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Reproductive > 2ndary Amenorrhea + Menopause > Flashcards

2ndary Amenorrhea + Menopause Flashcards

1
Q

What is menopause? What is the average age of menopause?

A
  • Last ever period
  • 51
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2
Q

What is perimenopause?

A

Menopausal symptoms for approx 5 years before

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3
Q

What causes menopause?

A
  • Ovarian insufficiency
    • oestrodial falls
    • FSH rises
    • still some oestrodial from peripheral conversion of adrenal androgens into fat
  • Menopause may be natural or follow suddenly post surgery
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4
Q

What are the symptoms of menopause?

A
  • [itchy, bitchy, sweaty, sleepy, bloated, forgetful, psycho]
  • Vasomotor symptoms ‘hot flushes’, 80% women 45% find them a problem, usually last 2-5 yrs- may be 10 years+
  • Vaginal soreness/dryness
  • Low libido
  • Muscle/joint aches
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5
Q

What are unoticeable changes (silent changes) that occur post menopause? Risks of these changes?

A
  • Reduced bone mass, DEXA scan and T score
  • Fractured hip/vertebra: 1% of women 50-69
  • Above has high risks of morbidity + mortality
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6
Q

RF for silent changes in menopause?

A
  • thin/caucasian/smokers/EtOH/+ve FH/ amenorrhoea/malabsorption/steroids/hyperthyroid
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7
Q

How can we treat and prevent these silent changes?

A
  • Exercise
  • Adequate calcium and Vit D
  • HRT
  • Bisphosphonates
  • Denosumab -monoclonal antibody to osteoclasts,teriparatide
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8
Q

How can we treat the symptoms of menopause?

Locally?

Systemically?

A

Hormone replacement therapy:

  • Local: vaginal oestrogen pessary/ring/cream
  • Systemic: transdermal, oral [transdermal reduces risk of VTE]
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9
Q

When do we give only oestrogen versus oestrogen + progesterone?

A
  • Oestrogen only if no uterus
  • Oestrogen and progesterone if uterus present
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10
Q

What are the contraindications to HRT?

A
  • Currently have a hormone dependent cancer: breast/endometrium
  • Currently have active liver disease
  • Univestigated abnormal bleeding
  • Seek advice if previous VTE
  • Seek advice if previous CA breast or BRCA carrier
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11
Q

What is the drug routine if there is still some ovary function?

A
  • Cyclical combined
  • 14 days E + 14 days E+P
  • will get a withdrawal bleed
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12
Q

What is the HRT routine for someone with no ovarian function >1yr or gone through menopause.

A
  • Continuous combined
  • 28 days E+P
  • bleed free after 3 months
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13
Q

Another treatment for menopause (not as commonly used)?

A
  • Selective Estrogen receptor Modulators (SERMs)
  • E effect on selected organs (eg tibolone )
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14
Q

What are the risks and benefits of HRT? Who is not effected?

A

Benefit

  • Vasomotor
  • Aids Local genital symptoms
  • Helps with osteoperosis

Risk

  • breast cancer if combined HRT
  • Ovarian cancer
  • Venous thrombosis if oral route

Not effected

  • Alzeimers
  • Not increase Cardiovascular risks if start before age 60 ie before atherosclerosis develops
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15
Q

Risk of breast cancer due to HRT?

A
  • 32/1000 50-65 no HRTC
  • Extra 8/1000 if 5yr combined HRT
  • Fewer 4 /1000 if 5yr E only HRT
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16
Q

What is the ovarian cancer risk due to HRT?

A
  • 2/1000 per 5 yrs age 50/59
  • extra 1/1000 if 5 yrs oral HRT
17
Q

Risk of VTE due to HRT?

A
  • 11/1000 50-69 no HRT
  • extra 13/1000 if 5yr oral HRT
  • no change if transdermal route
18
Q

Fracture femur risk due to HRT?

A
  • 10/1000 50-69 no HRT
  • 4/1000 fewer if 5 yr HRT
19
Q

Colon cancer risk due to HRT?

A
  • 11/1000 50-69 no HRT
  • 4/1000 fewer if 5 yr HRT
20
Q

What are some things to note about the risks of HRT in general?

A
  • Excess breast Ca Risk as for never users after 5years off HRT
21
Q

NICE guidance regarding HRT ?

A
  • If treating severe vasomotor symptoms need to review annually
  • For women with premature ovarian insufficiency HRT benefits outweigh risks till age 50
  • Not to be used as first line for osteoperosis prevention/treatment (biphosphates used instead)
  • Vaginal oestrogen for vaginal symptoms
22
Q

What is andropause?

A
  • Testosterone falls 1% a year after 30
  • DHEAS (male sex hormone) also falls
  • Fertility remains
  • Not a sudden change
  • (kinda like menopause for men but completely different as very gradual and rare to get symptoms)
23
Q

What are some causes of secondary amenorrhea?

A
  • Preggers
  • Contraception related (current use or for 6-9 months after depoprovera)
  • Early menopause
  • Polycystic ovaries
  • Thyroid disease
  • Raised prolactin
  • Hypothalamic stress
  • Androgen secreting tumour (testosteron > 5mg/l)
  • Sheehans syndrome - pituitary failure
24
Q

What can be found on examination with someone with seconary amenorrhea? What investigations do we do?

A
  • Enlarged clitoris
  • Deep voice
  • Hirsutism
  • Acne
  • Urine test, pregnancy test
  • Bloods, FSH, LH, oestrodial, prolactin, thyroid function, testosterone
25
Q

How do we treat secondary amenorrhea?

A
  • Treat the specific cause
  • Assume fertile and need contraception unless 2 yrs after confirmed menopause
  • If premature ovarian insufficiency offer HRT till 50
26
Q

How do people present with polycystic ovary syndrome?

A
  • acne
  • overweight or obesity
  • hypertension
  • scalp hair loss

Presence of risk factors:

  • Female or reproductive age
  • Irregular menstruation
  • Infertility
27
Q

What are the associated risks of polycystic ovary syndrome?

A
  • Higher risk of diabetes and CVS disease for any given BMI
  • Risk of endometrial hyperplasia if less than 4 periods per year
28
Q

What are the features seen in the ovaries in PCO?

A
  • Small peripheral ovarian cysts x 10/ovary or ovarian volume>12cm3
  • NB 20% women have this on scan but no other features ie not pco syndrome
  • NB Multicystic ovaries common in adolescents- no implications
29
Q

What is management of Polycystic ovary disease?

A

If currently infertile and desiring fertility

  1. line: weight loss
  2. line: metformin

or

  1. line: clomifene
  2. line: metformin

If currently infertile but not seeking fertility

  1. line: Oral contraceptive pill
  2. line: metformin

or

  1. line: anti-androgen therapy
  2. line: metformin

Reproductive (34 decks)

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