Climacteric, Menopause & Postmenopause Flashcards
contrast:
- menopause
- perimenopause
- menopause: 12 months amenorrhoea
- perimenopause: from time of symptom onset to 12months after last period (LMP)
Define post-menopausal bleeding:
-vaginal bleeding >12 months after LMP
Give 2 causes of post-menopausal bleeding:
- endometrial cancer
- cervical cancer
- premalignant endometrial hyperplasia
- atrophic vaginitis
- cervicitis, cervical polyps
- ovarian cancer
Investigation of woman presenting with post-menopausal bleeding:
- bimanual and speculum exam
- cervical smear if no recent screening
- TVUS (measure endometrial thickness, ovarian cysts, fibroids..)
- if abnormal findings eg. >4mm thickness must do endometrial biopsy AND hysteroscopy
In a women investigated for post-menopausal bleeding, if malignancy has been excluded, suggest 1 way that atrophic vaginitis can be managed?
- topical oestrogen
- oral ospemifene (selective oestrogen receptor modulator -SERM)
State 3 consequences of symptoms arising from what is known as the “genitourinary syndrome of menopause” (relate to oestrogen deficiency)
-vaginal atrophy -> dyspareunia, cessation of sexual activity, itching, burning, dryness
-urinary sx: frequency, urgency, nocturia, incontinence, recurrent infection
-
Give 4 key RFs for development of osteroporosis:
- prior fractures
- parental history of fractures (esp.hip)
- early menopause
- chronic use of steroids
- smoking
- prolonged immobilisation
FSH levels give an estimate of remaining ovarian reserve, what does increased FSH levels indicate? are FSH levels accurate, why? So how are samples taken/when?
- fewer oocytes remaining in ovaries
- FSH levels vary daily in perimenopause
- day 2-5 cycle best (avoids mid-cycle peak and luteal suppression)
- need 2 samples, 2 weeks apart to improve accuracy
AMH is produced by small ______ _____ and gives a direct measurement of ovarian _____ (low levels are consistent with ovarian ______)
- ovarian follicles
- ovarian reserve
- ovarian failure
When can HRT be given as oestrogen alone?
-in women who have had a hysterectomy (as risk of endometrial hyperplasia and carcinoma is irrelevant in these women)
Give an example of a progestogen used with oestrogens in HRT
- levonorgestrel
- norethisterone
Tibolone is a synthetic steroid that in vivo is converted to metabolites with: oestrogenic, progestogenic and androgenic actions. What does it help with in post-menopausal women?
- leads to amenorrheoa
- treats vasomotor, psychological and libido dysfunction
- conserves bone mass, reduces risk of vertebral fractures
What symptoms is topical oestrogens/ospemifene used for?
-urogenital sx e.g. vulvovaginal atrophy and burning, urgency, frequency…
Give 3 benefits of HRT
- oestrogen effectively treats hot flushed (often within 4weeks)
- oestrogen helps vaginal dryness, superficial dyspareunia, and urinary frequency/urgency
- sexuality can be improved with oestrogen (+/-testosterone)
- reduced risk of osteoporosis and related fractures
- reduces risk of colorectal cancer by ~30%
Give 3 risks of HRT:
- combined HRT increases risk of breast cancer (extra 4/1000 cases after 5yrs use) while taking it only, risk falls on stopping
- unopposed increased endometrial cancer risk (this is why progestogens are added for women with a uterus)
- oral HRT doubles risk of VTE, highest risk in 1st year of use
- increased risk of gallbladder disease
