Amenorrhoea and Menopause

Question 1

What is menopause?

Answer 1

Happens at age 51
Perimenopause for approx 5 years before
Premature = <40

Ovarian insufficiency

• Oestradiol falls
• FSH rises

Question 2

What are the symptoms of menopause?

Answer 2

Hot flushes 
Vaginal dryness/dyspareunia 
Low libido
Muscle and joint aches 
Mood changes and poor memory

Question 3

What to do in Menopause for osteoperosis and its treatments?

Answer 3

reduced density on DEXA scan
Significant morbidity and mortality
Prevent and treatment = exercise, Ca and V-D, HRT, bisphosphonates, MAB to osteoclasts

Question 4

What is given in hormone replacement treatment?

Answer 4

Patch or gel = avoids first pass

Oestrogen only if no uterus but with progesterone if uterus is present to prevent hyperplasia

Can be local in a pessary, ring or cream

Question 5

What are the contraindications to HRT?

Answer 5

Breast cancer or endometrial cancer
Active liver disease
Uninvestigated abnormal bleeding
Advice if VTE, thrombophilia
Advice if previous CA breast or BRCA cancer

Question 6

Combined oestrogen and progesterone HRT

Answer 6

Continuous daily
Lowers endometrial cancer risk
Bleed free fter 3M

Need cyclical 14d E then 14d E+P - bleed after P stops

Question 7

What are other treatments for menopause

Answer 7

SERM’s
SSRI SNRI
Natural methods
Non-hormonal lubricants

Question 8

What are the HRT risk and benefits?

Answer 8

Benefit

• Vasomotor
• Local genital symptoms
• Osteoperosis

Risk

• Breast and ovarian Ca
• VTE if oral
• CVA if oral

No alzheimers affect, no CV risk if before 60

Question 9

What does NICE say about HRT use?

Answer 9

Severe vasomotor symptoms review annually
Vaginal oestrogen for vaginal symptoms
Not first line treatment for osteoporosis

Question 10

What is Primary amenorrhoea?

Answer 10

Never had a period
>14y and no 2nd sexual characteristics
>16y if secondary sexual characteristics

Question 11

What is Secondary amenorrhoea?

Answer 11

Has had periods but none in the last 6 months

Question 12

What are the causes for Secondary amenorrhoea?

Answer 12

Pregnancy/breast feeding
Contraception
PCOS
Menopause
Thyroid disease
Raised prolactin
Hypothalamic
Androgen secreting tumour
Sheehans syndrome
Ashermans syndrome

Question 13

What are the tests for Secondary amenorrhoea?

Answer 13

BMI
Androgenic signs
Abdominal and bimanual
Urine pregnancy test + glucose
Bloods 
USS

Question 14

What are the treatments for Secondary amenorrhoea?

Answer 14

BMI in 20-25
HRT
Emotional support