Menopause and Premature Ovarian Insufficiency ☺️ Flashcards

1
Q

Gonadal function decline in males and females

A

Males-none

Females

  • gamete exhaustion
  • sudden decrease in fertility
  • senescent changes in reproductive activity
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2
Q

Difference between

  • Menopause
  • Perimenopause
  • POI
A

Menopause - 12 months of amenorrhea
-no O -ve feedback => high FSH

Perimenopause - irregular cycles, symptoms

POI - transient/permanent loss of ovarian function before 40 leading to menstrual irregularities

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3
Q

Presentation

A

Irregular heavy bleeds

Hot flushes, night sweats
Low mood, irritability
Dry vagina, vulva atrophy, low libido
Joint pain
Headaches

Long term

  • osteoporosis
  • increased CVD risk
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4
Q

Investigations

How would you manage menopause

  • non hormonal
  • hormonal
A

Typically a clinic diagnosis especially if

  • perimenopause - irregular periods, hotflushes
  • menopause - no period for 1 year + hormonal contraception

FSH => elevated

  • if presenting atypically/younger
  • 2 samples needed 4wks apart for POI
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5
Q

Management - lifestyle

A
  • regular exercise, weight loss
  • avoid triggers
  • keep house cool
  • sleep hygiene
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6
Q

Management - hormonal

-types

A

HRT for hot flushes/night sweats/headaches/insomnia

  • O => symptomatic relief
  • P => endometrial protection against unopposed O
  • T => increase energy, libido

Continuous O, P => no bleeds

Sequential (intermittent P) => bleeds

  • offered to perimenopausal
  • offered cont after 2 years
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7
Q

Pros and cons of HRT

A

Pros

  • symptomatic relief
  • osteoporosis protection
  • endometrial cancer risk low if P used
  • HDL increased, LDL decreased

Cons

  • breast, ovarian cancer
  • VTE (CVD and stroke)
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8
Q

Management - non hormonal

A

Vasomotor - SSRI/SNRI/clonidine (a2agonist)
Mood - CBT/antidepressants
Urogenital - vaginal lubricants

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9
Q

POI causes

-management

A

Idiopathic (most common)
Genetic (FHx)
AI
Iatrogenic (chemo, radio, bilateral oophorectomy)

HRT/COCP
Fertility treatment
Psychological support

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10
Q

How does COCP work?

What are the pros and cons

A

COCP

  • stops ovulation
  • thickens cervical mucus
  • thins endometrial lining

Advantages

  • highly effective
  • doesn’t interfere with sex
  • contraceptive effects reversible upon stopping
  • periods regular, lighter and less painful
  • reduced risk of ovarian, endometrial, colorectal cancer
  • reduced ovarian cysts, benign breast disease, acne
  • may protect against pelvic inflammatory disease

Disadvantages

  • must be taken daily
  • risk of STIs
  • VTE, stroke, IHD risk
  • breast, cervical cancer risk
  • headaches, nausea, breast tenderness
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