menopause Flashcards
what are the effects of ovarian insufficiency in menopause ?
oestradiol falls
FSH rises
still some oestriol form peripheral conversion of adrenal androgens in fat
what are symptoms of menopause ?
hot flushes may go on for years vaginal dryness dysparenuia low libido muscle and joint aches mood changes poor memory
osteoporosis
what is in the FRAX score risk for osteoporosis in menopause ?
thin white smoker alcohol FHx amenorrhoea malabsorption steroids hyperthyroid
how do you prevent and treat osteoporosis ?
exercise diet calcium and vit D HRT bisphosphonates denosumab teriparatide
what are options for hormone replacement therapy ?
transdermal patch
oestrogen only if no uterus
oestrogen and progesterone if uterus present to prevent hyperplasia
what are contraindications to systemic HRT ?
on current hormone dependent breast cancer
active liver disease
uninvestigated abnormal bleeding
VTE, thrmbophilia
previous CA breast
what are treatments for menopause symptoms ?
selective oestrogen receptor modulators
SSRI, SNRI
lubricants
what is the combined HRT regime ?
14 days E
14 days E+P
what is secondary amenorrhoea ?
has had periods in past but none for 6 months
what causes secondary amenorrhoea ?
pregnancy/breast feeding contraception related PCOS early menopause thyroid/cushings raised prolactin hypothalamic androgen secreting tumour Sheehans syndrome -pit fail Ashermans syndrome - intrauterine adhesion
what tests do you do for secondary amenorrhoea ?
BMI - cushingoid
androgenic signs
abdominal/bimanual
pregnancy test + dipstick
blood FSH, estradiol, prolactin, thyroid, testosterone
pelvic USS
how is PCOS diagnosed ?
2/3 of;
PCO on USS
clinical or biochemical hyperandrogenism
oligo/anovulation
how do you manage PCOS ?
weight loss - metformin
antiandrogen - COCP
endometrial protection - progestogens
fertility - clomiphene / metformin
