Lecture 17 Secondary Amenorrhea and Menopause Flashcards
What happens to the estradiol levels during menopause
Falls
Ovarian insufficiency
What happens to the FSH levels during menopause
Rise
What are menopause symptoms
Hot flushes/night sweats Vaginal dryness/soreness Low libido Muscle and joint aches Mood changes Poor memory
What are the silent changes that occur in menopause
Osteoporosis
Reduced bone mass
What are the risk factors for osteoporosis
Thin Caucasian Smoker FH Malabsorption of Vit D and Calcium Hyperthyroid oral corticosteroids
How are menopause symptoms treated
HRT Oestrogen pessary/ring/cream Hypnotherapy/CBT Non-hormonal lubricants Non clonidine or SSRI/SNRI antidepressants SERM- tibolone
Name contradictions to systemic HRT
Hormone dependent cancer breast/endometrium
Active liver disease
Uninvestigated abnormal bleeding
Previous VTE, FH of VTE
What are the benefits of HRT
Vasomotor
Local genital symptoms
Osteoporosis
What are the risks of HRT
Breast cancer combined HRT with ovarian cancer
VTE and CVA if oral route
What is Andropause
When testosterone falls by 1% a year after 30
Fertility remains
What is Primary Amenorrhoea
Never had a period
What is Secondary Amenorrhoea
had periods in past but not for 6 months
Name causes of Secondary Amenorrhoea
- Pregnancy / Breast feeding
- Contraception related- current use or for 6-9 months after depoprovera
- Polycystic ovary syndrome
- Premature ovarian insufficiency
- Thyroid disease/ Cushings/ Any significant illness
- Raised prolactin- prolactinoma/ medication related
- Congenital adrenal hyperplasia
- Hypothalamic- stress/ 10% wt change / excess exercise
- Androgen secreting tumour- testosterone >5mg/l
- Sheehans syndrome- pituitary failure
- Ashermans syndrome- intrauterine adhesions
When investigating secondary Amenorrhoea what would you be looking for in the bloods
FSH Oestrogen Prolactin Thyroid Function Testosterone Progesterone
How can Metformin be used for in the management of PCOS
May encourage ovulation
