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3rd Year - Reproductive Diseases > 12. Menopause and Secondary Amenorrhoea > Flashcards

12. Menopause and Secondary Amenorrhoea Flashcards

1
Q

What does Menopause mean?

A

Last Ever Period

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2
Q

When does Menopause occur?

A

51 Years Old - Average Age

May be Natural or follow Oophorectomy / Chemotherapy / Radiotherapy

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3
Q

When does Perimenoapuse occur?

A

For Approximately 5 years before Menopause

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4
Q

When would Premature Menopause occur?

A

40 years old or younger

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5
Q

Why does Menopause occur?

A

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

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6
Q

What are the Symptoms of Menopause?

A
  1. Vasomotor Symptoms - Hot Flushes
  2. Vaginal Dryness / Soreness
  3. Low Libido
  4. Muscle and Joint Aches
  5. Mood Changes / Poor Memory
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7
Q

What condition can occur during Menopause?

A

Osteoporosis (Reduced Bone Mass) - Menopause Silent Change

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8
Q

Who is more at Risk of developing Osteoporosis after Menopause?

A
  1. Thin
  2. Caucasian / Positive Family History
  3. Smokers / Alcohol
  4. Ammenorrhoea
  5. Malabsorption
  6. Steroids
  7. Hyperthyroid
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9
Q

What is the Prevention and Treatment of Osteoporosis after Menopause?

A
  1. Weight Bearing Exercise
  2. Adequate Calcium and Vitamin D
  3. Hormone Replacement Therapy
  4. Bisphosphonates
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10
Q

What are the methods of Delivery of Hormone Replacement Therapy (Menopaus-Symptoms Treatment)?

A
  1. Local - Vaginal Oestrogen Pessary / Ring / Cream
  2. Systemic - Transdermal / Oral Oestrogen + Progestogen
    Note - Oestrogen only is given in 2. if no Uterus is present
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11
Q

What is the treatment Regimen of the Combined Oestrogen and Progestogen Hormone Replacement Therapy?

A
  1. Cyclical Combined
  2. a) 14 Days Oestrogen
  3. ) 14 Days Oestrogen and Progestogen
  4. Continuous Combined - 28 Days Oestrogen and Progestogen
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12
Q

When is Cyclical Combined Oestrogen and Progestogen Hormone Replacement Therapy used?

A

Perimenopause - If there is still some Ovulatory Function

Note - Get a Withdrawal Bleed

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13
Q

When is Combined Continuous Oestrogen and Progestogen Hormone Replacement Therapy used?

A

If > 1 year after Menopause

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14
Q

Other Than Oestrogen and Progestogen Hormone Replacement Therapy, what Menopause-Symptom Treatments are there?

A
  1. Selective Oestrogen Receptor Modulators - Oestrogen effect on Selected Organs
  2. SSRI’s / SNRI’s - Antidepressants
  3. Natural Methods - Phytooestrogen / Herbs / Exercise
  4. Non-Hormonal Lubricants
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15
Q

What are the Benefits of Hormone Replacement Therapy?

A

Preventative against:

  1. Vasomotor
  2. Local Genital Symptoms
  3. Osteoporosis
  4. Colon Cancer
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16
Q

What are the Risks of Hormone Replacement Therapy?

A
  1. Breast Cancer - if combined HRT
  2. Ovarian Cancer
  3. Venous Thrombosis - Oral
17
Q

What is Andropause?

A
  1. Testosterone (and Dehydroepiandrosterone) falling by 1% per year after 30
  2. Fertility Remains and there is no sudden change
18
Q

What is Primary Amenorrhoea?

A

Never had a Period

Note - Affects 5% of girls

19
Q

What is Secondary Amenorrhoea?

A

Has had Period in the Past but none for 6 months

20
Q

What are the Causes of Secondary Amenorrhoea?

A
  1. Pregnancy / Breastfeeding
  2. Contraception Related
  3. Polycystic Ovaries
  4. Early Menopause
  5. Thyroid / Cushings / Any Significant Disease
  6. Raised Prolactin
  7. Hypothalamic - Stress / Weight Change / Exercise
  8. Androgen Secreting Tumour
  9. Sheehans Syndrome - Pituitary Failure
  10. Ashermans Syndrome - intrauterine Adhesion
21
Q

What are the Examinations for Secondary Amenorrhoea?

A
  1. Blood Pressure
  2. BMI
  3. Hirsutism / Acne
  4. Cushingoid
  5. Enlarged Clitoris / Deep Voice (Virilised)
  6. Abdominal / Bimanual Examination
22
Q

What Investigations are done for Secondary Amenorrhoea?

A
  1. Urine Pregnancy Test + Dipstick for Glucose
  2. Bloods - FSH / LH / Oestradiol / Prolactin / Thyroid Function / Testosterone
  3. Pelvic Ultrasound
23
Q

What is the Treatment of Secondary Amenorrhoea?

A
  1. Treat Specific Cause
  2. BMI between 20-25
  3. HRT - if premature Menopause
24
Q

What is the Presentation Spectrum of Polycystic Ovary Syndrome?

A
  1. Oligo / Amenorrhoea
  2. Androgenic Symptoms - Excess Hair / Acne
  3. Anovulatory Infertility
  4. Higher risk of Diabetes and CVS Disease
  5. Risk of Endometrial Hyperplasia (<4 periods per year)
    Note - PCO does not cause weight gain or pain
25
Q

What happens in Polycystic Overies?

A
  1. Small Peripheral Ovarian Cysts x 10

2. Ovary / Ovarian Volume > 12cm3

26
Q

What is Polycystic Ovary Syndrome?

A
  1. Irregular Ovulation / Cycle
  2. Plenty of Oestrogen but also high Androgens
  3. Underlying Insulin Resistance
  4. Not a cause of Pelvic Pain / Weight Gain
27
Q

How is Polycystic Ovary Syndrome managed?

A
  1. Weight Loss / Exercise
  2. Antiandrogen - Combined Hormonal Contraceptive / Spironolactone
  3. Endometrial Protection - CHC / Progestogens / Mirena
  4. Fertility Treatment - Clomiphene / Metformin (Helps ovulation)

3rd Year - Reproductive Diseases (41 decks)

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