

A

Osteoporosis: give a little bit of oestrogen to lower this risk.

84
Q

How is endometriosis diagnosed?

A

Laparoscopically

85
Q

What is the management of endometriosis in secondary care?

A

Surgery:

  1. Ablation
  2. Excision
  3. Oophorectomy
  4. Pelvic clearance
86
Q

Endometriosis and infertility are closely linked. Give some examples of how endometriosis might reduce fertility.

A
  • Immune factors
  • Oocyte toxicity
  • Adhesions
  • Tubal dysfunction
  • Ovarian dysfunction
87
Q

What population is adenomyosis usually found in?

A
  • Older
  • Multiparous
    > tissue from placenta scars over + becomes painful
  • dull, nagging, constant pain
88
Q

What pain is associated with adenomyosis?

A
  • Cyclic pain
  • Dysmenorrhoea
  • Dyspareunia
  • same as endometriosis!
89
Q

What are fibroids?

A
  • Benign uterine tumours
  • Smooth muscle tumours
  • Variable size + number
  • Oestrogen dependent
90
Q

What are the symptoms of uterine fibroids?

A
  • Asymptomatic
  • Heavy periods
  • Anaemia
  • Infertility
  • Miscarriage
91
Q

Summarise gynae conditions:

  1. Endometriosis
  2. Fibroids
  3. Adenomyosis
  4. Polyps
A
  1. Endometriosis:
    - pain + infertility
    - myomectomy for fertility preservation
    - oestrogen dependent
  2. Fibroids:
    - pain + infertility + bleeding
    - myomectomy for fertility preservation
    - oestrogen dependent
  3. Adenomyosis:
    - Pain
  4. Polyps:
    - Bleeding + infertility
92
Q

Define the ‘menopause’.

A
  • Cessation of menstruation
  • Average age: 51yrs
  • Diagnosed after 12 months of amenorrhoea
  • Onset of symptoms if hysterectomy
93
Q

Define the ‘perimenopause’.

A
  • Period leading up to the menopause
  • Characterised by irregular periods + symptoms
    eg. Hot flushes, mood swings, urogenital atrophy
  • if >45 years, do not measure FSH for diagnosis.
94
Q

What general symptoms are characteristic of the menopause?

A
  • Mood change / irritability
  • Loss of memory / concentration
  • Headaches, dry / itchy skin
  • Joint pains
  • Loss of confidence
  • Lack of energy
95
Q

Urogenital atrophy is a medium-term impact of the menopause. What symptoms accompany this?

A
  • Dyspareunia
  • Recurrent UTIs
  • Post-menopausal bleeding*
  • Note: this is a red flag symptoms!!!!
96
Q

What are the 3 main long term impacts of the menopause?

A
  1. Osteoporosis:
    - Menopause = significant RF for osteoporosis
    - Effects reliably reversible with oestrogen
  2. Cardiovascular disease:
    - Adverse changes in lipid
    - Increased prevalence with early menopause
  3. Dementia:
    - Increased prevalence with early menopause

*risk reduction strategies should start at the time of the menopause.

97
Q

How might the menopause be managed?

A
  • Holistic approach
  • Lifestyle advice
  • Reduce modifiable risk factors
  • Inform about options:
    > hormonal eg. HRT, vaginal oestrogen
    > Non-hormonal eg. clonidine
    > Non-pharmaceutical eg. CBT
98
Q

List 3 benefits of using HRT for menopausal symptoms

A
  • Relief of menopausal symptoms
  • Bone mineral density protection
  • Possibly prevent long term morbidity
99
Q

List 4 risks of using HRT for menopausal symptoms.

A
  • Breast cancer
  • VTE
  • Cardiovascular disease
  • Stroke
100
Q

What is the relationship between breast cancer + HRT?

A
  • Baseline risk varies from one woman to another
  • HRT with oestrogen alone: little / no change in risk
  • HRT + oestrogen + progesterone: increased risk
  • Increased risk is related to treatment duration and reduces after stopping HRT.
101
Q

If a woman is taking HRT and diagnosed with breast cancer, what action should you take?

A
  • Discontinue HRT in women diagnosed with Br Ca.
  • Do not routinely offer HRT to women with a Hx of Br Ca.
    > HRT may, in exceptional cases, be offered to women with severe menopausal symptoms and with whom the associated risks have been discussed.
102
Q

What’s the association between VTE and HRT ?

A
  • Risk of VTE is increased by HRT

- High risk women (eg. strong FHx or thrombophilia) -> refer to haematologist for assessment before starting HRT.

103
Q

What’s the association between HRT and Cardiovascular disease?

A
  • HRT does not increase CV risk when started in women <60years
  • Presence of CV risk factors is not a contraindication to HRT, as long as they are optimally managed.
104
Q

Which form of HRT slightly increases the risk of stroke?

A

Oral HRT

105
Q

What is the association between HRT and T2DM?

A

HRT is not generally associated with an adverse effect on blood glucose control.
Oral / transdermal HRT does not increase the risk of T2DM.

106
Q

What are the principles behind prescribing HRT?

A
  • Progesterone should be used for 12-14 days every 4 weeks or every 12 weeks
  • Protects the endometrium from the stimulatory effects of unopposed oestrogen
  • Mirena = licensed for HRT
  • Tibolone or continuous combined: not suitable within 12 months of last menstrual period
  • Risk of irregular bleeding
107
Q

Who should have transdermal HRT?

A
  • Gastric upset eg. Crohn’s
  • Need for steady absorption eg. Migraine / Epilepsy
  • Perceived increased risk of VTE
  • Older women
  • Medical conditions eg. Hypertension
  • Patient choice
108
Q

What is ‘Premature Ovarian Insufficiency’?

A
  • Menopause < 40 yrs
  • Natural / iatrogenic
  • Causes:
    > Chromosome abnormalities, Enzyme deficiencies, Autoimmune disease
    > Surgery / Chemotherapy / Radiotherapy
109
Q

How is a diagnosis of ‘Premature Ovarian Insufficiency’ made?

A

FSH > 25 IU/L

2 samples > 4 weeks apart + 4 months of amenorrhoea.

110
Q

What is the treatment for premature ovarian insufficiency?

A
  1. Oestrogen replacement:
    - HRT
    - COCP
  2. Androgen replacement
    - Testosterone gel
  3. Fertility:
    - Donor egg
111
Q

What is the European Menopause + Andropause Society’s position statement regarding hormone replacement (after a diagnosis of Premature Ovarian Insufficiency)?

A
  • To help alleviate symptoms of oestrogen deficiency
  • Minimise long term risks of oestrogen deficiency
  • Induce secondary sexual characteristics in adolescents
  • Continue at least until average age of the menopause (51 years).
112
Q

What is the consensus statement from the BMS regarding HRT after Premature ovarian insufficiency has been diagnosed?

A

It is imperative that women with POI are encouraged to use HRT at least until the average age of the menopause.

113
Q

Is contraception required around the time of the menopause?

A

Yes!

Fertile for 2 years if menopause < 50 years.

Fertile for 1 year if menopause > 50 years.

114
Q

Which dose of oestrogen should you give for HRT?

A

Aim for the lowest effective dose.

* oestrogen should never be unopposed in a woman who has her uterus in situ *

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