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Reproductive System > Secondary Amenorrhoea and Menopause > Flashcards

Secondary Amenorrhoea and Menopause Flashcards

(40 cards)

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1
Q

What is the dentition of menopause?

A

The Menopause is a woman’s last ever period

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2
Q

What is the average age of the menopause?

A

51

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3
Q

When does perimenopause start?

A

Approx. 5 years before

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4
Q

What is premature menopause and how common is it?

A
  • Premature menopause = 40 years or less

* Affects 1% of women

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5
Q

What happens in menopause?

A

•Ovarian insufficiency (oestradiol falls)
->Follicle stimulating hormone (FSH) rises

  • Still some oestriol from conversion of adrenal androgens in adipose tissue
  • FSH levels fluctuate in perimenopause - a premenopausal level does not exclude perimenopause as a cause for symptoms
  • Menopausal transition may be natural or sudden following oophorectomy/chemotherapy/radiotherapy
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6
Q

What are the symptoms of menopause?

A
  • Vasomotor symptoms
  • Vaginal dryness/soreness
  • Low libido
  • Muscle and joint aches
  • Mood changes/poor memory - possibly related to vasomotor effect on sleep
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7
Q

What are the vasomotor symptoms in menopause?

A
  • Hot flushes/night sweats - 80% women
  • 45% find them a problem
  • Usually last 2-5 yrs but may be 10 years+
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8
Q

What is a silent change in menopause?

A

Osteoporosis

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9
Q

What is osteoporosis?

A
  • Reduced bone mass

* DEXA scan •Bone density described as T score

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10
Q

What are the problems that come with osteoporosis?

A

•Fractured hip/vertebrae

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11
Q

What are the risk factors for osteoporosis?

A
  • Thin
  • Caucasian
  • Smoking
  • High EtOH - alcoholic
  • +ve FH
  • Malabsorption Vit D or Calcium
  • Prolonged low oestrogen amenorrhoea
  • Oral corticosteroids
  • Hyperthyroidism
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12
Q

How is osteoporosis prevented in menopausal women?

A
  • Weight-bearing exercise
  • Adequate calcium and vitamin D
  • HRT
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13
Q

How is osteoporosis treated in menopausal women?

A
  • Bisphosphonates
  • Denosumab - monoclonal antibody to osteoclasts
  • Calcitonin (hormone)
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14
Q

What are the 2 types of HRT?

A
  • Local

* Systemic

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15
Q

What is local HRT?

A
  • Oestrogen pessary/ring/cream
  • Local effects and minimal systemic absorption
  • Need to use longterm to maintain benefit
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16
Q

What is systemic HRT?

A
  • Oestrogen given transdermally or orally
  • Transdermal - avoids first pass, less risk of VTE
  • No uterus - oestrogen only
  • Uterus - oestrogen and progestogen
  • Progestogen given orally, transdermally and LNG IUS
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17
Q

Why is progestogen treatment required if the patient has a uterus?

Study These Flashcards
A

•Prevents endometrial hyperplasia from unopposed oestrogen

18
Q

What is combined cyclical menopause treatment?

Study These Flashcards
A
  • 14 days E + 14 days E+P
  • Expect withdrawal bleed after the P
  • Used if there may still be some ovarian function to avoid irregular bleeding
19
Q

What is combined continuous menopause treatment?

Study These Flashcards
A
  • 28 days E+P oral/patch
  • Expect to be bleed-free (after 1st 3 months)
  • Used if > 1yr after menopause or age 54+
20
Q

What combined treatment can any age use?

Study These Flashcards
A

Any age can use Mirena LNG IUS + daily E and expect

to be bleed free (and contraceptive cover under age 55)

21
Q

What are the contraindications for systemic HRT?

Study These Flashcards
A

•NOT the same as contraindications to combined
hormonal contraception- very few CI

  1. Current Hormone dependent cancer of 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 breast cancer or BRCA carrier
22
Q

How are the symptoms of menopause treated?

Study These Flashcards
A

•Selective Estrogen Receptor Modulators (SERMs)
E effect on selected organs (eg tibolone )

NOT clonidine or SSRI SNRI antidepressants eg venlafaxine common side effects &few benefit

phytooestrogen herbs eg red clover/soya

hypnotherapy/ exercise / Cognitive behavioural therapy

Non hormonal lubricants for vaginal dryness Regular eg Replens TM or Pre sex ‘Sylk’ TM

23
Q

What are the benefits of HRT?

Study These Flashcards
A
  • Vasomotor symptoms
  • Local genital symptoms
  • Osteoprosis
24
Q

What are the risks of HRT?

Study These Flashcards
A
  • Breast cancer if combined HRT
  • Ovarian cancer
  • VT if oral route
  • CVA if oral route (stroke)
25
What does HRT not affect?
* No effect on Alzheimer's | * No increase in CV risk if started before 60
26
How does HRT affect mortality?
* No overall increased mortality for HRT users recent studies * Reduced mortality - not certain enough to recommend HRT for all
27
What are the indications for HRT?
* For treatment of severe vasomotor symptoms, review annually * For women with premature ovarian insufficiency HRT benefits outweigh risks till age 50 * Not as first line for osteoporosis prevention/treatment (bisphosphonates instead) * Vaginal oestrogen for vaginal symptoms
28
What is andropause?
* Testosterone falls by 1% a year after 30 * DHEAS falls * Fertility remains * No sudden change * Different from hypogonadism
29
What is primary amenorrhoea?
* Never had a period * Affects 5% of girls * >14yrs and no 2ndry sexual characteristics * >16 years if 2ndry sexual characteristics
30
What is secondary amenorrhoea?
Has had periods in past but none for 6 months
31
What are the causes of secondary amenorrhoea?
* Pregnancy / Breast feeding * Contraception related - current use or for 6-9 months after depoprovera * Polycystic ovary syndrome * Premature ovarian insufficiency * Thyroid disease/Cushings/Any significant illness * Raised prolactin - prolactinoma/medication related * Congenital adrenal hyperplasia (CAH) * Hypothalamic - stress/10% wt change/excess exercise * Androgen secreting tumour - testosterone >5mg/l * Sheehans syndrome - pituitary failure * Ashermans syndrome - intrauterine adhesions
32
What examinations are carried out in secondary amenorrhoea?
* BP * BMI * Hirsutism * Acne * Cushingoid * Enlarged clitoris/deep voice =virilised * Abdominal/bimanual
33
What investigations are carried out in secondary amenorrhoea?
``` •Urine pregnancy test + dipstick for glucose •Bloods -FSH -oestradiol (menopause) -prolactin -thyroid function testosterone -17 hydroxy progesterone - congenital adrenal hyperplasia -pelvic ultrasound - polycystic ovaries ```
34
How is secondary amenorrhoea treated?
•Treat specific cause •Aim BMI 20-30 for ovulation •Assume fertile and need contraception unless 2 yrs after confirmed menopause •If premature ovarian insufficiency offer HRT till 50 -emotional support -Daisy network (for POI) -check for Fragile X - relatives may wish testing
35
How is polycystic ovary syndrome diagnosed?
Need 2/3: •Oligo/amenorrhoea •Androgenic symptoms: excess hair/acne •Polycystic ovarian morphology on scan
36
How may hormone levels indicate PCOS?
* Normal/high oestrogen levels | * Increased androgens
37
What are the issues associated with PCOS?
* Risk of endometrial hyperplasia if < 4 periods a year (and not on hormones) * Reduced fertility if not ovulating regularly BUT assume fertile and use contraception if not plan pregnancy * ?Higher risk diabetes & cardiovascular disease even if lean * Polycystic ovaries do NOT cause weight gain or pain * Weight gain can worsen PCOS symptoms as ↓SHBG levels ↑ androgens
38
How may polycystic ovaries be seen?
US, laparoscopy
39
What does PCOS look like on an USS?
* Small peripheral ovarian cysts x 10/ovary or ovarian volume>12cm3 * N.B. 20% women have this on scan but no other features ie not PCO syndrome * N.B. Multicystic ovaries common in adolescents – not associated with PCOS
40
How is PCOS managed?
•Weight loss/exercise to BMI 20-25 - can help all symptoms - increases SHBG so less free androgens * ?increased NIDDM (non-insulin dependent) risk even if slim - consider GTT * Support & information– Verity patient support group * Antiandrogen - combined hormonal contraception if no CI - spironolactone - eflornithine cream reduces facial hair growth •Endometrial protection - CHC, Mirena IUS - Oral provera 10/90 if no period •Fertility Rx clomiphene/metformin -ovulation induction •Metformin - may encourage ovulation but no consistent evidence of benefit for androgenic symptoms or helping weight loss

Reproductive System (31 decks)

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