Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health > T2 L7 Menopause and HRT > Flashcards

T2 L7 Menopause and HRT Flashcards

1
Q

What is menopause?

A

Permanent cessation of menses (no periods) following loss of ovarian activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What proportion of the average female lifespan is spent in menopause?

A

About 1/3 - 1/2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is happening to the gap between the age of menopause and the average life expectancy?

A

The gap is getting wider

More women are living for many years post-menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is perimenopuase?

A

Transition from reproductive cycles to post menopause

Few ova remain – less responsive to hormones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

At what age does perimenopuase usually start?

A

45-50 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the mean duration of perimenopause?

A

3.8 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which symptoms occur during perimenopause?

A

Irregular menstrual cycles

Occasional heavy bleeding

Hot flushes

Nervousness, irritability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

List the primary symptoms of menopause

A

Menstrual cycle changes
-oligomenorrhea, amenorrhea

Vasomotor symptoms (this may be burdensome to most women)
   -hot flushes, night sweats

Vaginal dryness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

List the secondary symptoms of menopause

A
  • Urinary stress/urge incontinence
  • Cystitis-like symptoms
  • Depression/irritability changes
  • Musculoskeletal pains (joint aches & osteoporosis- this can be an issue in women who have menopause early)
  • Dry skin, hair thinning, nail changes
  • Decreased concentration
  • Decreased libido
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How many women were included in the British Prospective Cohort study?

A

695 women followed up from birth (1946)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Name the 4 menopausal symptoms groups identified in the British Prospective Cohort study?

A

Psychological (severe in 10% of women)

Somatic

Vasomotor

Sexual discomfort

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What % of women in the British Prospective Cohort study had “early severe” vasomotor symptoms?

A

14%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What % of women in the British Prospective Cohort study had “late severe” vasomotor symptoms?

A

11%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Which subgroup of women had less severe vasomotor symptoms in the British Prospective Cohort study?

A

Women of higher social class and better educational qualifications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Name the two hormones involved in Hormone Replacement Therapy (HRT). What are they required for?

A

Oestrogen required for symptoms

Progestogens required to prevent endometrial cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

COMPLETE THE SENTENCE

Women that have undergone a _____________ do not need progestagens

A

HYSTERECTOMY

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the alternative drugs (to HRT) that can be used to treat osteoporosis?

A

Biphosphonates

Alendronate

Risedronate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the alternative drugs (to HRT) that can be used to reduce vasomotor symptoms?

A

Progesterone

SERMs (Selective estrogen receptor modulators) – Raloxifene

Beta-blocker

Clonidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

List the other forms of alternative treatement/drugs (to HRT) used to treat menopausal symptoms

A

-Phyto-oestrogens (soya bean)

-Herbalism
   Black Cohost
   St John’s Wort
   Gingseng
   Oil of Evening Primrose
  • Progesterone Cream
  • Homeopathy
  • Acupunture
  • Reflexology
20
Q

What choices do patients have regarding their HRT?

A

Choice of route

Choice of dose and type of drug

Choice of regimen

21
Q

What are the different routes used to administer HRT drugs?

A
  • Oral
  • Patches
  • Implants
  • Vaginal rings
  • Transdermal gel
  • Nasal
22
Q

How is HRT given?

A

1) Continous oestrogen - there is no tablet break and no bleeding due to lack of uterus
2) Continuous sequential HRT - oestrogen is given continuously but progestogen is given at day 14. There is regular bleeding at the end of the cycle
3) Continuous combined HRT - combined therapy without a tablet break. There is no bleeding at the end of the cycle

23
Q

Why is Continuous Combined HRT (CC HRT) preferred for older women?

A

Older women have an increased risk of endometrial neoplasia

REMEMBER: Progestogens prevent endometrial cancers

24
Q

What does of oestradiol is given in Continuous oestrogen (HRT)?

A

1 mg

Taken continuously as symptoms would return if not taking the oestrogen

25
Q

Is the dose of oestradiol given in Continuous oestrogen enough to act as a contraception?

A

NO

26
Q

Name the absolute contraindications to HRT

A
  • Pregnancy
  • Active venous thromboembolism
  • Severe active liver disease
  • Endometrial carcinoma with recurrence
  • Breast carcinoma with recurrence
27
Q

BONUS: Why is a breast cancer with recurrence a contraindication to HRT?

A

About 70% of breast cancers are oestrogen-receptor positive

Giving oestrogen “stimulates” this cancer type, causing it to grow

28
Q

Name the relative contraindications to HRT

A
  • Abnormal bleeding
  • Breast lump (prior to investigation)
  • Previous endometrial cancer
  • Previous breast cancer
  • Strong family history breast cancer
  • Family history of thromboembolism
29
Q

List the side effects of HRT

A
  • Tender or painful breasts
  • Fluid retention causing bloating and weight gain
  • Nausea
  • Headaches
  • Leg cramps
  • Mood swings/Low mood
  • Acne
  • Backache
  • Lower abdominal ache
  • Bleeding
  • Stomach upset (indigestion)
30
Q

What are the short term benefits of HRT?

A

Reduces vasomotor symptoms (eg hot flushes)

Improves psychological symptoms (eg mood swings)

31
Q

What are the long term benefits of HRT?

A
  • Maintains bone mass and reduces the risk of fracture
  • Reduces urogenital problems (eg dry vagina)
  • Improves skin (cosmetic)
  • Reduces the risk of bowel cancer
  • May improve balance and reduce falls – less fractures
  • May reduce tooth loss
  • May protect against arthritis
32
Q

What are the risks associated with HRT?

A

Endometrial Cancer (if unopposed oestrogen used)

Breast Cancer

Cardiovascular disease (stroke and MI)

Venous thrombo-embolic disease (VTE)

33
Q

Under which age is endometrial cancer rare?

A

45 years

34
Q

What is the most common presentation of endometrial cancers?

A

Post menopausal bleeding

35
Q

Which investigation is used to determined endometrial cancer?

A

Trans vaginal USS

Measure the endometrial thickness (>5mm)

36
Q

What procedure is used to diagnose endometrial cancer?

A

Endometrial sample/biopsy

37
Q

What is the treatment for endometrial cancer?

A

Hysterectomy and oophorectomy

Possible radiotherapy

38
Q

What are the risk factors for endometrial cancer?

A
  • Obesity (endogenous oestrogens)
  • Unopposed HRT (oestrogens without progestagens)
  • Nulliparity
  • Late menopause
  • Diabetes
  • Family history of breast, colon and ovary Ca (genetic)
  • Tamoxifen
39
Q

What are the characteristics of COCP?

A
  • Ethinyl oestradiol (not natural)
  • Massive first pass metabolism by the liver
  • Increased clotting factors
  • High dose oestrogen suppressing GnRH/ FSH/LH
  • Stops ovulation
  • Progestagen given to prevent hyperplasia of endometrium not really to add to contraception
40
Q

What are the characteristics of HRT?

A
  • Oestradiol (natural)
  • Lower dose to the body
  • Some increased clotting factors
  • Doesn’t suppress the FSH and LH to the same degree as the COCP
  • Doesn’t stop ovulation
  • Progestagen given to prevent hyperplasia of endometrium
41
Q

What was the overall aim of the Women Health Initiative (WHI) study?

A

Assess the overall balance of HRT risk and benefits

via a mix of population studies and RCT (randomised controlled trial)

42
Q

Who funded the WHI study?

A

Funded by the US government (with Pharma support) to resolve the HRT risk/benefit issue

$800 million budget

43
Q

When was the WHI study launched? How long did it last?

A

Launched in 1991

Lasted 15 years

44
Q

What was the population sample for the WHI study?

A

161,808 generally healthy postmenopausal women

45
Q

What other factors did the WHI study examine?

A

Studied effects of dietary fat, vit D, calcium

46
Q

What were the main outcome measures of the WHI study?

A

Coronary heart disease (CHD)

Invasive breast cancer

Module 203, Theme 3- Gynaecological pathology, common gynaecological disorders and sexual health (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions