Chapter 29: Menopause And HRTs Flashcards
You are a trainee intern in a general practice reviewing Rangi, a 39 year old para 1 wahine Māori. She presented a week ago with secondary amenorrhoea after stopping the oral contraceptive pill nine months ago. Her history reveals that she has also been having hot flushes, and experiences vaginal dryness with sex. She has no surgical or medical history of note. Bloods requested last week showed a random FSH of 90 (N<9)? N premenopausal range <9 IU.L, and an oestradiol of 60 (early follicular N <200) mm/L. Rangi tells you that her 4 year old son has mild autism and intellectual impairment. She has been told that the underlying cause is “the commonest inherited cause of intellectual impairment” and this was confirmed on a blood test. She is awaiting an appointment for counselling. Which of the following options is the most likely cause of Rangi’s secondary amenorrhoea?
Autoimmune premature ovarian insufficiency
Primary hypothyroidism
Turner’s Syndrome (45XO)
Idiopathic premature ovarian insufficiency
Fragile X premutation
Trisomy X (47XXX)
Fragile X premutation
You are a trainee intern in a general practice and have been asked to see Rewa, a 52 year old para 4 wahine Māori who has menopausal symptoms. Rewa is troubled by increasing hot flushes and night sweats which now sometimes wake her from sleep. She reports low mood over the last 6 months and attributes this to “going through the change of life”. Her last period was 6 months ago and her cycle had become irregular in the previous year. She had a left mastectomy for breast cancer when she was 45. She is of normal weight and height. History and physical examination is otherwise unremarkable. Which of the following options would be the most appropriate choice of therapy?
Vaginal oestrogen
Transdermal oestrogen and oral Provera
A sleeping tablet
SSRI or SNRI e.g. Venlafaxine
Red clover
Gabapentin
Clonidine patch
SSRI or SNRI e.g. Venlafaxine
Hormones contraindicated - breast cancer
You are a trainee intern in a GP practice and have been asked to see Ngaire, a 52 year old Māori woman who wishes to discuss menopause management. Ngaire has had no periods for 18 months but has been experiencing hot flushes and night sweats for the last 2 years. She finds these symptoms particularly troubling and is looking for advice on how she can manage these symptoms. Which of the following options do you offer Ngaire?
A lab form to check oestradiol to see if she is low on oestrogen
Prescribe sleeping tablets
A lab form to check FSH to see if she is menopausal
Advise her that the vasomotor symptoms can continue for several years after periods have stopped
Provide advice on pharmacological and non-pharmacological management options of menopausal symptoms
Provide advice on pharmacological and non-pharmacological management options of menopausal symptoms
Agnes, a 55 year old para 2 Pilipino woman presents to you in general practice concerned about a watery vaginal discharge and irritation. This is not associated with itch or odour. She is in a long term married monogamous relationship with a male partner and has no concerns re STIs. Her GP recently treated her presumptively for bacterial vaginosis which had no effect, and the subsequent High Vaginal Swab result was normal. She consents for an examination which shows atrophic vaginitis and is otherwise normal. Which of the following is your most likely treatment suggestion?
Vaginal oestrogen long term
Vaginal oestrogen for 6 months
Oral oestrogen and Provera
Treatment for vaginal thrush
Transdermal oestrogen and oral Provera
Vaginal oestrogen long term
If stopped symptoms will return
You are a trainee intern in general practice with Helen, a 48-year-old para 2 Pākehā woman who has presented with hot flushes and night sweats. She is having difficulty coping with her job and her family. Prior to referral she had tried some herbs and dietary supplements without any noticeable benefit. She had a laparoscopic hysterectomy 5 years ago for menorrhagia and the histology was benign. Examination is normal, including blood pressure, breast and pelvic examination. Which of the following is the most likely hormonal treatment recommended to Helen?
Oral therapy with continuous daily synthetic progestogen
Transdermal oestrogen therapy
Vaginal oestradiol cream twice weekly
Oral therapy with daily continuous synthetic progestogen and sequential oestradiol
Oral therapy with daily continuous oestradiol and sequential synthetic progestogen
Transdermal oestrogen therapy
Doesnt need progesterone as no uterus.
Pania, a 65 year old para 2 wahine Māori presents to her GP concerned about recurrent bacterial vaginosis (BV). This has been a problem since she went through menopause about 10 years ago. She has been treated with metronidazole several times after BV was confirmed on a HVS. She has not been sexually active since her husband died four years ago. Your examination shows atrophic vaginitis. Which of the following is the most useful pharmacological treatment to help prevent her recurrence of BV?
Oral oestrogen therapy
Oral amoxycillin therapy
Vaginal oestrogen therapy
Menopausal Hormone Therapy with oestrogen and progesterone
Lactic acid pessaries
Stat dose of oral metronidazole
Vaginal oestrogen therapy
low estrogen –> low glycogen –> deficient in lactic acid
You are a trainee intern in general practice with Lesley, a 47 year old para 2 Pākehā woman who has come to see you to discuss painful sexual intercourse. This has been a problem for the last four months and she thinks it is due to vaginal dryness. She has also not had her period for the last 4 months. In the year prior to her last period, her periods were infrequent. Lesley is not on any medications. Which of the following is the most likely cause of her symptoms?
Pregnancy
Peri-menopause
Bacterial vaginosis
Pituitary adenoma
PCOS
Vaginal thrush
Peri-menopause
You are a trainee intern in general practice seeing Katherine, a 45 year old para 2 Irish woman who presents with 18 months of amenorrhoea. Prior to that her periods were infrequent. She has no hot flushes, night sweats or vaginal atrophy symptoms. Katherine is concerned as her mother went through menopause at age 42 and had significant osteoporosis with back fractures in her 60s and then died after a hip fracture at age 70. She has had a tubal sterilisation, but no other medical history of note (need to consider contraception otherwise as > 2 years postmenopause and age <50). Which of the following is your most likely treatment advice?
Combined oral contraceptive therapy
Transdermal oestrogen therapy
Oral calcium therapy
Continuous progestogen therapy
Oral oestrogen therapy
Hormone therapy with continuous oestrogen and sequential progestogen
Hormone therapy with continuous oestrogen and continuous progestogen
A bisphosphonate
Hormone therapy with continuous oestrogen and continuous progestogen
You are a trainee intern in general practice seeing Grace, a 40 year old, para 2, Pākehā woman who has premature ovarian insufficiency (POI). The POI was confirmed by blood tests when she became amenorrhoeic. Grace has hot flushes that are interfering with her sleep and some depression and moodiness. Her mother also had a premature menopause and had no therapy, but within 10 years suffered with osteoporotic back fractures (which Grace wishes to avoid), and died of a heart attack when aged 60 yrs. You arrange a bone density scan which shows mild osteopenia. Which of the following is the most important investigation you arrange before starting hormone replacement therapy?
Ultrasound scan for endometrial thickness
Lipids
Cervical smear
Vaginal swabs
Pipelle endometrial biopsy
Lipids
Assess cvs risk before HRT
You are a trainee intern in a general practice and are seeing Sarojini, a 56 year old Asian woman who is having severe hot flushes and night sweats that impact significantly on her sleep. You saw her two days ago for clinical assessment and noted her last period was 3 years ago. Sarojini then described herself as an emotional wreck and this combined with lack of sleep was affecting her ability to work and impacting on her relationship with her husband. She is feeling desperate and wants something “that actually works”. Sarojini is para 2. Her smears and mammograms are up to date and normal. You arrange investigations to consider her cardiovascular risk prior to starting any treatment. When calculating her cardiovascular risk using systolic blood pressure, diabetes and smoking status, and HDL risk ratio, you determined that she has a moderate (10-15%) 5 year cardiovascular risk. Which of the following is the most appropriate treatment to recommend?
Oral oestrogen only
Transdermal oestrogen (patch) and oral progestogen
Clonidine patches
Oral continuous oestrogen and progestogen
Venlafaxine
Acupuncture
Transdermal oestrogen (patch) only
Transdermal oestrogen (patch) and oral progestogen
Transdermal estrogen doesnt increase cvs risk like oral does.
