23 - 2y Amenorrhoea & Menopause Flashcards
define menopause?
woman’s last ever period
average age of menopause?
51 years
when does perimenopause occur?
~ 5 years before
define premature menopause?
40 years or less
describe 2 things which happen in menopause?
ovarian insufficiency - oestradiol falls
FSH rises
what happens to FSH levels in perimenopause?
they fluctuate
describe 3 scenarios when menopausal transition may be sudden?
following -
oophorectomy
chemotherapy
radiotherapy
describe 2 vasomotor symptoms of menopause and how long they last?
hot flushes & night sweats
usually last 2-5 yrs- but may be 10 years+
describe 5 other symptoms of menopause?
Vaginal dryness / soreness
Low libido
Muscle and joint aches
Mood changes
poor memory
what is a severe and hard to detect change which can occur with menopause?
osteoporosis
what is osteoporosis?
reduced bone mass -
DEXA scan shows bone density described as T score
what is a possible result of osteoporosis?
fractured hip / vertebra
give 4 RFs for developing osteoporosis?
thin
caucasian
smoking
high EtOH
give 4 ways to prevent and treat osteoporosis?
wt bearing exercise
adequate calcium & Vit D
HRT
calcitonin
give 3 examples of local vaginal HRT?
oestrogen pessary/ring/cream
how long does local HRT need to be used to be effective?
longterm
what is a benefit of systemic oestrogen transdermal/ oral HRT?
less risk of Venous thromboembolism
when should combined oestorgen and progesterone HRT be used?
if there may still be some ovary function to avoid irregular bleeding
3 contraindications for systemic HRT?
Current Hormone dependent cancer breast/endometrium
Current active liver disease
Un-investigated abnormal bleeding
which lubricants should be used for vaginal dryness?
Non hormonal lubricants -
Replens or Pre sex ‘Sylk’
in terms of treating depression for those with menopause, which medications should NOT be used?
clonidine
SSRI SNRI
give 3 benefits for using HRT?
control vasomotor symptoms
local genital symptoms controlled
reduces risk of osteoporosis
3 risks with using HRT?
breast Ca if combined HRT
ovarian Ca
venous thrombosis if oral route
association with HRT and risks of CVS?
no increase of CVS risks if HRT is started before 60 years
if HRT is being used to control night-sweats and hot flushes, how often should it be reviewed?
annually
what is the first line for osteoporosis prevention?
bisphosphonates
what is first line for vaginal symptoms?
vaginal oestrogen
what is andropause?
condition characterised by Testosterone falling by 1% a year after 30 yrs
what, other than testosterone, falls with andropause?
DHEAS
andropause’s effect on fertility?
fertility remains
define 1y amenorrhoea?
never had a period
define 2y amenorrhoea?
has had periods in past but none for 6 months
give 5 causes of 2y amenorrhoea?
Pregnancy / Breast feeding
Premature ovarian insufficiency
PCOS
contraception-related
Asherman’s syndrome
give 7 endocrine causes for 2y amenorrhoea?
Thyroid disease
Cushing’s syndrome
raised Prolactin (prolactinoma)
hypothalamic causes (stress)
androgen secreting tumour
Sheehan’s Syndrome (pituitary failure)
congenital adrenal hyperplasia
7 components of examination for 2y amenorrhoea?
BP
BMI
enlarged clitoris
deep voice
acne
hisutism
Cushingoid
4 tests for 2y amenorrhoea?
urine pregnancy test
dipstick for GLC
bloods
pelvic ultrasound
name 7 things the FBC will be measuring?
FSH
oestadiol (to rule out menopause)
prolactin
thryroid function
testosterone
17 hydroxy progesterone
3 treatments for 2y amenorrhoea?
treat specific cause
aim for BMI >20 and <30 for ovulation
emotional support
what should be offered as treatment if found to have premature ovarian insufficiency?
HRT until turn 50 years old
how to diagnose PCOS?
need 2/3 of the following -
oligo/amenorrhoea
androgenic symptoms: excess hair/acne
Polycystic ovarian morphology on scan
risks associated with PCOS?
diabetes and cardiovascular disease regardless of BMI and body shape
Does PCOS cause weight gain/ pain?
No - but weight gain can worsen PCOS
treatment for PCOS?
weight loss & exercise - BMI of 20-25
antiandrogen combined hormonal contrception - spironolactone
alfornithine cream to reduce facial hair
support and information - e.g. support group
role of metformin for PCOS patients?
encourages ovulation but no consistent evidence of benefit for androgenic symptoms or helping weight loss
