L7 Menstruation

Question 1

what is menopause?

Answer 1

permanent cessation of menses (no periods) following loss of ovarian activity

Question 2

Define the peri-menopause stage?

Answer 2

transition from rep cycles to post menopause 
starts 45-50yrs
last about 3.8 yrs
few ova remain - less responsive to hormones'
irregular menstrual cycles 
hot flushes 
occasional heavy bleeding 
nervousness irritability

Question 3

what are primary symptoms of menopause?

Answer 3

menstrual cycle changes
oligo, ameno
vasomotor symptoms - hot flushes, night sweats
vaginal dryness

Question 4

secondary symptoms of menopause

Answer 4

urge incontinence 
cystitis like symptoms
depression
dry skin 
hair thinning 
decreased concentration
decreased libido

Question 5

HRT

Answer 5

Oestrogen needed for symptoms

progestogens needed to prevent endometrial cancer

Question 6

alternatives to HRT

Answer 6

Drugs for osteoporosis - bisphosphonates
alendronate, risedronate

Reducing vasomotor symptoms 
progesterone 
SERMs - Raloxifene 
beta blocker 
clonidine 
Herbalism 
progestogen cream 
acupuncture 
reflexology 
Phyto-oestrogens

Question 7

options in HRT

Answer 7

Choice of route -

oral, patches, implants, vaginal rings, transdermal gel, nasal

Question 8

What about if the woman has no uterus? - HRT

Answer 8

only oestrogen given
oestradiol 1mg
taken continously

Question 9

With a uterus

Answer 9

oestradiol everyday

oestrogen plus progestagen for 11 days

Question 10

Absolute contraindications to HRT

Answer 10

pregnancy 
active venous thromboembolism 
severe active liver diease 
endometrial carcinoma with recurrence 
breast carcinoma with recurrance 

BASEP

Question 11

Relative contraindications to HRT

Answer 11

abnormal bleeding 
breast lump prior to investigation 
previous endometrial cancer 
previous breast cancer 
strong family history of breast cancer 
family history of thomboembolism

Question 12

Side effects of HRT

Answer 12

Tender/painful breasts 
fluid retention 
nausea
headaches 
leg cramps 
mood swings 
acne 
backache 
bleeding 
indigestion

Question 13

benefits of HRT

Answer 13

short term: reduce vasomotor symptoms
improve psychological symtoms - mood swings

Long term benefits - 
maintain bone mass reduce fracture risk 
improve skin 
reduce risk of bowel cancer 
may protect against arthritis

Question 14

risks of HRT

Answer 14

Venous thromboembolism
breast cancer
endometrial cancer
cardiovascular disease - stroke/MI

Question 15

How would you investigate for endometrial cancer?

Answer 15

trans vaginal USS measure the endometrial thickness - more than 5mm

Question 16

how would you diagnose endometrial cancer?

Answer 16

sample - endometrial sample - biopsy

Question 17

treatment for endometrial cancer

Answer 17

hysterectomy and oopherctomy and possible radiotherapy

Question 18

risk factors for endometrial cancer?

Answer 18

obesity 
late menopause
diabetes 
famil history of breast, colon and ovarian cancer 
nulliparity 

FOUND

Question 19

what are the difference between COCP and HRT

Answer 19

COCP stops ovulation but HRT does not

HRT uses natural oestradiol whereas COCP does not - it uses ethinyl oestradiol
COCP - high dose oestrogen supressing GnRH/FSH/LH whereas in HRT does not suppress FSH and LH to the same degree

BOTH GIVEN TO PREVENT HYPERPLASIA OF THE ENDOMETRIUM AND INC CLOTTING FACTORS