Menopause Flashcards
(34 cards)
Definition of menopause
12 consecutive months of amenorrhoea. Permanent cessation of follicular activity.
Median age Menopause
51
What is the Climacteric phase?
Phase in which decline of ovarian function. Decrease sex steroid, increase in anovulatory cycles and irregular menstruation.
Define perimenopause
from the first onset of symptoms til 12m after last period
What is Premature menopause?
<40 years. 1% women.
Causes premature menopause
infection, bilateral oophorectomy, autoimmune, chemo, ovarian dysgenesis, metabolic disease, unknown.
Causes of post menopausal bleeding
20% malignancy (endometrial, cervical, ovarian)
Endometrial hyperplasia, cervicitis, atrophic vaginitis
polyps
Investigations for postmenopausal bleeding
bimanual, speculum, smear, TVUSS
if TVUSS shows endometrium >4mm and >1ep bleed -> endometrial biopsy with hysteroscopy
sign that would indicate endometrial CA
purulent blood stained discharge
atrophic vaginitis treatment
topical oestrogen or oral ospemifene (SERM) cream
do you need to investigate regular withdrawal bleeds following sequential menopausal HRT?
No. Not if they are regular.
symptoms of menopause
flushes and night sweats (70%, vasomotor -> tiredness, present <5yrs most), dyspareunia, dry, itch, urinary freq/urg/nocturia/infection (genitourinary syndrome of menopause), loss libido and sexual problems (50%), osteoporosis (1/3 >50 have osteoporotic fracture)
proportion of deaths from CVD women
1/4
how is osteoporosis measured
bone strength = density and quality. BMD scores (T score -2.5 or lower)
common sites osteoporotic fractures
colles (wrist), spine, hip
RF osteoporosis
- FHX (esp. 1st degree relationship with hip fracture)
- low BMI, early menopause
- smoking, alc, low ca, sedentary
- > 5mg pred or equivalent corticosteroids
- rheumatoid arth, NMD, CLD, hypogonadism, hyperparathyroidism, hyperthyroidism, malab syndromes
what level of FSH is significant in menopause and explain
increase in serum FSH >30IU. show degree of ovarian reserve remaining. increase means fewer. helpful in prem ovarian failure. taken days 2-5. if had hysterectomy, 2 samples 2 weeks apart.
what is AMH
Anti-mullerian hormone. direct measure ovarian reserve. low = failure. somewhat predict menopause depending on clinical context
IX for Menopause (6)
- FSH (increase)
- AMH (decrease)
- TFTs
- LH, oestradiol, progesterone (low PG = an ovulation)
- bone profile (BMD, DEXA scan, biochem markers of turnover to monitor tx)
- catecholamines and 5-HIAA (increase pheochromocytoma and carcinoid syndrome)
causes of falsely increased spine BDM
osteophytes from OA, Kyphosis, scoliosis, aortic calcification
HRT principle for
a) hysterectomy
b) no hysterectomy
a) just oestrogen
b) oestrogen and progesterone (progesterone sequentially for 10-14 days every 4 weeks or 14 days every 13 weeks or continuously with oestrogen)
how long do you give HRT for before review
5 yrs
If prem meno usually continue til normal median age menopause
what tx can you give to perimenopausal women
sequential or cyclic therapy or IUS with oral/patch oestrogen if very heart menstrual bleed or need contraception
post menopausal HRT regimen should be…
continuous due to lack of induced bleeding and reduced risk of endometrial CA. induces endometrial atrophy. SERM and oestrogen approved (eg if PG not appropriate).
