Menopause and Secondary Amenorrhoea Flashcards
(32 cards)
What is menopause?
Menopause mean last ever period
Can be natural or follow oophorectomy/chemotherapy/ radiotherapy
What is the average age of menopause?
51 years old
What is perimenopause?
Approx 5 years before menopause
What is premature menopause?
> 40 years old
What causes menopause?
Can be natural or follow oophorectomy/chemotherapy/ radiotherapy
Ovarian insufficiency:
- Oestradiol falls
- FSH rises
- Still some oestriol from peripheral
- Conversion of adrenal androgens in fat
What are the symptoms of menopause?
1) Vasomotor symptoms ‘hot flushes’ 80% women 45% find them a problem usually last 2-5 yrs, may be 10 years+
2) Vaginal dryness / dyspareunia
3) Low libido
4) Muscle and joint aches
5) Mood changes / poor memory
6) Osteoporosis
How are the symptoms of menopause managed?
1) Hormone replacement therapy
2) Local vaginal oestrogen only pessary/ring/cream
3) Selective estrogen receptor modulators (SERMs).
4) SSRI SNRI antidepressants
5) Natural methods phytooestrogen
6) Non hormonal vaginal lubricants
Contraindications to systemic hormone replacement therapy?
1) Current Hormone dependent cancer breast/endometrium
2) Current active liver disease
3) Uninvestigated abnormal bleeding
4) Seek advice if previous VTE, thrombophilia, FH VTE
5) Seek advice if previous CA breast or BRCA carrier
How are the symptoms of menopause managed - HRT?
1) Hormone replacement therapy:
- Systemic transdermal patch
- Gel/oral transdermal avoids first pass- less risk VTE
- a/oestrogen only if no uterus
- b/oestrogen + progestogen if uterus present to prevent
- Endometrial hyperplasia
- Progestogen oral
- Transdermal patch
- LNG IUS
How are the symptoms of menopause managed - Local vaginal oestrogen only pessary/ring/cream?
Local vaginal oestrogen only pessary/ring/cream. Minimal absorption-no increased VTE/breast Ca risk –no need progestogen for endometrial protection
How are the symptoms of menopause managed - combined oestrogen and progesterone HRT?
Combined Estrogen and Progestogen HRT:
- Continuous combined HRT ie E+P taken daily
- Lower endometrial cancer risk - Bleed free after 3 months or so
How are the symptoms of menopause managed - combined oestrogen and progesterone HRT what if bleeding still occurs?
Need Cyclical combined 14 days E + 14 days E+P
Withdrawal bleed after stop P
How are the symptoms of menopause managed - example of a SERM?
Tibolone
How are the symptoms of menopause managed - example of a SSRI SNRI antidepressant?
Venlafaxine or Clonidine
How are the symptoms of menopause managed - example of a natural methods phytooestrogen?
> Red clover & soy > Black cohosh > Hypnotherapy > Exercise > CBT > High placebo effect
Risks of hormonal replacement therapies?
1) Breast cancer if combined HRT
2) Ovarian Ca
3) Venous thrombosis if oral route
4) CVA if oral route
5) Fracture
6)
Benefits of hormonal replacement therapies?
1) Vasomotor
2) Local genital symptoms
3) Osteoporosis
Jane is 48 and has hot flushes and night sweats. She has periods 5/30 cycle but has missed 2 periods in the last year.
- What should you consider?
- What is the most likely diagnosis?
- How can you manage?
1) Consider TB/ thyroid/ lymphoma
2) Information likely perimenopause
3) Lifestyle changes / Red clover / Hormone replacement therapy
Jane is 48 and has hot flushes and night sweats. She has periods 5/30 cycle but has missed 2 periods in the last year. Which HRT should be used.
1) Vasomotor symptoms
2) Has a uterus
3) Has some ovarian function
1) Vasomotor symptoms need oestrogen
2) Has a uterus so needs progestogen
3) Has some ovarian function so needs cyclical combined
OR
Mirena + Oestrogen oral/transdermal
Sheila had a hysterectomy for menorrhagia when she was 36 18/40 size fibroids. Her ovaries were conserved. She is now 39 and has hot flushes.
1) She wonders if she is menopausal?
2) Tests?
3) Management?
1) Menopause frequent after hysterectomy even if ovaries conserved
2) - Follicle stimulating hormone = FSH.
- FRAX score/DEXA scan
3) If symptomatic oestrogen, can use vaginal HRT for vaginal symptoms.
(Does not have uterus so does not require progesterone)
What is andropause?
Drop in testosterone and DHEAS
What is the normal fall of testosterone each year after 30?
1% a year after 30 years old
What happens to fertility with andropause?
Fertility remains
What is primary amenorrhoea?
Never had a period
