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Y4 - GOSH > Menopause > Flashcards

Menopause Flashcards

1
Q

What is menopause and how can it be diagnosed?

A
  • defined as the permanent end to menstruation
  • it is a retrospective diagnosis made after a woman has had no periods for 12 months

most women go through the menopause around the age of 51

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2
Q

What is meant by postmenopause?

A

the period from 12 months after the final menstrual period onwards

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3
Q

What is meant by perimenopause?

A
  • this includes the time leading up to the final menstrual period and the 12 months afterwards
  • women may experience vasomotor symptoms + irregular periods during this phase
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4
Q

What is meant by premature menopause?

A
  • menopause occurring before the age of 40 years
  • it is a result of premature ovarian insufficiency
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5
Q

How are the hormone levels different in menopause?

A
  • menopause is caused by a lack of ovarian follicular function
  • oestrogen + progesterone levels are LOW
  • FSH + LH levels are HIGH
  • this is due to a lack of negative feedback from oestrogen
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6
Q

How does development of follicles occur in the ovaries independent of menstruation?

A
  • primordial follicles ALWAYS mature into primary + secondary follicles
  • this occurs independently of menstruation
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7
Q

How does follicular development occur during menstruation?

A
  • FSH stimulates further development of the secondary follicles
  • the granulosa cells surrounding the follicles secrete increasing amounts of oestrogen
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8
Q

How does the process of menopause begin?

A
  • begins with a decline in the development of ovarian follicles
  • without follicular growth, there is reduced production of oestrogen
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9
Q

What is the result of a decline in oestrogen production as a result of a decline in follicular development?

A
  • oestrogen usually has a negative feedback effect on the pituitary gland, suppressing the amount of FSH + LH produced
  • as the level of oestrogen falls, the levels of FSH + LH increase
  • this is due to an absence of negative feedback
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10
Q

How does failing follicular development + lack of oestrogen lead to symptoms of menopause?

A
  • failing follicular development means that ovulation does not occur (anovulation)
  • this results in irregular menstrual cycles
  • without oestrogen, the endometrium does not develop
  • this results in amenorrhoea
  • low levels of oestrogen cause the perimenopausal symptoms
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11
Q

What are the symptoms associated with perimenopause?

A
  • hot flushes
  • emotional lability / low mood
  • premenstrual syndrome
  • irregular periods
  • joint pains
  • heavier / lighter periods
  • vaginal dryness / atrophy
  • reduced libido

all of these symptoms occur due to a lack of oestrogen

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12
Q

What are the risks associated with a lack of oestrogen?

A
  • cardiovascular disease / stroke
  • osteoporosis
  • pelvic organ prolapse
  • urinary incontinence
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13
Q

How is a diagnosis of menopause made?

A
  • a diagnosis of menopause OR perimenoapuse can be made without investigations
  • ONLY if symptoms are present in women over 45
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14
Q

When might a blood test be needed to aid in the diagnosis of menopause?

A

FSH blood test

  • women < 40 with suspected premature menopause
  • women aged 40-45 with menopausal symptoms / change in menstrual cycle
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15
Q

For how long after the menopause should women use contraception for?

A
  • 2 years after the last menstrual period in women < 50
  • 1 year after the last menstrual period in women > 50

this is important as pregnancy > 40 is associated with increased risks + complications

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16
Q

How do hormonal contraceptives affect the menopause?

A
  • they do not affect the menopause, when it occurs or how long it lasts
  • they may suppress / mask the symptoms
  • menopause can be more difficult to diagnose in women on hormonal contraception
17
Q

What are the good contraception options (UKMEC1) in women approaching menopause?

A
  • barrier methods
  • Mirena / copper coil
  • progesterone only pill
  • progesterone implant
  • progesterone depot injection (if < 45)
  • sterilisation
18
Q

What are the regulations around use of the COCP in older women?

A
  • it is considered UKMEC2 in women > 40
  • it can be used up to 50 if there are no contraindications
  • COCPs containing norethisterone or levonorgestrel should be used in women > 40 due to lower risk of VTE
19
Q

What 2 side effects are unique to the progesterone depot injection (Depo-Provera)?

Why does this make it unsuitable in women > 45?

A

weight gain + reduced bone mineral density

  • unsuitable in women > 45 due to the risk of osteoporosis

reduced bone mineral density = osteoporosis

20
Q

When do vasomotor symptoms associated with menopause resolve?

A

they tend to resolve after 2-5 years without any treatment

21
Q

What are the management options available for management of perimenopausal symptoms?

A
  • HRT
  • tibolone (acts as continuous HRT)
  • clonidine
  • SSRI antidepressants
  • testosterone (gel or cream) used to increase libido
  • vaginal oestrogen (cream / tablets) used to help vaginal dryness / atrophy
  • vaginal moisturisers
21
Q

What are the management options available for management of perimenopausal symptoms?

A
  • HRT
  • tibolone (acts as continuous HRT)
  • clonidine
  • SSRI antidepressants
  • testosterone (gel or cream) used to increase libido
  • vaginal oestrogen (cream / tablets) used to help vaginal dryness / atrophy
  • vaginal moisturisers
22
Q

What is premature ovarian insufficiency and why does it occur?

A
  • menopause occurring before the age of 40
  • occurs due to a decline in normal activity of the ovaries at an early age
23
Q

What is premature ovarian insufficiency characterised by?

A

hypergonadotrophic hypogonadism

  • hypogonadism is due to underactivity of the gonads
  • there is a lack of negative feedback on the pituitary gland
  • this results in hypergonadotropism - an excess of gonadotropins being produces (FSH / LH)
24
Q

What would hormonal analysis show in premature ovarian insufficiency?

A
  • raised LH + FSH (gonadotropins)
  • low oestradiol (oestrogen)
25
Q

What are the potential causes of premature ovarian insufficiency?

A
  • idiopathic
  • iatrogenic
  • autoimmune
  • genetic
  • infectious

the cause is unknown in > 50% cases

26
Q

What is meant by an iatrogenic cause of POI?

A
  • this occurs as a result of an intervention
  • e.g. chemotherapy, oophorectomy or radiotherapy
27
Q

What autoimmune diseases are potentially associated with POI?

A
  • coeliac disease
  • adrenal insufficiency
  • type 1 diabetes
  • thyroid disease
28
Q

What infections are associated with POI?

A
  • mumps
  • tuberculosis
  • cytomegalovirus
29
Q

How does premature ovarian insufficiency present?

A
  • irregular menstrual periods
  • secondary amenorrhoea (lack of menstrual periods)
  • symptoms of low oestrogen - vaginal dryness, hot flushes + night sweats
30
Q

How can premature ovarian insufficiency be diagnosed?

A
  • diagnosed with women under 40
  • with typical menopausal symptoms

AND

  • an elevated FSH
31
Q

What is meant by an “elevated FSH” in the diagnosis of premature ovarian insufficiency?

A
  • the FSH must be persistently raised > 25 IU/l
  • on 2 consecutive samples
  • separated by more than 4 weeks

!! results are difficult to interpret in women using hormonal contraception !!

32
Q

What conditions are women presenting with POI at an increased risk of?

A
  • CVD / stroke
  • osteoporosis
  • cognitive impairment
  • dementia
  • Parkinsonism
33
Q

What is involved in the management of POI?

A

hormone replacement therapy (HRT)

  • this is continued until the age at which women typically go through the menopause
  • contraception is still required as a there is a small risk of pregnancy in women with POI

HRT reduces the risks of CVD, osteoporosis + cognitive impairment

34
Q

What are the 2 options for HRT in POI?

A
  • traditional HRT
  • combined oral contraceptive pill
35
Q

What are the benefits of choosing HRT / COCP in POI?

A
  • HRT is associated with a lower blood pressure than COCP
  • COCP additionally acts as contraception
36
Q

What is the increase in risk of cancer in women using HRT in POI?

A
  • HRT before 50 is NOT considered to increase the risk of breast cancer
  • women would ordinarily produce the same hormones at this age
37
Q

What is HRT in women < 50 associated with an increased risk of?

A

venous thromboembolism

  • this risk is reduced through the use of transdermal patches

Y4 - GOSH (62 decks)

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