Exam 7- post-menopausal health Flashcards
Definition of menopause?
Retrospective diagnosis made after 12 months amenorrheoa
What constitutes a) early b) premature menopause?
a) before 45
b) before 40
Main symptoms of the climacteric
a) vasomotor
b) urogenital
c) sleep
d) mood/libido
e) nails/skin/hair
Vasomotor- hot flushes, sweats Urogenital- dryness, recurrent UTI, dyspareunia Sleep disturbance Mood changes Loss of libido Brittle nails, thin skin and hair
HRT is protective against….(2)
Osteoporosis
Possibly Alzheimers
Risks of HRT (3)
Increased risk of:
stroke/VTE
Breast cancer
Endometrial cancer
The risk of which adverse effects of HRT are a) increased and b) decreased by inclusion of a progestogen?
a) breast cancer, VTE
b) endometrial cancer
Most suitable HRT for women
a) without a uterus
b) with a uterus, still have a period
c) post-menopausal, with a uterus
a) oestrogen-only continuous
b) cyclical combined HRT
c) continuous combined
What schedules of combined HRT are available and who are they most suitable for? (2)
Monthly (oestrogen every day, progesterone for 12-14 days at end of cycle) [regular period]
Three-monthly (take oestrogen every day and progesterone for 12-14 days, every 13 weeks)[best for women who have irregular periods]
Contraceptive options for patients taking HRT (2)
Barrier methods
Mirena IUS with added oestrogen in tablet/gel/patch form
For how long after the last period can women still become pregnant?
up to 2 years if under 50
up to 1 year if over 50
Alternative drugs for vasomotor symptoms (2)
Gabapentin
SSRIs
Main types of endometrial cancer (4)
Endometrioid and mucinous- oestrogen-related
Serous and clear cell- not oestrogen related
Risk factors for endometrial ca (3)
Obesity
Late menopause and nulliparity
PCOS
Endometrial cancer management
a) surgical
b) adjuvant
a) total hysterectomy with bilateral salpingo-oophorectomy
b) radiotherapy, high dose progestogens, chemotherapy
Why does obesity lead to higher oestrogen?
Androgens are converted to oestrogens in adipose tissue.
Sex hormone binding globulin is lower in obese people
Why do fibrioids rarely progress following menopause?
oestrogen-dependent
Management of fibroids
a) medical
b) surgical
a) COCP, GnRH analogues
b) Myomectomy, hysteroscopic ablation, hysterectomy
Nerve responsible for voluntary control of urination, mechanism
Pudendal nerve innervates the external urethral sphincter, contracts it
Treatment of overactive bladder
Oxybutynin (anti-muscarinic)
Drug therapy for stress incontinence
Duloxetine (SNRI)
What are the three degrees of uterine prolapse?
1st- in vagina
2nd- at interoitus
3rd- outside vagina
Types of physiological ovarian cyst
Follicular and corpus luteum cyst
Types of epithelial ovarian cysts
Serous and mucinous (rupture can cause pseudomyxoma peritonei)
What are ovarian fibromas?
Benign sex cord stromal tumours
What is Meigs syndrome?
Fibroma + ascites + pleural effusion
In what age group are dermoid cysts (teratomas) most common?
Young women
Investigations in suspected ovarian mass (5)
Pregnancy test TVUS CA-125 FNA cytology AFP and bHCG (for dermoid cysts)
What is the risk of malignancy index?
US score x menopause score x CA-125 score. Assesses the risk of ovarian malignancy in post-menopausal women
Complications of benign ovarian masses (4)
Torsion
Haemorrhage
Rupture
Infertility
Serum tumour marker used to monitor efficacy of treatment and recurrence in ovarian cancer
CA-125
Management of ovarian cancer (3)
Total hysterectomy with bilateral sapingo-oophorectomy
Peritoneal inspection and washings
Infracolic omentecomy
