Menopause and Amenorrhoea Flashcards
(27 cards)
What is menopause?
Lack of menstruation for >1 year and defined as permanent end to menstruation
What is andropause?
When testosterone begins to fall by 1% a year after 30, yet there are no sudden changes and fertility remains
What is the average age of menopause onset?
51
How long does perimenopause last?
Approx 5 years before menopause and the 12 months after
What age does premature menopause occur?
<40 years as the result of premature ovarian insufficiency
Describe the pathophysiology of menopause
Menopause is caused by the lack of of ovarian follicular function, so oestrogen and progestogen are low and FSH/LH are high and erratic due to negative feedback absence
How does menopause present?
Vasomotor symptoms/hot flushes
Vaginal dryness
Dyspareunia
Atrophy and thinning of vaginal epithelium
Low libido
Muscle and joint aches
Mood changes
Poor memory/concentration
Osteoporosis
Overactive bladder symptoms, such as frequency and urgency
What are the two types of hormonal replacement therapy?
Systemic Transdermal
- Oestrogen or oestrogen + progestogen
Local Vaginal
- Oestrogen only
Why does HRT require progestogen if women has a uterus?
To prevent endometrial hyperplasia/overactive uterus, as oestrogen causes endometrium to proliferate
Give contraindications for systemic HRT
Current hormone dependent cancer (breast or endometrium)
Current active liver disease
Un-investigated abnormal bleeding
Previous venous thromboembolism, thrombophilia
Previous breast cancer or BRCA carrier
Give benefits of HRT
Vasomotor symptom relief
Local genital symptoms relief
Osteoporosis risk reduced
Give complications of HRT
CVS if oral
Ovarian cancer
Venous thrombosis (and thrombotic events, such as stroke)
Breast cancer if combined HRT
Gall bladder disease
When is transdermal HRT used?
Women at risk of VTE
Give symptomatic management of menopause, other than HRT
Selective oestrogen receptor modulators (SERMs), for hot flushes
SSRI antidepressants
Natural methods, due to high placebo effect
Non hormonal vaginal lubricants
What is primary amenorrhoea?
Never had a period, >14 years if no secondary sexual characteristics and >16 if secondary sexual characteristics
What is secondary amenorrhoea?
Has had period but none for 6 months
Give causes of primary amenorrhoea
Late puberty
Turner syndrome
Vaginal agenesis
Testicular feminisation
What is the most common cause of primary amenorrhoea?
Late puberty
Give causes of secondary amenorrhoea
Pregnancy
Breast feeding
Contraceptive related
PCOS
Early menopause
Thyroid disease/Cushing’s
Raised prolactin
Hypothalamic-Pituitary-Ovarian Dysfunction
Androgen secreting tumour
Sheehan’s syndrome
Ashermans syndrome/Intrauterine adhesions
What is the most common cause of secondary amenorrhoea?
Hypothalamic-Pituitary-Ovarian Dysfunction (stress, weight change)
What investigations are used in trying to find the cause of amenorrhoea?
BMI
Urine pregnancy test and dipstick for glucose
FSH bloods
- Oestradiol
- Prolactin
- Thyroid function
- Testosterone
Pelvic USS: PCOS
What is atrophic vaginitis?
Atrophy of the vaginal mucosa due to lack of oestrogen, resulting in it becoing thin, dry and less elastic, occuring in menopausal and post-menopausal women
How does atrophic vaginitis present?
Vaginal dryness
Vaginal itchyness
Dyspareunia (discomfort or pain during sex)
Occasional spotting/bleeding due to localised inflammation
Pale mucosa, erythema and inflammation
Thin and sparse pubic hair
How is atrophic vaginitis managed?
Vaginal lubricants and moisturisers
Topical oestrogen (ring, cream or pessary)
