Menopause Flashcards Preview

Toni's Obs and Gynae > Menopause > Flashcards

Flashcards in Menopause Deck (19):
1

Perimenopause

Begins with first menopausal features:
E.g. Vasomotor sx, menstrual irregularity
Ends 12 months after last menstrual period

2

Premature menopause

Menopause before 40 yrs
1% women
No cause found in most
HRT indicated until 51

3

Causes of post-menopausal bleeding

Endometrial carcinoma
Ovarian carcinoma
Endometrial hyperplasia
Cervical carcinoma
Atrophic vaginitis
Cervicitis
Cervical polyps

4

Menopause

12 consecutive months amenorrhoea
Ovaries stop responding to LH and FSH
Follicle activity ceases
End of menstruation
Median age: 51

5

Consequences of menopause

CVD
Vasomotor sx
Urogenital sx
Sexual problems
Osteoporosis

6

Vasomotor symptoms of menopause

Hot flushes
Night sweats:
- sleep disturbance
Usually

7

Urogenital problems of menopause

Vaginal atrophy:
- dyspareunia, itching, burning, dryness
Urinary symptoms:
Frequency, urgency, nocturia, incontinence, recurrent infection

8

Osteoporosis and menopause

1/3 >50yrs have >1 osteoporotic fracture
DEXA to measure bone mineral density: T score
Normal: 1 to -1
Osteopenic: -1 to -2.5
Osteoporotic: less than -2.5

9

Risk factors for osteoporosis

Genetic: fhx of fracture
Constitutional: low BMI, early menopause (5mg/day pred
Disease: Autoimmune disease, malabsorption

10

Investigating amenorrhoea

FSH: day 2 & day 5
2 samples 2 weeks apart >35IU/L
Oestradiol:

11

HRT in women without a uterus

Oestrogen alone
Increases risk of endometrial cancer

12

HRT in women with a uterus

Oestrogen & progestogen
To oppose oestrogen action on endometrium
Increases risk of breast cancer

13

Types of HRT

Oral: increases risk of VTE and gallbladder disease
Transcutaneous
Subcutaneous

14

Non oestrogen based menopause therapy

Night sweats & hot flushes:
Progestogens + SSRIs

Vaginal atrophy:
Lubricants + moisturisers

15

Osteoporosis treatment:

Bisphosphonates:
Strontium ranelate: reduces risk of vertebral and hip fracture
Raloxifene: oestrogen receptor modulator
Parathyroid hormone peptides: reduce risk of vertebral fractures
Denusomab: RANKL mab, reduces osteoclast activity, 6 mthly subcut

16

Topical oestrogens for urogenital menopause symptoms

Low dose oestrogens, local administration

Oestriol: cream or pessary
Oestradiol: tablet or ring

17

DEXA scan

Dual energy X-ray absorptometry
2 different energies of X-ray differentiate betw soft tissue & bone
BMD =g/cm2 often converted into:
T score, relating to avg male/ female peak bone mass
Z score, relating to age group

18

Primary ovarian failure

Onset of menopause

19

Risks of HRT

VTE: risk highest in 1st year
If fhx of VTE consider thrombophilia screen
CI with personal Hx VTE
Stop immed if VTE occurs
No continued risk of VTE once HRT stopped