12. Menopause and Secondary Amenorrhoea Flashcards
What does Menopause mean?
Last Ever Period
When does Menopause occur?
51 Years Old - Average Age
May be Natural or follow Oophorectomy / Chemotherapy / Radiotherapy
When does Perimenoapuse occur?
For Approximately 5 years before Menopause
When would Premature Menopause occur?
40 years old or younger
Why does Menopause occur?
Ovarian Failure:
1. Oestradiol Falls
2. Follicular Stimulating Hormone Rises
3. Still some Oestriol from Peripheral Conversion of Adrenal Androgens in Fat
Note - 3. is why Obese Women are likely to produce more Oestrogen and get Cancer
What are the Symptoms of Menopause?
- Vasomotor Symptoms - Hot Flushes
- Vaginal Dryness / Soreness
- Low Libido
- Muscle and Joint Aches
- Mood Changes / Poor Memory
What condition can occur during Menopause?
Osteoporosis (Reduced Bone Mass) - Menopause Silent Change
Who is more at Risk of developing Osteoporosis after Menopause?
- Thin
- Caucasian / Positive Family History
- Smokers / Alcohol
- Ammenorrhoea
- Malabsorption
- Steroids
- Hyperthyroid
What is the Prevention and Treatment of Osteoporosis after Menopause?
- Weight Bearing Exercise
- Adequate Calcium and Vitamin D
- Hormone Replacement Therapy
- Bisphosphonates
What are the methods of Delivery of Hormone Replacement Therapy (Menopaus-Symptoms Treatment)?
- Local - Vaginal Oestrogen Pessary / Ring / Cream
- Systemic - Transdermal / Oral Oestrogen + Progestogen
Note - Oestrogen only is given in 2. if no Uterus is present
What is the treatment Regimen of the Combined Oestrogen and Progestogen Hormone Replacement Therapy?
- Cyclical Combined
- a) 14 Days Oestrogen
- ) 14 Days Oestrogen and Progestogen
- Continuous Combined - 28 Days Oestrogen and Progestogen
When is Cyclical Combined Oestrogen and Progestogen Hormone Replacement Therapy used?
Perimenopause - If there is still some Ovulatory Function
Note - Get a Withdrawal Bleed
When is Combined Continuous Oestrogen and Progestogen Hormone Replacement Therapy used?
If > 1 year after Menopause
Other Than Oestrogen and Progestogen Hormone Replacement Therapy, what Menopause-Symptom Treatments are there?
- Selective Oestrogen Receptor Modulators - Oestrogen effect on Selected Organs
- SSRI’s / SNRI’s - Antidepressants
- Natural Methods - Phytooestrogen / Herbs / Exercise
- Non-Hormonal Lubricants
What are the Benefits of Hormone Replacement Therapy?
Preventative against:
- Vasomotor
- Local Genital Symptoms
- Osteoporosis
- Colon Cancer
What are the Risks of Hormone Replacement Therapy?
- Breast Cancer - if combined HRT
- Ovarian Cancer
- Venous Thrombosis - Oral
What is Andropause?
- Testosterone (and Dehydroepiandrosterone) falling by 1% per year after 30
- Fertility Remains and there is no sudden change
What is Primary Amenorrhoea?
Never had a Period
Note - Affects 5% of girls
What is Secondary Amenorrhoea?
Has had Period in the Past but none for 6 months
What are the Causes of Secondary Amenorrhoea?
- Pregnancy / Breastfeeding
- Contraception Related
- Polycystic Ovaries
- Early Menopause
- Thyroid / Cushings / Any Significant Disease
- Raised Prolactin
- Hypothalamic - Stress / Weight Change / Exercise
- Androgen Secreting Tumour
- Sheehans Syndrome - Pituitary Failure
- Ashermans Syndrome - intrauterine Adhesion
What are the Examinations for Secondary Amenorrhoea?
- Blood Pressure
- BMI
- Hirsutism / Acne
- Cushingoid
- Enlarged Clitoris / Deep Voice (Virilised)
- Abdominal / Bimanual Examination
What Investigations are done for Secondary Amenorrhoea?
- Urine Pregnancy Test + Dipstick for Glucose
- Bloods - FSH / LH / Oestradiol / Prolactin / Thyroid Function / Testosterone
- Pelvic Ultrasound
What is the Treatment of Secondary Amenorrhoea?
- Treat Specific Cause
- BMI between 20-25
- HRT - if premature Menopause
What is the Presentation Spectrum of Polycystic Ovary Syndrome?
- Oligo / Amenorrhoea
- Androgenic Symptoms - Excess Hair / Acne
- Anovulatory Infertility
- Higher risk of Diabetes and CVS Disease
- Risk of Endometrial Hyperplasia (<4 periods per year)
Note - PCO does not cause weight gain or pain
What happens in Polycystic Overies?
- Small Peripheral Ovarian Cysts x 10
2. Ovary / Ovarian Volume > 12cm3
What is Polycystic Ovary Syndrome?
- Irregular Ovulation / Cycle
- Plenty of Oestrogen but also high Androgens
- Underlying Insulin Resistance
- Not a cause of Pelvic Pain / Weight Gain
How is Polycystic Ovary Syndrome managed?
- Weight Loss / Exercise
- Antiandrogen - Combined Hormonal Contraceptive / Spironolactone
- Endometrial Protection - CHC / Progestogens / Mirena
- Fertility Treatment - Clomiphene / Metformin (Helps ovulation)
