Menopause Flashcards Preview

Gynaecology > Menopause > Flashcards

Flashcards in Menopause Deck (13):
1

Sx and consequences of menopause (9)

CVD

vasomotor disturbance: hot flushes, sweating, palps

atrophy of oestrogen-dependant tissues, atrophic vaginitis, vaginal dryness

osteoporosis

irritability/depression

memory loss

loss of libido

stress incontinence

prolapse

2

Ix for menopause

2 FSH readings >30 indicate menopause

if uncertainty in cause of Sx:
-TFTs
-urinary 5-HIAA

3

Rx of menopausal Sx (4)

HRT is mainstay

if uterus absent: oestrogen replacement only

if uterus present: add progestogen e.g. levonorgestrel, norethisterone:
-continuous therapy if post menopausal
-cyclical therapy if still having periods

can use tibolone alone: not HRT, has both oestrogenic and progestogenic properties

Raloxifene is given to protect bones and reduce risk of endometrial and cervical ca.

4

criteria for HRT (3)

early menopause-prevent osteoporosis

severe Sx

high risk of osteoporosis: parkinson's, depression, CHD

5

SEs of HRT (5)

wt. gain, bloating, mood swings, vomitting

cholestasis

cancers: breast, ovarian, endometrial

increased risk of VTE

PMS

bleeding common in 1st 4mo of use, if bleeding after 8mo do endometrial biopsy

6

HRT CIs (6)

PMHx of oestrogen-dependant cancers: breast, ovarian, endometrial

PMHx of VTE

liver disease: risk of cholestasis

unexplained PV bleeding

breastfeeding

phlebitis

(avoid/monitor in Dubin-Johnson/Rotor syndromes: hepatic jaundice)

7

monitoring while on HRT (2)

annually monitor:
-breasts
-BP

(menopausal Sx last on average for 4yrs but can be longer. Risks of HRT increase over time so annual monitoring required to assess risks vs benefits)

8

Other Mx for menopausal Sx (4)

bisphosphonates for osteoporosis

for vasomotor Sx:
-SSRIs 1st line: paroxetine
-clonidine, tibolone

topical oestrogens for vaginal dryness and urinary incontinence/frequency

lifestyle modification:
-good diet
-wt. loss
-wt.-bearing exercises
-quite smoking
-more vit D

9

Causes of post-menopausal bleeding (3)

most important: endometrial ca.

most common: atrophic vaginitis

others:
-cervical polyps
-cervicitis
-endometrial hypoplasia

10

Mx of PMB (4)

bimanual+speculum

smear if not recently done

TV USS:
-if endometrial thickness <4mm and one episode of bleeding, do nothing

if >4mm or multiple bleeds do biopsy+/-hysteroscopy

11

definition of premature ovarian failure

onset of menopausal Sx <40yrs

12

Causes of premature ovarian failure (4)

idiopathic

autoimmune

chemotherapy

radiation

(features similar to menopause and often preceded by irregular cycles)

13

Mx of premature ovarian failure

HRT