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Gynaecology > 1: Climateric and Menopause > Flashcards

1: Climateric and Menopause Flashcards

1
Q

Define menopause

A

End of women’s reproductive life, defined as 12-months of amenorrhoea with no underlying physiological or pathological cause

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2
Q

Define climacteric

A

phase encompassing transition from reproductive to non-reproductive state

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3
Q

Explain relationship between menopause and climacteric

A

menopause occurs in the climacteric

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4
Q

What is the peri-menopause

A

period from first onset of clinical, biological and endocrinological symptoms of the menopause and ends 12 months later

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5
Q

Define pre-menopause

A

1-2y pre-menopause

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6
Q

What is post-menopause

A

period following final menstrual period

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7
Q

when does perimenopause usually start

A

45

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8
Q

what is the average age of menopause

A

51

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9
Q

Explain symptoms menopause involving following

a. periods
b. vasomotor
c. urogenital
d. psychological

A

a. Irregular cycle length, Dysfunctional uterine bleeding
b. Hot flushes, Night sweats
c. UTI, Urinary incontinence, Frequency
d. Depression, Anxiety, Short-term memory impairment

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10
Q

what are the 2 long-term complications of menopause

A

Increase osteoporosis

IHD

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11
Q

what % of menopausal women experience hot-flushes

A

75

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12
Q

what cause hot flushes

A

Pulsatile LH release

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13
Q

what genital changes are associated with menopause

A

Vaginal atrophy

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14
Q

why does vaginal atrophy occur

A

Decrease in oestrogen causes thinning vagina and myometrium

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15
Q

what are the two urological symptoms of menopause

A

Increase UTI

Urinary incontinence

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16
Q

why does urinary incontinence occur

A

Trigone is derived from same embryological tissue as genitals and therefore also sensitive to oestrogen

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17
Q

why does osteoporosis occur in menopause

A

Oestrogen normally inhibits osteoclast activity.

Drop in oestrogen, causes increase in osteoclast activity and bone reabsorption

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18
Q

why does menopause increase risk of IHD

A

Oestrogen normally maintains HDLs as high and LDLs as low. Loss of oestrogen, reduces this effect

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19
Q

describe levels of oestrogen during menopause

A

low levels of oestrogen

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20
Q

why is oestrogen low during the menopause

A
  • Less follicles for LH and FSH to bind to

- Remaining follicles are less sensitive to LH and FSH

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21
Q

explain LH levels in menopause

A

High.

Due to less oestrogen removing negative feedback on HPA axis, increasing LH

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22
Q

explain FSH levels in menopause

A

Very High.

Less oestrogen removing negative feedback
Less inhibin produced by granuloma cells

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23
Q

outline hormonal changes in menopause

A
  • Low E2
  • High LH
  • High FSH
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24
Q

why may irregular bleeding happen in the menopause

A

Anovulatory cycles: E2 produced by follicles causes proliferation of endometrium. As there is no dominant follicle, no corpus luteum forms and no progesterone is released. Therefore secretory endometrium is not maintained - this results in breakdown of endometrium.

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25
Q

what investigations are ordered for the women if over 45

A

No investigations required. If women has symptoms of menopause it is a clinical diagnosis

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26
Q

what are symptoms of peri-menopause justifying clinical diagnosis

A

Hot flushes

Irregular cycles

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27
Q

what are symptoms of menopause justifying clinical diagnosis

A

Amenorrhoea 12m

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28
Q

when should FSH be used to determine if a women is in menopause

A

<45-years and symptoms menopause

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29
Q

how will FSH present in menopause

A

Very High

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30
Q

What lifestyle factors can be used to treat hot flushes

A

Sleep hygiene
Exercise
Reduce Stress

31
Q

What lifestyle factors can be used to decrease insomnia

A

Sleep hygiene

Avoid exercise before bed

32
Q

What lifestyle factors are used to address mood in menopause

A

Sleep
Exercise
Relaxation

33
Q

What lifestyle factors are used to improve cognition in menopause

A

Sleep hygiene

Exercise

34
Q

What hormonal pharmacological treatments may be given for menopause

A

HRT

35
Q

What non-hormonal pharmacological treatment is given for vasomotor symptoms

A

Fluoxetine
Citalopram
Venlafaxine

36
Q

What non-hormonal pharmacological treatment is given for vaginal dryness/ urogenital atrophy

A

Topical oestrogen

37
Q

What non-hormonal pharmacological treatment is given for psychological symptoms

A

CBT

Anti-depressants

38
Q

What type of HRT should be given if a women has a uterus

A

Oestrogen and Progesterone

39
Q

What type of HRT should be given if a women has a no uterus

A

Oestrogen

40
Q

What is the problem with oral HRT and VTE

A

Oral HRT increases risk VTE

41
Q

Explain relationship between transdermal HRT and VTE

A

transdermal HRT has no increased risk of VTE

42
Q

What should be given to women already at risk of VTE

A

transdermal HRT

43
Q

Explain relationship between CVD and HRT

A

HRT does not increase risk of CVD if given to women under-60

44
Q

Explain relationship between HRT and stroke

A

Oral, not transdermal, increases risk of stroke

45
Q

Explain relationship between HRT and breast cancer

A
  • Oestrogen and progesterone HRT increases risk of breast cancer
  • Oestrogen alone HRT does not increase risk of breast cancer
46
Q

Explain relationship between HRT and osteoporosis

A

HRT decreases risk of fragility fractures

47
Q

If LMP is before 50 how long should contraception be continued for

A

2-years

48
Q

If LMP is after 50 how long should contraception be continued for

A

1-year

49
Q

What HRT should women with a uterus be given and why

A

Oestrogen and Progesterone.

As unopposed oestrogen is a major RF for endometrial cancer.

50
Q

What HRT can women without a uterus be given

A

Oestrogen alone

51
Q

If a women is still having periods or within 12-months of having had LMP, what type of HRT is she given

A

Cyclical progesterone and oestrogen

52
Q

What does continous combined HRT usually contain

A

Oestrogen: oral, transdermal or vaginal
Progesterone: oral, transdermal or coil

53
Q

What are 5 contraindications to HRT

A
  1. Previous PE
  2. Current or previous breast cancer
  3. Oestrogen-responsive breast cancer
  4. Unexplained PV bleed
  5. Untreated endometrial hyperplasia
54
Q

What are side effects of HRT

A 
Bloating 
N+V
Headaches
Breast tenderness 
Mood swing s
FLUID RETENTION 
Acne
55
Q

What are 3 things to monitor in HRT

A

Weight
BP
Breast screening

56
Q

At what BP should HRT be stopped

A

> 160/100

57
Q

What are 5 benefits of HRT

A
  • Improve QOL
  • Reduce night-sweats
  • Reduce vaginal atrophy
  • Reduce risk colorectal cancer
  • Reduce risk osteoporosis
58
Q

What are 4 risks of HRT

A
  • VTE
  • Brest cancer
  • Endometrial cancer
  • Increases risk gallbladder disease
59
Q

Explain risk of breast cancer in HRT

A

Combined HRT - increases risk breast cancer

Oestrogen alone does not

60
Q

Explain risk of endometrial cancer in HRT

A

Unopposed oestrogen increases risk endometrial cancer - persists for 5-years

61
Q

Explain risk of VTE with HRT

A

Increased risk with oral HRT

62
Q

What 3 conditions are NICE unsure about effect of HRT on

A

Ovarian cancer
CVD
Dementia

63
Q

What are alternatives to HRT to treat hot flushes

A

Fluoxetine

64
Q

What are alternatives to HRT to treat osteoporosis

A

Bisphosphonates, Vitamin D, Calcium

65
Q

What are alternatives to HRT to treat vaginal dryness

A

Topical oestrogen

66
Q

Define premature ovarian failure

A

onset of menopausal symptoms prior to age-40

67
Q

What is the most common cause of premature ovarian failure

A

idiopathic

68
Q

What are 3 primary causes of pre-mature ovarian failure

A

chromosomal abnormality
FSH receptor polymorph
autoimmune

69
Q

What are 3 secondary causes of pre-mature ovarian failure

A

chemotherapy
bilateral oophorectomy (surgical menopause)
hysterectomy and oophorectomy

70
Q

What is the most common feature of premature ovarian failure

A
  • oligomenorrhoea or amenorrhoea
  • hot flushes
  • infertility
71
Q

What age defines premature ovarian failure

A

<40

72
Q

Explain diagnostic criteria for premature ovarian failure

A

< 40 with:
- Menopausal symptoms at least including
oligomenorrhoea
- High FSH on two tests at least 4-6W apart

73
Q

What is used to manage premature ovarian failure

A

HRT

Gynaecology (22 decks)

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