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Flashcards in Postmenopausal Beeding Deck (39):
1

What age does menopause usually occur?

50-51

2

What is menopause? Why does menopause occur?

>Permanent cessation of menstruation resulting from loss of ovarian follicular activity
>The supply of oocytes has been exhausted

3

As menopause approaches what hormonal changes occur?

*Oestradiol production by the granulosa cells of the developing follicles decreases
*Progesterone production decreases as the proportion of anovultary cycles increases
*FSH and LH production increases in response to diminishing negative feedback from oestrogen

4

When can perimenopause be clinical diagnosed without tests?

In women aged over 45 who have:
*vasomotor symptoms and irregular periods

5

When can menopause be clinically diagnosed without tests?

In women aged over 45 who have:
*not had a period in at least 12 months and are not using hormonal contraception

6

When would we use laboratory and imaging tests to diagnose perimenopause or menopause?

When a women is <45 years old

7

What diagnostic tests can be done to diagnose menopause? Age group that this is appropriate in?

< 45 years old
Bloods:
*anti-Mullerian hormone (marker of follicular reserve)
*inhibin A
*inhibin B
*oestradial
*FSH test in women age 40-45 with symptoms or <40 without symptoms but suspected anyway
Imaging
*antral follicle count
*ovarian volume

8

What are the classes of symptoms of menopause? What is it a consequence of?

All a consequence of oestrogen deficiency
Short term:
*Vasomotor
*psychological

Intermiditate:
*Urogenital
*Cutaneous/connectice tissue

Long-term problems:
*Arterial
*Skeletal

9

What are the vasomotor symptoms of menopause? How long do they present?

Short term problems
*Headaches
*Hot flushes
*Night sweats
*Palpitations
*Insomnia

10

What are the psychological symptoms of menopause? How long do they present?

Short term problem
*Irritability
*Poor concentrations
*Poor short-term memory
*Depression
*Lethargy
*Loss of libido/self confidence
*Generalised aches

11

What are the urogenital symptoms of menopause? How long do they present?

Intermediate problem
*Urethral symptoms
*Uterine prolapse
*Stress/urge incontinence
*Dyspareunia
*Atrophic vaginitis/vulvitis
*Vaginal dryness

12

What are the cutaneous/connective tissue symptoms of menopause? How long do they present?

Intermediate problem
*Dry skin
*Dry hair
*Brittle nails

13

What are the arterial long term problems of menopause?

*Cardiovascular disease
*Cerebrovascular disease

14

What are the skeletal long term problems of menopause?

*Osteoporosis

15

What is perimenopause?

Includes the time beginning with the first feature of the approaching menopause, such as vasomotor symptoms and menstrual irregularity, and ends 12 months after the last menstrual period

16

What is premature menopause?

Menopause occurring before the age of 40, affects 1% of women

17

How can we manage women who present with vasomotor symptoms of menopause?

*HRT
>Oestrogen & progesterone to women with a uterus
>Oestrogen alone to women without a uterus
*Explain short and long term benefits and risks of HRT
*SSRIs/SNRIs
*Exercise, weight loss and stress reduction

18

How can we manage women who present with psychological symptoms of menopause?

*HRT -to alleviate low mood due to menopause
*Consider CBT
*No clear evidence for SSRIs use to ease low mood in women with menopause who have not been diagnosed with depression

19

How can we manage women who present with an altered sexual function due to menopause?

*HRT 1st line
*Consider testosterone supplementation if HRT alone is not effective

20

How can we manage women with urogenital atrophy due to menopause?

*HRT
*Offer vaginal oestrogen (including to those on HRT) and continue for as long as needed to relieve symptoms
*Can increase dose after seeking advice from expertise if not working
*Vaginal lubricants and moisturisers

21

What is vaginal atrophy?
Symptom presentation? Why does it occur?

*Thinning, drying and inflammation of the vaginal walls
*Dyspareunia and distressing urinary symptoms
*May occur when the body has less oestrogen
*Due to menopause

22

What needs to be explained to women starting HRT?

*Uscheduled vaginal bleeding common side effect of HRT within first 3 months
*Should be reported if continued bleeding after 3 months

23

What needs to be explained to women stopping HRT?

*Choice of gradually or immediately stopping
*Gradually reducing HRT may limit recurrence of symptoms in short term
*However, makes no difference to symptoms in the long term

24

How long do the symptoms of menopause typically last?

2-5years

25

What are the contraindications to HRT?

*Current or past breast cancer
*Any oestrogen-senstive cancer
*Undiagnosed vaginal bleeding
*Untreated endometrial hyperplasia

26

How does HRT affect the risk of a Venous thromboembolism?

*Increased risk of VTE with oral HRT
*Oral HRT risk greater than transdermal preparations
=Should consider transdermal rather than oral for women at increased risk of VTE (including BMI >30)

27

How does HRT affect the risk of breast cancer?

*Oestrogen alone HRT does not increase risk
*Oestrogen and progesterone HRT increases risk of breast cancer

28

How does HRT affect the risk of fragility fracture due to osteoporosis?

*Decreased risk while taking HRT

29

How does HRT affect the risk of a stroke?

*Increased risk with oral oestrogen only preparations

30

If a woman has a uterus what HRT treatment is given? Why is a certain form not given?

*Oral or transdermal combined (oestrogen and progesterone) is usually given
*Oestrogen only not given as increases risk of endometrial cancer

31

If a woman does not have a uterus what HRT treatment can be given?

Oestrogen alone can be given, orally or transdermal

32

How do we manage vasomotors symptoms due to menopause without using HRT?

Give 1 of these:
*Fluoxetine (SSRI)
*Citalopram (SSRI)
*Venlafaxine (SNRI)

33

How doe we psychological symptoms due to menopause without using HRT?

*Self-help groups
*CBT
*Antidepressants

34

When would a woman with menopause be referred to secondary care?

*treatment has been ineffective
*ongoing side effects
*unexplained bleeding

35

What is postmenopausal bleeding?

Vaginal bleeding occurring at least 12 months after the last menstrual period

36

What are the causes of postmenopausal bleeding?

*Endometrial carcinoma
*Endometrial hyperplasia +/- atypia and polyps
*Cervical carcinoma
*Atrophic vaginitis
*Cervicitis
*Ovarian carcinoma
*Cervical polyps

37

What can be a normal cause of postmenopausal bleeding with women on HRT?

*Withdrawal bleeds
>Occurs with sequential menopausal hormonal therapy
>regular bleeds = don't warrant investigation
*Atrophic vaginitis
>poorly oestrogenised wall

38

Investigations of women with postmenopausal bleeding?

*Bimanual examination
*Speculum examination
*Cervical smear
*Transvaginal sonography
If concern:
*Hysteroscopy/endometrial biopsy for histological diagnosis

39

What does transvaginal sonography look for? What are worrying signs?

*endometrial thickness
*looks for fibroids and ovarian cysts
*Thickened endometrium or cavity filled with fluid indicates increased risk of malignancy/hyperplasia/polyps