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Menopause + Amenorrhoea Flashcards

(61 cards)

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1
Q

What is the menopause

A 
Last ever period 
Can be Dx if no period for 12 months 
Typically age 50
Perimenopause 5 years prior 
Require contraception for 2 years if <50 and 1 year if >50
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2
Q

What causes menopause

A 
Ovarian insufficiency 
- natural
- surgery - oophorectomy 
- chemo / RT  
- autoimmune 
- Turner's 
Low oestrogen 
FSH rises due to low oestrogen
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3
Q

Why do obese people suffer less in menopause

A

Conversion of androgens in fat stores to oestrogen

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4
Q

When is menopause premature?

A

<40
Common after hysterectomy
Will have raised FSH and LH

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5
Q

What are the symptoms of menopause?

A 
DUB 
Vasomotor 'hot flush' 
Night sweats 
Atrophy of vagina / myometrial thinning 
- Vagina dryness
- Dyspareunia 
- Urinary incontinence 
- Recurrent UTI 
Low libido
Muscle and joint aches
Mood changes
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6
Q

What is the silent change of menopause

A

Osteoporosis
Oestrogen protective of bone mass as it acts on osteoclasts
Reduced bone mass on DEXA
Fractures more likely

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7
Q

When is osteoporosis more likely?

A 
Low BMI
Malabsorption 
Smoker 
Alcohol 
FH
Steroids 
Hyperthyroid
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8
Q

When should you always start HRT

A

If premature
Benefits > risks
Benefits = reduced symptoms and osteoporosis

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9
Q

What is important in the history

A

LMP

Pattern of bleeding before

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10
Q

How do you Dx menopause

A

FSH and LH - will be high

DEXA

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11
Q

When do you refer to secondary care

A

Rx not worked
Ongoing bleeding
Ongoing SE from HRT

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12
Q

What are lifestyle measures

A

Exercise
Weight loss
Reduce stress
Sleep hygiene

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13
Q

What types of HRT is there

A

Local oestrogen cream or ring if vaginal symptoms only
Transdermal - less risk VTE
Oral
SERM

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14
Q

When do you give local cream

A

If only vaginal Sx

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15
Q

What are non-hormonal Rx

A 
CBT
Hypnotherapy
Lubricant
Anti-depressant - SSRI 
Vaginal E
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16
Q

What are CI to HRT

A

Hormone dependent breast or endometrial cancer
Liver disease
Abnormal bleeding

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17
Q

What are relative CI to HRT

A

VTE
Thrombophilia
FH / previous cancer
BRCA

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18
Q

What can HRT cause in breast

A

Proliferation of breast tissue

Appear dense on mammogram

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19
Q

What can you do for osteoporosis

A 
Weight bearing exercise
Ca + vit D
Biphosphonates = 1st line
Denosumab
Teritamide 
HRT reduce fracture
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20
Q

What is action of denosumab and teritamide

A

Denosumab - Ab to osteoclast

Teritamide - stimulate PTH

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21
Q

What are risks of HRT

A

Breast, ovarian and endometrial cancer
VTE
CVS risk if start >60 as may disrupt atherosclerosis

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22
Q

How do you give HRT

A

Oestrogen only if no uterus

O+P if uterus to prevent hyperplasia of endometrium (but increased risk of breast)

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23
Q

What are SE of HRT

A 
Nausea
Breast pain
Bleeding
Fluid retention / bloating 
Weight gain
Headache
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24
Q

How can O+P be given

A

Combined / cyclical - 14 days O then 14 days O+P (if perimenopause as gives more predictable bleeds)
Continuous if >1 year from menopause
Mirena + daily E - any age

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25
What is primary amenorrhoea
Never had a period
26
What triggers menstruation
Fall in progesterone 2 weeks after ovulation if no pregnancy
27
What can cause primary amenorrhoea
Hypogonadotrophic hypogonadism - hypothalamus / AP not producing LH or FSH - Hypothyroid - Hyperprolactin Hypergonadotrophic hypogonadism - ovaries not producing sex hormones Turner's - 45x Androgen insensitivity Congential adrenal hyperplasia Other Congenital malformation blocking tract - imperforate hymen
28
What are symptoms of blockage
Pelvic pain | Bloating
29
When do you investigate primary amenorrhoea
16 if normal 2 sexual characteristic e.g. breast budding | 14 if absence of 2
30
What investigations do you do prior to referral / what do you look for in examination
Examination - BP / BMI / pelvic USS to ensure structural normal - Abdo and pelvic exam for structural cause - Evidence of puberty ``` Hypothalamic Evidence of eating disorder / chronic disease / exercise / stress Signs of androgen excess Signs of hypothyroid Signs of hyperprolactin ``` ``` Investigation FSH + LH Oestrogen / Testosterone Prolactin / TFT Pelvic USS ```
31
What does low FSH / LH suggest
Hypothalamic cause
32
What does raised FSH / LH suggest
Ovarian cause
33
How do you treat primary amenorrhoea
``` Treat cause Puberty induction Gradual build up of oestrogen Add progesterone when max height reached If persistent / unable to treat then consider treating osteoporosis risk with Ca / vit D / COCP ```
34
When do you refer to gynae
Obstruction / malformation
35
When do you refer to endocrinology
Other
36
What is a normal period
13-51 30-40ml lasting 4-5 days Cycle 21-35 days
37
What are other symptoms of period
``` Cramps Sore breast Fluid retention Appetite Mood change ```
38
What is secondary amenorrhoea
No period for 6 months after having a normal period
39
What are causes of secondary amenorrhoea
``` Structural Ovarian Hypothalamic Pituitary Adrenal ```
40
What are structural causes
Asherman's Fibroids PCOS
41
What are ovarian causes
``` PCOS Premature ovarian failure Menopause Contraception Pregnancy Breast feeding ```
42
What are hypothalamic causes
Weight loss Excessive exercise Stress Chronic disease
43
What are pituitary / endocrine causes
``` Prolactinoma Piuitary adenoma Cushing's Acromegay Hypothyroid / hyper Sheehan's Contracpetion ```
44
What does a prolactinoma do and how d you Rx
Act on hypothalamus to decrease GnRH Results in hypogonadotrophic hypogonadism Raised prolactin Rx = dopamine agonist
45
What does pituitary adenoma do
Secrete androgen
46
What is Sheehan
Destruction of gland
47
What is Asherman's, what does it cause and how do you Dx
``` Intrauterine adhesions Usually after dilatation and curettage Leads to - Amenorrhoea - Infertility - Recurrent miscarriage Dx = hysteroscopy ```
48
What is adrenal causes
Adrenal hyperplasia Adrenal tumour Increased steroid
49
What investigations do you do and examination
``` Exclude pregnancy FSH + LH to see if hypothalamic or ovarian cause Androgen - may be raised in PCOS Prolactin / TFT if indicated Pelvic USS Oestrogen / testosterone ``` Examination BP BMI Abdo / bimanual
50
What can be raised in PCOS
Testosterone
51
How do you treat
Treat cause | Weight loss
52
What must you offer
Contraception | Assume fertile
53
If premature ovarian
HRT till 50
54
How do you regulate cycle
COCP POP IUS
55
How do you see if ovulating
Mid literal progesterone
56
What is Sheehan
Destruction of pituatary gland Amenorrhoea Lack of milk Hypothyroid
57
What is SSRI used for
Vasomotor symptoms
58
What is androgen insensitivity syndrome
Body insensitive to androgens e.g. testosterone Normal male sexual characteristics do not develop Female phenotype externally Male genotype 46XY Internally they have testes and absence of female reproductive hormones
59
How is it inherited
X-linked
60
What are complications
Infertile | Risk of testicular cancer
61
How do you Rx
Raise as female as insensitive to all male hormones Oestrogen Orchidectomy

Obs & Gynae (23 decks)

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