9 - Menopause Flashcards

1
Q

What is the definition of menopause?

A

- Permanent cessation of menstruation for 12 consecutive months

  • When no primary follicles left so oestrogen levels deccline
  • “monthly stop”
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2
Q

What is the average age of menopause?

A
  • 45-55 so 50
  • Below 40 with abrupt cessation is usually pathological so needs to be investigated
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3
Q

What are the stages of menopause?

A
  • Pre-menopause
  • Perimenopause
  • Menopause
  • Post-menopause
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4
Q

What happens in pre and perimenopause?

A

- Pre: Initial changes in menstrual cycle, may be shorter or ovulation may be early or absent. Oestrogen falls so FSH and LH rise, FSH more, but cycle normal. Around 40 and reduced fertility

- Peri: Transition phase where physiological changes like hot flushes and mood swings so infrequency of menstruation

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5
Q

What happens in menopause and post menopause?

A

- Menopause: Permanent cessation of menstruation for 12 months

- Post: After 12 months. No longer able to concieve like in pre and perimenopause

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6
Q

What happens to the quality and quantity of oocytes as we age?

A

Both decline

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7
Q

What happens to the levels of gonadotrophins during menopause?

A
  • Oestrogen levels fall due to no follicles
  • No inhibin either
  • LH and FSH, especially FSH rise rspidly
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8
Q

What hormone is used to diagnose menopause?

A

FSH

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9
Q

What is responsible for all of the horrible symptoms of menopause?

A
  • Mostly oestrogen deficiency
  • Different symptoms in early, intermediate and late stages
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10
Q

What are some symptoms that can occur in early stages of menopause?

A
  • Hot flushes and sweating
  • Insomnia
  • Mood swings and depression
  • Irregular menstruation
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11
Q

What are some symptoms that can occur in the intermediate of menopause?

A
  • Vaginal atrophy leading to dyspareunia
  • More UTIs and stress incontinence
  • Reduction of pubic hair due to lowered testosterone
  • Loss of vaginal rugae
  • Breast tissue reduce in size
  • Loss of skin elasticity
  • Changes to hair and voice
  • Bloating and constipation as low motor activity
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12
Q

If a postmenopausal woman presents with symptoms of vaginal bleeding, what should you investigate into?

A
  • Endometrial carcinoma as no progesterone being produced so woman is subject to unopposed oestrogen
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13
Q

If a woman of post-menopausal age presents to you with bloating, what diagnosis should you consider?

A
  • Ovarian cancer
  • Ask if they were on HRT as link between the two
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14
Q

What are some disease processes that can occur in the post menopausal woman?

A
  • Increased risk of osteoporosis, athersclerosis and Alzheimer’s disease.
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15
Q

Why are post menopausal woman at risk of osteoporosis?

A

Oestrogen inhibits osteoclast activity so without it calcium loss from bone. Lose bone mass and bone height

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16
Q

Why are post menopausal woman at risk of CVS disease?

A
  • Low levels of oestrogen and progesterone change the lipid profiles
  • Increases circulating lipid levels so at risk of atherosclerosis, MI and stroke
17
Q

What is a hot flush?

A
18
Q

What changes occur to the internal genitals during menopause?

A
  • Ovaries shrink due to less oestrogen. Some aromatisation occurs to keep oestrogen level up
19
Q

What changes occur to the external genitals in menopause?

A
20
Q

What changes occur to the general appearance of a woman in menopause and her digestive/urinary system?

A
  • Constipation due to reduced motor activity
  • Thinner less elastic bladder and loss of pelvic tone so urinary incontinence
  • UTIs
21
Q

How can doctors help woman to manage menopause?

A

Hormonal:

  • HRT such as vaginal cream, patches or orally

<strong>Non-hormonal: </strong>

  • Lifestyle advice such as exercise and low fat diet
  • Dress in light layers, avoid caffiene and spicy foods
22
Q

What are the risks and benefits of HRT?

A

Benefits

  • Can improve wellveing
  • Can limit osteoporosis
  • Endometrial cancer risk only in oestrogen-only HRT

Risks

  • Ovarian and Breast cancer
  • Not advised for cardioprotection
  • Blood clots
23
Q

What effect does progesterone have on the endometrium?

A

When high it turns the glands from straight to coiled and they start secreting thick mucus

24
Q

What roles do oestrogen and progesterone have in the body, apart from its roles in the reproductive tract?

A
25
Q

What are some signs of Turner’s syndrome and what health problems are they at risk of?

A
  • Diabetes
  • Hypertension due to kidney and heart issues
  • Low IQ
  • Abnormal bone development
  • Thyroid issues (hypo)
26
Q

If a woman had primary amenorrhea and high FSH levels, what is the possible cause of the amenorrhea?

A

Ovarian agenesis as no oestrogen to have negative feedback on FSH

27
Q

What are some causes of menorrhagia?

A
  • Endometriosis
  • Fibroids
  • Coagulation disorders
  • Drugs like warfarin