Menopause and secondary amenorrhoea

Question 1

What causes menopause?

Answer 1

Ovarian insufficiency- oestradiol falls and FSH rises

Question 2

What are the signs and symptoms of the menopause?

Answer 2

Hot flushes
Vaginal dryness/soreness
Low libido
Joint and muscle aches
Mood changes
Poor memory

Question 3

What are the symptomatic treatment options for the menopause?

Answer 3

HRT
Selective oestrogen receptor modulators
Non hormonal lubricants

Question 4

Whatare the options of HRT?

Answer 4

Local vaginal oestrogen cream/pessary/ring
Systemic transdermal/oral oestrogen and progesterone
Mirena IUD
Selective oestrogen receptor modulators (SERMs)

Question 5

What oral HRT would be given to a woman who is 54+ or >1 year without a period?

Answer 5

28 day continuous oestrogen and progesterone

Question 6

What oral HRT would be given to a woman who still has ovarian function?

Answer 6

14 days oestrogen, 14 days oestrogen nd progesterone

Question 7

What are the contraindications for HRT?

Answer 7

Current hormone dependent breast/endometrial cancer
Curent active liver disease
Uninvestigated abnormal bleeding

Question 8

What are the possible complications of HRT?

Answer 8

VTE if oral
Breast cancer
Ovarian cancer

Question 9

What is secondary amenorrhoea?

Answer 9

HAs had previous periods but none for 6 months

Question 10

What are the causes of secondary amenorrhoea?

Answer 10

Pregnancy/breastfeeding
Contraception
Polycyctsic ovaries
Early menopause
Thyroid disease
Cushings
Raised prolactin
Stress
Weight change
Sudden increase in exercise
Androgen secreting tumour
Sheehans syndrome
Ashermans syndrome

Question 11

What is Sheehans syndrome?

Answer 11

Pituitary failure

Question 12

What is Ashermans syndrome?

Answer 12

Intrauterine adhesions

Question 13

What investigations are done for secondary amenorrhoea?

Answer 13

Exam- BP. BMI, hirsutism, Cushingoid, enlarged clitoris, deep voice
Pregnancy test
Urine lipstick for glucose
Bloods
Pelvic US

Question 14

What bloods are done for secondary amenorrhoea?

Answer 14

FSH, LH
Oestradiol
Prolactin
Thyroid function
Testosterone

Question 15

What is the treatment of secondary amenorrhoea?

Answer 15

Treat specific cause

Question 16

What is the treatment of premature ovarian insufficiency?

Answer 16

HRT

Question 17

When is menopause classed as premature?

Answer 17

If woman experiences menopause before the age of 40

Question 18

What % of woman are affected by premature menopause?

Answer 18

1%

Question 19

What happens approximately 5 years before the menopause?

Answer 19

Perimenopause where FSH levels begin to fluctuate

Question 20

What is a silent but bad change during menopause?

Answer 20

Osteoporosis

Question 21

What can increase your risk of post-menopusal osteoporosis?

Answer 21

Smoking
Thin
Caucasian
Previous eating disorder
Vit D malabsorption
Steroids
Hyperthyroidism

Question 22

Prevention of osteoporosis

Answer 22

Weight bearing exercise
Calcium and Vit D supplements
HRT
Bisphosphonates
Denosumab

Question 23

What can HRT help with?

Answer 23

Vasomotor symptoms
Local genital symptoms
Osteoporsis (reduces risk from 10/1000 to 4/1000)
Colon cancer risk reduction (from 11/1000)

Question 24

HRT NICE guidelines

Answer 24

For treatment of severe vasomotor symptoms
For women with premature ovarian insufficiency
HRT benefits outweigh risk until age 50

Question 25

Examinations and investigations for secondary amenorrhea

Answer 25

BP
BMI
Hirsuitism
Acne
Cushingoid tests
Enlarged clitoris and deep v oice - virulised
Urine pregnancy test and dipstick for glucose
Abdominal/bimanual palpation
Bloods for FSH, oestradiol, prolactin, thyroid function, testosterone and 17 hydroxyprogesterne
Pevic ultrasound

Question 26

Treatment for secondary amenorrhea

Answer 26

Treat specific cause
Aim for BMI between 20 and 30
Assume fertility until 2 years post confirmed menopause
HRT until 50 for those with ovarian insufficiency
Emotional support - daisy network, check for fragile X