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O&G: Gynaecology > Menopause > Flashcards

Menopause Flashcards

1
Q

What is menopause and when does it happen?

A
  1. Permanent cessation of menstruation resulting from loss of ovarian follicular activity. Ends after 12 consecutive months of amenorrhoea.
  2. Median age of 51 in the UK.
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2
Q

What is perimenopause?

A

From the first features of menopause (vasomotor symptoms and menstrual irregularity), to 12 months after last menstrual period.

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3
Q

What is premature menopause?

A

Menopause occurring before the age of 40 (usually idiopathic)

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4
Q

What are the vasomotor symptoms of menopause and when do they occur?

A
  1. Hot flushes, night sweat
  2. Tiredness, irritability (due to sleep disturbance)
  3. Begin before periods stop and present for about 5 years
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5
Q

What are the urogenital symptoms of menopause?

A
  1. Vaginal atrophy - dyspareunia, itching, burning, dryness leading to cessation of sex
  2. Frequency, urgency, nocturia, incontinence
  3. Recurrent infection
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6
Q

What are the sexual symptoms of menopuse?

A
  1. Loss of sexual desire and arousal

2. Problems with orgasm and dyspareunia

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7
Q

What condition can develop in the bones during menopause?

A

Osteoporosis (fractures very common)

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8
Q

What are the cardiovascular symptoms of menopause?

A
  1. Increase in CAD and stroke occurrence

2. Leg cramps

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9
Q

What investigations are performed in suspected menopause and what do they show?

A
  1. FSH - increased levels suggest fewer oocytes
  2. AMH - low levels suggest ovarian insufficiency
  3. TFTs, PRL, 5-HIAA, urinary metanephrins
  4. Oestrogen (low)
  5. Mid-luteal progesterone for anovulation
  6. DEXA for those at risk of OP
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10
Q

How is HRT administered?

A
  1. Oral, transdermal, or vaginal

2. Lowest effective dose, encourage breast awareness and self-examination monthly

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11
Q

What is the difference between HRT with and without a uterus present?

A
  1. With - oestrogen and progesterone

2. Without - oestrogen only

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12
Q

What is the different between HRT in women with periods and post-menopausal women?

A
  1. Periods - oestrogen and cyclical progesterone (normal periods)
  2. Post-menopause - continuous combined HRT (amenorrhoea)
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13
Q

What does HRT importantly not provide?

A

Contraception

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14
Q

What contraception is provided for those on HRT?

A
  1. Full dose COCP for 1 or 2 years depending on LMP then wean to low doses in HRT
  2. HRT plus non-hormonal contraception (condoms)
  3. Mirena IUS and HRT dosing of oestrogen (most popular)
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15
Q

What can be given in high osteoporosis risk after HRT?

A

Bisphosphonates when HRT stopped.

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16
Q

What are the contraindications to HRT?

A
  1. Oestrogen dependent cancer
  2. History of VTE
  3. Undiagnosed vaginal bleeding
  4. Raised LFTs
  5. Pregnancy, breastfeeding
  6. Caution in those with family history of breast cancer
17
Q

What are the side effects of HRT?

A
  1. Oestrogenic - nausea, vomiting, bloating, breast tenderness, headache, fluid retention
  2. Progestogenic - acne, hirsutism
18
Q

What are the benefits of HRT?

A
  1. Reduction in vasomotor symptoms
  2. Improvement in urogenital symptoms
  3. OP fractures reduced whilst on treatment
  4. Reduced risk of colorectal cancer
19
Q

What are the risks involved in HRT?

A
  1. Breast cancer in combined, falls on stopping therapy for 5 years.
  2. Endometrial cancer in unopposed oestrogen therapy
  3. VTE - highest risk in first year of use
  4. Increased risk of gallbladder disease
20
Q

What is the purpose of androgen HRT?

A

Testosterone for low libido, especially in younger women.

21
Q

What is tibolone and when is it used?

A
  1. Synthetic steroid converted in vivo to metabolites with oestrogenic, progestogenic, and androgenic actions.
  2. Used in post-menopausal state as HRT
22
Q

What are the options for non-hormonal menopausal therapy?

A
  1. SSRI/SNRI - for hot flushes
  2. Alpha 2 antagonist - clonidine for vasomotor symptoms
  3. Herbal
  4. Adjuncts - vaginal lubricants

O&G: Gynaecology (48 decks)

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