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Gynae > Menopause > Flashcards

Menopause Flashcards

1
Q

How is premature ovarian insufficiency diagnosed

A

Aged under 40 not on HRT/COCP
Symptoms of menopause including oligo/amenorrhoea
2 FSH readings above 30 4 weeks apart

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2
Q

What symptoms can precede menopause

A

Reduction in length of periods
Change in bleeding most often increases

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3
Q

Symptoms of menopause

A

Hot flushes/night sweats
Cognitive impairment and mood disorders
Vaginal dryness affecting libido
Urogenital symptoms
Sleep disturbances

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4
Q

When use FSH to diagnose menopause

A

Under 45
Over 45 with atypical symptoms
Over 50 on progestogen contraception

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5
Q

In general when can women stop taking contraception

A

After 55

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6
Q

After menopause when can women stop using contraception knowing they cant get pregnant

A

Under 50- 2 years after last period
Over 50- 1 year after last period

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7
Q

Management of vasomotor symptoms in menopause

A

Offer lifestyle- regular exercise and weight loss, smoking, spicy foods
If wants to use HRT
- with uterus use oral or transdermal oestradiol and progestogen
- without a uterus offer oral or transdermal oestogen only
If not consider SSRI, SNRI, clonidine, gabapentine

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8
Q

Management of mood disorders in menopause

A

If wants HRT
- Choice of oral or transdermal HRT preparations
If not
- CBT
- SSRI if diagnosis of depression

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9
Q

Management of genitourinary symptoms of menopause

A

Can always use vaginal moisturisers and lubricants esp when do not want HRT
Low dose vaginal oestrogen 1st line
Increase dose 2nd line
If contraindicated or not tolerated use opsemifene

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10
Q

MOA of ospemifene

A

Selective oestrogen receptor modulator

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11
Q

How often should people on HRT be followed up

A

3 months after initiation or dose change
1 year thereafter

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12
Q

What does HRT increase the risk of

A

VTE- oral greater risk
Stroke- oral oestrogen negligible risk
CHD- combined has slight risk

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13
Q

What is management of premature ovarian failure

A

HRT until 51 but note this is not contraception in case ovary spontaneously returns to functioning

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14
Q

Contraindications to HRT

A

Breast cancer currently or in past
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Active liver disease
Thrombophilic
Previous VTE
Oestrogen dependant cancer history

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15
Q

Who do you use HRT with caution in

A

Porphyria cutanea tarda.
Diabetes mellitus (increased risk of heart disease).
Factors predisposing to venous thromboembolism.
History of endometrial hyperplasia.
Migraine and migraine-like headaches.

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16
Q

Causes of post menopausal bleeding

A

Vaginal atrophy most common
HRT
Endometrial cancer/hyperplasia
Cervical cancer
Vaginal/vulval cancer
Bleeding disorders

17
Q

How is PMB due to vaginal atrophy treated

A

Topical oestrogens- increases thickness of uterus
Lubricants

18
Q

How is PMB due to HRT use treated

A

Change preparation

19
Q

Which HRT combination gives lowest VTE risk

A

Transdermal

20
Q

What do if someone with LNG-IUS needs HRT

A

Just give oestradiol
Mirena counts as progesterone part for 4 years

21
Q

What are recognised causes of premature menopause

A

Addisons
Infections- TB, mumps, malaria
Chemo and radiation

22
Q

What diseases are HRT patients at increased risk of

A

Breast cancer
Endometrial cancer
Gallbladder disease

23
Q

What are options for combined and oestrogen only HRT

A

Oral or transdermal for both

24
Q

How long after HRT commencement should abnormal bleeding be investigated for endometrial cancer

A

6 months

25
Q

Which oestrogens are used in HRT

A

Natural conjugated oestrone etc
Avoid synthetic unless POI

26
Q

Which progestogens are used in HRT

A

Synthetic
- dydrogesterone
- medroxyprogesterone
- norethisterone
- levonorgestrel

27
Q

What are regime options for combined HRT

A

Cyclical
Monthly- take oestrogen every day, progesterone for last 14 days of cycle
3 monthly- oestrogen every day, progesterone for 14 days every months
Continuous
Both every day

28
Q

What regime is used for oestrogen only HRT

A

Daily forever

29
Q

What regime is used for perimenopausal women without regular periods

A

3 monthly cyclical regime

30
Q

What regime is used for perimenopausal women with regular periods still

A

Monthly

31
Q

Who is continuous combined HRT regime used in

A

Woman whos last period was over a year ago

32
Q

Why is cyclical HRT used in perimenopausal women

A

To identify when periods end

33
Q

Can you have HRT with prior VTE

A

Only if being actively anti-coagulated

33
Q

Can you have HRT with prior VTE

A

Only if being actively anti-coagulated

34
Q

What do if woman has irregular bleeding over age of 45

A

TVUSS

Gynae (11 decks)

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