Menopasue and Secondary Amenorrhoea Flashcards Preview

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Flashcards in Menopasue and Secondary Amenorrhoea Deck (29):
1

what is andropause?

testosterone falls by 1% a year after 30 but fertility remains and there is no sudden change

2

what is menopause?

last ever periods

3

what is ovarian insufficiency?

> oestradiol falls
> FSH increases
> still some oestriol from peripheral conversion of adrenal androgens in fat

4

before what age if menopause classed premature?

40 years

5

what is the average age of menopause?

52 years

6

when does perimenopause start?

5 years before menopause approximately

7

what can cause menopause?

> ooprectomy
> radiotherapy
> chemo
> natural

8

what are the symptoms of perimenopause?

> hot flushes (usually 2-5years sometimes >10)
> vaginal dryness
> low libido
> muscle and joint aches
> osteoporosis

9

what are the risk factors for osteoporosis in perimenopause?

> thin
> smoking
> malabsorption
> steroids
> hyperthyroidism

10

how is osteoporosis investigated?

DEXA scan

11

how is osteoporosis managed?

> HRT
> exercise
> adequate calcium and vitamin d
> denosumab (monoclonal antibody and osteoclasts)

12

what symptomatic treatment is available for menopause?

> antidepressants
> selective oestrogen receptor modulators
> "natural methods" £$£ not worth the expense

13

when is HRT indicated?

> premature ovarian insufficiency until 50 years
> severe vasomotor symptoms

14

what are the benefits of HRT therapy?

> local genital symptoms
> osteoporosis
> vasomotor symptoms

15

what are the contraindications of HRT therapy?

> un-investigated vaginal bleeding
> current active liver disease
> current hormone dependent cancer
> seek advice in
- brac carrier
- thrombophilia
- previous breast cancer
- VTE

16

how often is a women on HRT reviewed?

annually

17

in what form is HRT given for vaginal symptoms?

as a pessary

18

what routes can systemic HRT be delivered?

> transdermal
> oral
> oestrogen

19

describe cyclical HRT

> for perimenopause
> 14 days oestrogen and 14 days progesterone and oestrogen
> can get withdrawal bleeding after progesterone part

20

describe continuous HRT

28 days oestrogen and progesterone

21

when is continuous HRT given?

> no ovarian function
> over 54

22

what can cause secondary amenorrhoea?

> pregnancy/breast feeding
> contraception related
> cushings
> polycystic ovaries
> early menopause
> thyroid disease
> raised prolactin
> hypothalamic
> androgen excreting tumour
> sheenans syndrome
> ashermans syndrome

23

what would you investigate in secondary amenorrhoea?

> BMI
> BP
> abdominal and bimanual examination
> urine glucose
> pregnancy test
> bloods
- FSH
- LH
- oestradiol
- prolactin
- prolactin
- thyroid function
> pelvic ultrasound

24

what BMI should you aim for when treating amenorrhoea?

20-25

25

what management is available for premature ovarian insufficiency?

> emotional support
> HRT till 50
> check fragile x

26

someone presents with secondary amenorrhoea what should you assume about their fertility?

that they are still fertile and need contraception unless 2 years after confirmed menopause

27

what is the pathology of poly cystic ovarian syndrome?

> small peripheral ovarian cysts (10 on one ovary and ovarian volume more than 12cm)
> high oestrogen
> high androgen
> underlying insulin resistance

28

how does polycystic ovarian syndrome present?

> acne
> excess hair
> oligo/amenorrhoea
> anovulatory infertility
> NOT PAIN OR WEIGHT GAIN

29

what is the management of polycystic ovarian syndrome?

> weight loss and exercise
> antiandrogen
- CHC
- spironolactone
- eflorithine cream for facial hair
> endometrial protection
- progesterone
- CHC
- mirena ius
> [clomiphene] [metformin] for fertility