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Gynaecology > Menopause > Flashcards

Menopause Flashcards

1
Q

When is the diagnosis of menopause made

A

Retrospective diagnosis made after woman has not had any periods for 12 months. Permanent end to menstruation around 51 years of age

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2
Q

What is the perimenopausal stage

A

Time around the manopause where the woman may experience vasomotor symptoms and irregular bleeding

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3
Q

What is classed as premature menopause

A

Before age of 40

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4
Q

Cause of menopause

A

Lack of ovarian follcular function, resulting in changes in the sex hormones associated with menstrual cycle. Oestrogen and progesterone are low, LH and FSH are high in response to absence of negative feedback

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5
Q

Process of menopause

A

Begins with a decline in development of ovarian follicles -> reduced production of oestrogen -> negative feedback on pituitary gland, but there is absence of feedback -> increasing levels of FSH and LH -> ovulation does not occur -> endometrium does not develop without oestrogen -> perimenopausal symptoms

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6
Q

What are perimenopausal symptoms

A

Hot flushes
Emotional lability or low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and strophy
Reduced libido

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7
Q

Risk of menopause

A

CVD and stroke, osteoporosis, pelvic organ prolapse, urinary incontinence - from lack of oestrogen

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8
Q

Management of perimenopausal symptoms

A

HRT
Tibolone
Clonidine
CBT
SSRI
Testosterone
Vaginal oestrogen
Vaginal moisturisers

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9
Q

What is HRT used for

A

Alleviate symptoms associated with perimenopause and menopause.
Oestrogen and progesterone given - progesterone is to prevent endometrial hyperplasia and endometrial cancer secondary to unopposed oestrogen

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10
Q

Indications for HRT

A

Replacing hormones in premature ovarian insufficiency
Reducing vasomotor symptoms
Improving symptoms such as low mood, poor sleep, joint pain and decreased libido
Reducing risk of osteoporosis in women under 60

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11
Q

Different regimes for HRT

A

Cyclical HRT
Continuous combined
Oestrogen only for those with no uterus

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12
Q

Risk of HRT

A

Breast cancer, endometrial cancer, VTE risk, stroke and coronar artery disease risk

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13
Q

Contraindications of HRT

A

Undiagnosed abnormal bleeding
Endometrial hyperplasia or cancer
Breast cancer
Uncontrolled HTN
VTE
Liver failure
Active angina or MI
Pregnancy

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14
Q

Three criteria to chose formulation of HRT

A

Local or systemic symptoms
Does the woman have a uterus
Have they has a period in the last 12 months

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15
Q

Side effects of oestrogen

A

Nausea, bloating, breast swelling, breast tenderness, headaches, leg cramps

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16
Q

Side effects of progesterone

A

Mood swings, bloating, fluid retentoin, weight gain, acne, greasy skin

17
Q

What is atrophic vaginitis

A

Refers to dryness and atrophy of the vaginal mucosa related to lack of oestrogen

18
Q

Presentation of atrophic vaginitis

A

Thin mucosa, less elastic and dry, tissue is prone to inflammation, changes in vaginal pH and microbial flora contributing to localised infections, itching, dryness, dysparenuria, bleeding from localised inflammation,

19
Q

What will you find in examination of atrophic vaginitis

A

Pale mucosa, thin skin, reduced skin folds, erythema and inflammation, dryness, sparse pubic hair

20
Q

Management of atrophic vaginitis

A

Vaginal lubricants - Sylk, replens, and YES
Topical oestrogen - estriol cream, pessaries, tablets and ring

21
Q

What is lichen sclerosis

A

Chronic inflammatory skin condition affecting the labia, perineum, and perianal skin of women, but can also infect other areas such as axilla, thighs, foreskin and glans of penis

22
Q

Presentation of lichen sclerosis

A

45-60 years old, vuvlal itching, skin changes in the vulva, asymptomatic, soreness and pain possibly worse at night, dysparenuria, skin tightness, erosions, fissures

23
Q

How is lichen sclerosis diagnosed

A

Clinical examination but if there is dount a vulval biopsy can be taken

24
Q

What is Koebner phenomenon

A

Signs and symptoms are made worse by friction to the skin, occurs with lichen sclerosis and can be made worse by wearing tight underwear, clothes, urinary incontinence and scratching

25
Q

What is the appearance of atrophic vaginitis

A

Fissures, cracks, erosions, haemorrhages under skin, poreclaine white in colour, shiny, tight, thin, slightly raised, papules or plaques

26
Q

Management of lichen sclerosis

A

Potent topical steroids - clobetasol propionate 0.05%
Cannot be cured but symptoms controlled
Used once a day for 4 weeks then gradually reduced
Emollietns used regularly

27
Q

Complications of lichen sclerosis

A

Pain and discomfort, sexual dysfunction, bleeding, narrowing of vagina and urethral openings, 5% risk of developing SCC of vulva

28
Q

What is the cause of premature overian insuffciency

A

Result of decline in normal activity of ovaries at early - typical onset of menopause symptoms

29
Q

What is hypergonadotrophic hypogonadism

A

Unactive gonads -> lack of feedback to pituitary -> release of excessive gonadotrophins (LH and FSH)

30
Q

Causes of premature ovarian insufficiency

A

Idiopathic (50%)
Iatrogenic - chemo, radiotherapy, oophorectomy
Autoimmune - coeliac, adrenal insufficiency,T1DM, thyroid disease
Genetic - Turner’s, FHx
Infections - mumps, TB, CMV

31
Q

Presentation of premature ovarian insufficiency

A

Irregular menstrual periods, secondary amenorrhoea, symptoms of low oestrogen, hot flush, night sweats, vagina dryness

32
Q

Diagnosis of premature ovarian insufficiency

A

Younger than 40, typical menopausal symptoms, elevated FSH level

33
Q

Associations with premature ovarian insufficiency

A

Higher risk of conditions relating to lack of oestrogen, CVD, stroke, osteoporosis, cognitive impairment, dementia and parkinsonism

34
Q

Management of premature ovarian insufficiency

A

HRT taken until normal menopausal age
Reduced complications and risks
Small risk of pregnancy still - contraception

Gynaecology (7 decks)

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