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DM 2 - Gynecology > Menopause > Flashcards

Menopause Flashcards

1
Q

What is the definition of menopause

A

The age at the last menstrual period

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2
Q

What is the climacteric

A

The time period from when the ovaries start to fail until 12 months after the last menstrual period

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3
Q

What is postmenopause?

A

The time after complete cessation of menstruation. Can only be determined after 12 mnths of amenorrhoea

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4
Q

Primary ovarian insufficiency definition

A

Menopause that occurs before age 40

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5
Q

What is the average age of menopause ?

A

51

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6
Q

What factors can result in early menopause? (3)

A

1- Genetic predisposition (30-70%)
2- type 1 diabetes
3- smoking

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7
Q

Hallmark endocrine changes of menopause

A

1- decreased inhibin B
2- increased FSH

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8
Q

What is the source of estrogen postmenopause

A

Aromatisation of androstenedione in peripheral tissues

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9
Q

What is the percentage fall of testosterone by the time of menopause

A

50%

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10
Q

What effect does decreased estrogen have in the body (4)

A
  • decreases production of neurotransmitters
  • decreased collage
  • endothelial function
  • atrophy of estrogen sensitive epithelial surfaces
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11
Q

What are the acute manifestations of menopause ? (4)

A
  • cessation of menses
  • vasomotor symptoms
  • psychological: mood swings, panic attacks, depression, memory loss
  • headaches
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12
Q

What percentage of women are affected by vasomotor symptoms?

A

70-80%

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13
Q

What is the median duration of vasomotor symptoms

A

7 years

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14
Q

What are the medium term symptoms of menopause? (5)

A
  • vaginal dryness and dyspareunia
  • reduced libido
  • increased vaginal pH: >4.5 with recurrent UTIs
  • atrophy GU tract : increased urge incontinence
  • thinning skin, hair loss
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15
Q

What are the long-term health implications (2)

A
  • increased fragility fractures
  • increased Cardiovascular disease
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16
Q

What are the indications for HRT?

A

Significant vasomotor symptoms

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17
Q

What are the types of HRT (5)

A
  • estrogen only
  • sequential combined cyclic
  • sequential combined long cycle
  • continuous combined
  • continuous progestogen
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18
Q

What are the different estrogen preparations? (4)

A
  • transdermal estradiol
  • oral conjugated equine estrogen
  • subcutaneous estradiol pellets
  • transvaginal: ring, tablets, cream
19
Q

What are the routes of progesterone for hrt? (5)

A
  • oral
  • patch
  • pessary
  • cream
  • IUS
20
Q

What is a consequence of LNGIUS when used with estrogen

A

Doubles the risk of breast cancer

21
Q

What is a consequence of tibolone

A

Doubles the risk of stroke

22
Q

What is a benefit of the estrogen patch

A

Decreases the risk of venous thromboembolism

23
Q

How does the patch decrease the risk of VTE

A

It by passes the gut and liver first pass metabolism hence preventing hepatic globin and coagulation factor synthesis

24
Q

Benefits of oral estrogen (2)

A
  • more affordable
  • improves HDL LDL and cholesterol
25
Q

What is the percentage reduction in osteoporosis with HRT

A

30%

26
Q

What HRT method carries the highest risk of breast cancer

A

Continuous combined therapy

27
Q

Baseline risk of VTE in women age 50-70

A

100-200:100,000 women/years

28
Q

Contraindications to HRT (7)

A
  • hormone dependent malignancy
  • history of active or recent arterial thrombosis (MI/stroke)
  • venous thromboembolism
  • pregnant
  • active severe liver disease
  • univestigated AUB
  • acute intermittent porphyria
29
Q

Recommended followup on HRT

A

Three months
Six months
Yearly

30
Q

A)What test can confirm cessation of ovarian function with the absence of vasomotor symptoms?

B) what is the value

A

A) FSH 2 separate occasions

B) >30IU/L

31
Q

Recommended duration of HRT use

A

5 years

32
Q

Non hormonal agents for menopause (2)

A
  • clonidine( alpha 2 agonist)
  • SSRI and SNRI (only with vasomotor plus depression)
33
Q

Agents that do not benefit menopausal symptoms

A

DHEA

34
Q

Complementary therapies (further studies needed)
Phytoestrogens

A
  • Soy
  • flaxseed
  • red clover
    (Highest levels)
35
Q

Herbal preparations(5)

A
  • black cohosh (not effective for hotflushes)
  • evening primrose oil (not effective for hotflushes)
  • kava (anxiolytic)
  • ginko biloba (improves memory)
  • st John’s wort (drug interactions
36
Q

What is the pathophysiology of bone resorption in menopause

A

Estrogen deficiency results in cytokine inhibition of osteoblastogenesis , stimulates the activity and prolongs the life span of osteoclast .

37
Q

What percentage of patients with surgical menopause have hot flushes

A

90%

38
Q

How is primary ovarian insufficiency diagnosed

A

Two FSH levels >20iu/l 1 month apart

39
Q

What is the most common chromosomal cause of POI

A

Turner syndrome 45 XO

40
Q

What autoimmune diseases are associated with POF

A
  • hypothyroidism
  • hypoparathyroidism
  • hypoadrenalism
  • Addison disease
  • type 1 diabetes
41
Q

Can cyclic HRT function as a contraceptive

A

-No

HRT only inhibits ovulation in 40% of women

42
Q

What is the incidence of POI

A

1%

43
Q

What are the overall causes of poi

A

90% idiopathic
10% chromosomal, autoimmune, infective , iatrogenic

DM 2 - Gynecology (22 decks)

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