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Repro > Menopasue and Secondary Amenorrhoea > Flashcards

Menopasue and Secondary Amenorrhoea Flashcards

1
Q

what is andropause?

A

testosterone falls by 1% a year after 30 but fertility remains and there is no sudden change

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2
Q

what is menopause?

A

last ever periods

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3
Q

what is ovarian insufficiency?

A

> oestradiol falls
FSH increases
still some oestriol from peripheral conversion of adrenal androgens in fat

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4
Q

before what age if menopause classed premature?

A

40 years

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5
Q

what is the average age of menopause?

A

52 years

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6
Q

when does perimenopause start?

A

5 years before menopause approximately

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7
Q

what can cause menopause?

A

> ooprectomy
radiotherapy
chemo
natural

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8
Q

what are the symptoms of perimenopause?

A 
> hot flushes (usually 2-5years sometimes >10)
> vaginal dryness
> low libido
> muscle and joint aches
> osteoporosis
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9
Q

what are the risk factors for osteoporosis in perimenopause?

A 
> thin
> smoking
> malabsorption
> steroids
> hyperthyroidism
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10
Q

how is osteoporosis investigated?

A

DEXA scan

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11
Q

how is osteoporosis managed?

A

> HRT
exercise
adequate calcium and vitamin d
denosumab (monoclonal antibody and osteoclasts)

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12
Q

what symptomatic treatment is available for menopause?

A

> antidepressants
selective oestrogen receptor modulators
“natural methods” £$£ not worth the expense

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13
Q

when is HRT indicated?

A

> premature ovarian insufficiency until 50 years

> severe vasomotor symptoms

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14
Q

what are the benefits of HRT therapy?

A

> local genital symptoms
osteoporosis
vasomotor symptoms

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15
Q

what are the contraindications of HRT therapy?

A 
> un-investigated vaginal bleeding
> current active liver disease
> current hormone dependent cancer
> seek advice in
 - brac carrier
 - thrombophilia
 - previous breast cancer
 - VTE
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16
Q

how often is a women on HRT reviewed?

A

annually

17
Q

in what form is HRT given for vaginal symptoms?

A

as a pessary

18
Q

what routes can systemic HRT be delivered?

A

> transdermal
oral
oestrogen

19
Q

describe cyclical HRT

A

> for perimenopause
14 days oestrogen and 14 days progesterone and oestrogen
can get withdrawal bleeding after progesterone part

20
Q

describe continuous HRT

A

28 days oestrogen and progesterone

21
Q

when is continuous HRT given?

A

> no ovarian function

> over 54

22
Q

what can cause secondary amenorrhoea?

A 
> pregnancy/breast feeding
> contraception related
> cushings
> polycystic ovaries
> early menopause
> thyroid disease
> raised prolactin 
> hypothalamic
> androgen excreting tumour
> sheenans syndrome
> ashermans syndrome
23
Q

what would you investigate in secondary amenorrhoea?

A 
> BMI
> BP
> abdominal and bimanual examination
> urine glucose
> pregnancy test
> bloods
 - FSH
 - LH
 - oestradiol
 - prolactin  
 - prolactin
 - thyroid function
> pelvic ultrasound
24
Q

what BMI should you aim for when treating amenorrhoea?

A

20-25

25
Q

what management is available for premature ovarian insufficiency?

A

> emotional support
HRT till 50
check fragile x

26
Q

someone presents with secondary amenorrhoea what should you assume about their fertility?

A

that they are still fertile and need contraception unless 2 years after confirmed menopause

27
Q

what is the pathology of poly cystic ovarian syndrome?

A

> small peripheral ovarian cysts (10 on one ovary and ovarian volume more than 12cm)
high oestrogen
high androgen
underlying insulin resistance

28
Q

how does polycystic ovarian syndrome present?

A 
> acne
> excess hair
> oligo/amenorrhoea
> anovulatory infertility
> NOT PAIN OR WEIGHT GAIN
29
Q

what is the management of polycystic ovarian syndrome?

A 
> weight loss and exercise
> antiandrogen
 - CHC
 - spironolactone
 - eflorithine cream for facial hair
> endometrial protection
 - progesterone
 - CHC
 - mirena ius
> [clomiphene] [metformin] for fertility

Repro (22 decks)

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