Menopasue and Secondary Amenorrhoea Flashcards
what is andropause?
testosterone falls by 1% a year after 30 but fertility remains and there is no sudden change
what is menopause?
last ever periods
what is ovarian insufficiency?
> oestradiol falls
FSH increases
still some oestriol from peripheral conversion of adrenal androgens in fat
before what age if menopause classed premature?
40 years
what is the average age of menopause?
52 years
when does perimenopause start?
5 years before menopause approximately
what can cause menopause?
> ooprectomy
radiotherapy
chemo
natural
what are the symptoms of perimenopause?
> hot flushes (usually 2-5years sometimes >10) > vaginal dryness > low libido > muscle and joint aches > osteoporosis
what are the risk factors for osteoporosis in perimenopause?
> thin > smoking > malabsorption > steroids > hyperthyroidism
how is osteoporosis investigated?
DEXA scan
how is osteoporosis managed?
> HRT
exercise
adequate calcium and vitamin d
denosumab (monoclonal antibody and osteoclasts)
what symptomatic treatment is available for menopause?
> antidepressants
selective oestrogen receptor modulators
“natural methods” £$£ not worth the expense
when is HRT indicated?
> premature ovarian insufficiency until 50 years
> severe vasomotor symptoms
what are the benefits of HRT therapy?
> local genital symptoms
osteoporosis
vasomotor symptoms
what are the contraindications of HRT therapy?
> un-investigated vaginal bleeding > current active liver disease > current hormone dependent cancer > seek advice in - brac carrier - thrombophilia - previous breast cancer - VTE
how often is a women on HRT reviewed?
annually
in what form is HRT given for vaginal symptoms?
as a pessary
what routes can systemic HRT be delivered?
> transdermal
oral
oestrogen
describe cyclical HRT
> for perimenopause
14 days oestrogen and 14 days progesterone and oestrogen
can get withdrawal bleeding after progesterone part
describe continuous HRT
28 days oestrogen and progesterone
when is continuous HRT given?
> no ovarian function
> over 54
what can cause secondary amenorrhoea?
> pregnancy/breast feeding > contraception related > cushings > polycystic ovaries > early menopause > thyroid disease > raised prolactin > hypothalamic > androgen excreting tumour > sheenans syndrome > ashermans syndrome
what would you investigate in secondary amenorrhoea?
> BMI > BP > abdominal and bimanual examination > urine glucose > pregnancy test > bloods - FSH - LH - oestradiol - prolactin - prolactin - thyroid function > pelvic ultrasound
what BMI should you aim for when treating amenorrhoea?
20-25
what management is available for premature ovarian insufficiency?
> emotional support
HRT till 50
check fragile x
someone presents with secondary amenorrhoea what should you assume about their fertility?
that they are still fertile and need contraception unless 2 years after confirmed menopause
what is the pathology of poly cystic ovarian syndrome?
> small peripheral ovarian cysts (10 on one ovary and ovarian volume more than 12cm)
high oestrogen
high androgen
underlying insulin resistance
how does polycystic ovarian syndrome present?
> acne > excess hair > oligo/amenorrhoea > anovulatory infertility > NOT PAIN OR WEIGHT GAIN
what is the management of polycystic ovarian syndrome?
> weight loss and exercise > antiandrogen - CHC - spironolactone - eflorithine cream for facial hair > endometrial protection - progesterone - CHC - mirena ius > [clomiphene] [metformin] for fertility
