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MFSRH Part II 2022 > Menopause > Flashcards

Menopause Flashcards

1
Q

What are the 4 endogenous estrogens?

A

E1 - estrone - predominates in menopause
-> made in peripheral tissues
E2 - estradiol - predominates in reproductive years
-> made in granulosa cells of the ovary
E3 - estriol - predominates during pregnancy
-> made by placenta
E4 - estetrol - produced only during pregnancy

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2
Q

In a patient with an implant that has been in situ for 3.5y, how would you manage a patient requesting insertion of LNG-IUS?

A

PT - if negative, replace and advise 7 days additional precautions

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3
Q

When would an FSH measurement be indicated when managing menopause?

A

If under 40y when signs of menopause - 6 weeks apart
Consider if <45y with amenorrhea and signs of menopause
If >50 y on POC who which to know whether they can stop contraception or not

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4
Q

What are the differential diagnoses for hot flushes and what tests would you do to rule them out if necessary?

A

Thyroid disease - TSH
Phaeochromocytoma - catecholamines
Carcinoid - 24h urinary 5-hydroxyindoleacetic acid

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5
Q

Why is measuring estradiol levels not recommended when on PO estrogen is used in HRT?

A

Major circulating metabolite in oral preparations is estrone

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6
Q

Why do you use free androgen index?

A

Gives guide to the level of free testosterone (2/3 bound to SHBG, 1/3 bound to albumin) only 2% is free and metabolically active

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7
Q

How do you calculated free androgen index?

A

FAI = 100 x (total testosterone / SHBG)

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8
Q

What does QRISK2 indicate?

A

Risk of having MI or stroke in the next 10y

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9
Q

How often is cervical screening indicated?

A

25-50y - every 3y

50-64y - every 5y

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10
Q

How often is breast screening undertaken?

A

50-71y - every 3y

>71y - can request every 3y

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11
Q

What is the cardiovascular timing hypothesis?

A

Window of opportuniy for prevention of CV disease if HRT is initiated before the age of 60. HRT commenced <10y from onset of menopause is associated with lower risk of CV disease

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12
Q

What is the background risk of breast cancer in menopausal aged women?

A

23/1000 cases

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13
Q

How would you counsel a patient regarding the increased risk of breast cancer?

A

Increased risk in combined HRT group
Increased risk emerges 3y after exposure
3 extra cases of breast cancer per 1000 women
5 y following cessation, background risk returns

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14
Q

How is osteoporosis diagnosed?

A

BMD assessment via DXA scan

osteoporosis is BMD > 2.SD below mean BMD for young adult population

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15
Q

What is the prevalence of POI?

A

1%

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16
Q

What blood tests are indicated in POI?

A

2 FSH measurements 6-8 weeks apart >30

17
Q

By how much can fibroids expect to decrease in size during menopause?

A

40%

18
Q

How would you counsel a patient regarding the effect of HRT on her pre-existing fibroids

A

May cause enlargement of existing fibroids but will not cause new ones to develop

19
Q

What effect does HRT have on on hypertension?

A

No evidence that estradiol-based HRT has an adverse effect on existing HTN

20
Q

How much does combined HRT increase the risk of VTE?

A

RR = 2 with oral preparations

No increased risk with transdermal preparations

21
Q

What are contraindications to HRT?

A

Current or past breast cancer
Other types of estrogen dependent cancer
Untreated endometrial hyperplasia
Active liver disease

22
Q

What are the 3 main groups of drugs used to help manage troublesome menopausal symptoms in cases where HRT is contraindicated?

A

A- blocker - clonidine
SSRIs/SNRIs
Neuropathic pain killers / antiepileptics

23
Q

What are the side effects of clonidine?

A

dry mouth, sedation, dizziness, nausea, nocturnal restlessness

24
Q

What are the first line SSRI/SNRIs used in menopause in women without a past medical of breast cancer?

A

Paroxetine
Sertraline
Fluoxetine

25
Q

Which SSRI/SNRIs are first line in management of menopause in a woman taking tamoxifen for previous breast cancer?

A

Venlafaxine (SNRI)

Citalopram (SSRI)

26
Q

Why should paroxetine and fluoxetine not be used in women taking tamoxifen for previous breast cancer?

A

They inhibit the conversion of tamoxifen to its acitve metabolite and therefore increase the risk of breast cancer recurrence.

27
Q

What proportion of breast cancers in the UK are attributed to the BRCA1/2 gene mutations?

A

2%

28
Q

What class of drug is tibolone?

A

Synthetic steroid with weak estrogenic, progestogenic and androgenic effects

29
Q

When is tibolone used in management of menopause?

A

In young women on GnRH treatment or for post menopausal prevention of osteoporosis

MFSRH Part II 2022 (8 decks)

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