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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
what investigations are ordered for the women if over 45
No investigations required. If women has symptoms of menopause it is a clinical diagnosis
26
what are symptoms of peri-menopause justifying clinical diagnosis
Hot flushes | Irregular cycles
27
what are symptoms of menopause justifying clinical diagnosis
Amenorrhoea 12m
28
when should FSH be used to determine if a women is in menopause
<45-years and symptoms menopause
29
how will FSH present in menopause
Very High
30
What lifestyle factors can be used to treat hot flushes
Sleep hygiene Exercise Reduce Stress
31
What lifestyle factors can be used to decrease insomnia
Sleep hygiene | Avoid exercise before bed
32
What lifestyle factors are used to address mood in menopause
Sleep Exercise Relaxation
33
What lifestyle factors are used to improve cognition in menopause
Sleep hygiene | Exercise
34
What hormonal pharmacological treatments may be given for menopause
HRT
35
What non-hormonal pharmacological treatment is given for vasomotor symptoms
Fluoxetine Citalopram Venlafaxine
36
What non-hormonal pharmacological treatment is given for vaginal dryness/ urogenital atrophy
Topical oestrogen
37
What non-hormonal pharmacological treatment is given for psychological symptoms
CBT | Anti-depressants
38
What type of HRT should be given if a women has a uterus
Oestrogen and Progesterone
39
What type of HRT should be given if a women has a no uterus
Oestrogen
40
What is the problem with oral HRT and VTE
Oral HRT increases risk VTE
41
Explain relationship between transdermal HRT and VTE
transdermal HRT has no increased risk of VTE
42
What should be given to women already at risk of VTE
transdermal HRT
43
Explain relationship between CVD and HRT
HRT does not increase risk of CVD if given to women under-60
44
Explain relationship between HRT and stroke
Oral, not transdermal, increases risk of stroke
45
Explain relationship between HRT and breast cancer
- Oestrogen and progesterone HRT increases risk of breast cancer - Oestrogen alone HRT does not increase risk of breast cancer
46
Explain relationship between HRT and osteoporosis
HRT decreases risk of fragility fractures
47
If LMP is before 50 how long should contraception be continued for
2-years
48
If LMP is after 50 how long should contraception be continued for
1-year
49
What HRT should women with a uterus be given and why
Oestrogen and Progesterone. | As unopposed oestrogen is a major RF for endometrial cancer.
50
What HRT can women without a uterus be given
Oestrogen alone
51
If a women is still having periods or within 12-months of having had LMP, what type of HRT is she given
Cyclical progesterone and oestrogen
52
What does continous combined HRT usually contain
Oestrogen: oral, transdermal or vaginal Progesterone: oral, transdermal or coil
53
What are 5 contraindications to HRT
1. Previous PE 2. Current or previous breast cancer 3. Oestrogen-responsive breast cancer 4. Unexplained PV bleed 5. Untreated endometrial hyperplasia
54
What are side effects of HRT
``` Bloating N+V Headaches Breast tenderness Mood swing s FLUID RETENTION Acne ```
55
What are 3 things to monitor in HRT
Weight BP Breast screening
56
At what BP should HRT be stopped
>160/100
57
What are 5 benefits of HRT
- Improve QOL - Reduce night-sweats - Reduce vaginal atrophy - Reduce risk colorectal cancer - Reduce risk osteoporosis
58
What are 4 risks of HRT
- VTE - Brest cancer - Endometrial cancer - Increases risk gallbladder disease
59
Explain risk of breast cancer in HRT
Combined HRT - increases risk breast cancer | Oestrogen alone does not
60
Explain risk of endometrial cancer in HRT
Unopposed oestrogen increases risk endometrial cancer - persists for 5-years
61
Explain risk of VTE with HRT
Increased risk with oral HRT
62
What 3 conditions are NICE unsure about effect of HRT on
Ovarian cancer CVD Dementia
63
What are alternatives to HRT to treat hot flushes
Fluoxetine
64
What are alternatives to HRT to treat osteoporosis
Bisphosphonates, Vitamin D, Calcium
65
What are alternatives to HRT to treat vaginal dryness
Topical oestrogen
66
Define premature ovarian failure
onset of menopausal symptoms prior to age-40
67
What is the most common cause of premature ovarian failure
idiopathic
68
What are 3 primary causes of pre-mature ovarian failure
chromosomal abnormality FSH receptor polymorph autoimmune
69
What are 3 secondary causes of pre-mature ovarian failure
chemotherapy bilateral oophorectomy (surgical menopause) hysterectomy and oophorectomy
70
What is the most common feature of premature ovarian failure
- oligomenorrhoea or amenorrhoea - hot flushes - infertility
71
What age defines premature ovarian failure
<40
72
Explain diagnostic criteria for premature ovarian failure
< 40 with: - Menopausal symptoms at least including oligomenorrhoea - High FSH on two tests at least 4-6W apart
73
What is used to manage premature ovarian failure
HRT

Gynaecology (22 decks)

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