Flashcards in Menopasue and Secondary Amenorrhoea Deck (29):
what is andropause?
testosterone falls by 1% a year after 30 but fertility remains and there is no sudden change
what is menopause?
last ever periods
what is ovarian insufficiency?
> oestradiol falls
> FSH increases
> still some oestriol from peripheral conversion of adrenal androgens in fat
before what age if menopause classed premature?
what is the average age of menopause?
when does perimenopause start?
5 years before menopause approximately
what can cause menopause?
what are the symptoms of perimenopause?
> hot flushes (usually 2-5years sometimes >10)
> vaginal dryness
> low libido
> muscle and joint aches
what are the risk factors for osteoporosis in perimenopause?
how is osteoporosis investigated?
how is osteoporosis managed?
> adequate calcium and vitamin d
> denosumab (monoclonal antibody and osteoclasts)
what symptomatic treatment is available for menopause?
> selective oestrogen receptor modulators
> "natural methods" £$£ not worth the expense
when is HRT indicated?
> premature ovarian insufficiency until 50 years
> severe vasomotor symptoms
what are the benefits of HRT therapy?
> local genital symptoms
> vasomotor symptoms
what are the contraindications of HRT therapy?
> un-investigated vaginal bleeding
> current active liver disease
> current hormone dependent cancer
> seek advice in
- brac carrier
- previous breast cancer
how often is a women on HRT reviewed?
in what form is HRT given for vaginal symptoms?
as a pessary
what routes can systemic HRT be delivered?
describe cyclical HRT
> for perimenopause
> 14 days oestrogen and 14 days progesterone and oestrogen
> can get withdrawal bleeding after progesterone part
describe continuous HRT
28 days oestrogen and progesterone
when is continuous HRT given?
> no ovarian function
> over 54
what can cause secondary amenorrhoea?
> pregnancy/breast feeding
> contraception related
> polycystic ovaries
> early menopause
> thyroid disease
> raised prolactin
> androgen excreting tumour
> sheenans syndrome
> ashermans syndrome
what would you investigate in secondary amenorrhoea?
> abdominal and bimanual examination
> urine glucose
> pregnancy test
- thyroid function
> pelvic ultrasound
what BMI should you aim for when treating amenorrhoea?
what management is available for premature ovarian insufficiency?
> emotional support
> HRT till 50
> check fragile x
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
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
how does polycystic ovarian syndrome present?
> excess hair
> anovulatory infertility
> NOT PAIN OR WEIGHT GAIN