Menopause and secondary amenorrhoea

Question 1

average age of menopause

Answer 1

51

Question 2

How long does the perimenopause usually last?

Answer 2

5 years before the menopause

Question 3

What is known as premature menopause?

Answer 3

40 or less

Question 4

Cause of menopause

Answer 4

ovarian insufficiency - oestradiol falls and FSH rises

Question 5

Other source of oestradiol in ovarian sufficiency with menopause

Answer 5

peripheral conversion of adrenal androgens in fat

Question 6

What may bring on menopause?

Answer 6

oophorectomy, chemo, radiotherapy

Question 7

symptoms of menopause

Answer 7

vasomotor - hot flushes 
vaginal dryness and soreness 
mood change and poor memory
low libido 
muscle and joint pains

Question 8

Risk factors of osteoporosis

Answer 8

thin, Caucasian, smokers, alcohol, positive FH, amenorrhoea, malabsorption, steroids, hyperthyroid

Question 9

Prevention and treatment of osteoporosis

Answer 9

calcium, Vit D, bisphosphonates, exercise, HRT, teriparatide, denosumab monoclonal ab

Question 10

Local treatment of menopause symptoms

Answer 10

vaginal oestrogen pessary/ring/cream

Question 11

Systemic HRT

Answer 11

oestrogen only if no uterus

oestrogen and progestogen if uterus present

Question 12

Advantage of transdermal systemic HRT

Answer 12

avoids first pass so less risk of VTE

Question 13

What types of oestrogen and progestogen HRT is there?

Answer 13

progestogen oral, transdermal or LNG IUS

Question 14

CI to HRT

Answer 14

current hormone dependent breast or endometrial ca
current active liver disease
un investigated abnormal bleeding

Question 15

What things should you seek advice on before starting someone on HRT?

Answer 15

previous VTE, thrombophilia or FH of VTE

previous breast or endometrial ca

Question 16

2 methods of combined E+P HRT

Answer 16

cyclical or continuous

Question 17

cyclical combined HRT

Answer 17

14 days E and 14 days E+P

withdrawl bleed

Question 18

Who would you use cyclical combined HRT in?

Answer 18

still some ovarian function eg perimenopause

Question 19

continuous combined HRT

Answer 19

28 days E+P

Question 20

who would you use continuous combined HRT in?

Answer 20

no ovarian function eg >1 year after menopause

Question 21

SERMS

Answer 21

E effect on some selected organs eg tibolone

Question 22

Are antidepressants helpful with menopause symptoms?

Answer 22

no

Question 23

Natural methods for menopause symptoms

Answer 23

phytoestrogen/herbs eg red clover/hypnotherapy/exercise/CBT

Question 24

Benefits of HRT

Answer 24

vasomotor
local genital symptoms
osteoporosis

Question 25

Risk of HRT

Answer 25

breast cancer if combined HRT ovarian cancer VTE, CVA

Question 26

How often to review HRT for vasomotor symptoms

Answer 26

annually

Question 27

What age do benefits of HRT outweigh the risks for ovarian insufficiency?

Answer 27

50

Question 28

treatment for osteoporosis and vaginal dryness

Answer 28

bisphosphonates | vaginal oestrogen

Question 29

Andropause

Answer 29

testosterone falls by 1% every year after 30 and DHEA falls | fertility remains as it is a gradual change

Question 30

secondary amenorrhoea

Answer 30

has had periods in past but none for 6 months

Question 31

causes of secondary amenorrhoea

Answer 31

``` pregnancy/breastfeeding sheehans syndrome - pituitary failure contraception - depoprovera PCO thyroid disease/cushingoid etc early menopause raised PRL hypothalamic eg weight change, stress androgen secreting tumour ashermans syndrome - intrauterine adhesions ```

Question 32

Exams and tests for secondary amenorrhoea

Answer 32

``` BP, BMI, hirsutism, acne, cushingoid enlarged clitoris/deep voice abdominal/bimanual pregnancy test and urine dipstick for glucose bloods - FSH,LH,PRL,TSH, oestradiol pelvic USS ```

Question 33

BMI aim in secondary amenorrhoea

Answer 33

20-25

Question 34

Premature ovarian insufficiency

Answer 34

HRT until 50 | emotional support and check for fragile X

Question 35

Risks associated with PCOS

Answer 35

DM, CVS, endometrial hyperplasia

Question 36

PCO

Answer 36

small peripheral ovaries, 20% women, common in adolescents

Question 37

PCOS

Answer 37

irregular ovulation so irregular cycle plenty E but increased androgens underlying insulin resistance

Question 38

Managing PCOS

Answer 38

weight/exercise - increases SHBG anti-androgen eg CHC, spironolactone endometrial proliferation - CHC, progestogens, mirena IUS fertility - clomifene/metformin