Menopause Flashcards
What do the ovaries produce in reproductive years?
Estradiol, testosterone and androstenedione
What do the ovaries produce postmenopausally?
Androstenedione and testosterone (androgens then being converted by peripheral tissues into estrone)
What is the first and last hormone to be affected in menopause?
FIRST - FSH
LAST - oestradiol
How do circulating hormone levels differ in someone that is post-oopherectomy vs. postmenopausal?
People that have had a oopherectomy have far less testosterone and androstenedione
When should HRT be continued until?
At least until the natural average age of menopause (i.e. 51)
What proportion of older women have osteoporosis?
1 in 3
At what age is peak bone mass achieved?
25
What type of osteoporosis is more common in postmenopausal women?
Type 2
Type 2 affects men and women equally and in characterised by the loss of trabecular and cortical bone mass
What proportion of women will experience irregular bleeding within the first 3 months of using HRT?
80%
An ET of what, in a woman bleeding in the progesterone phase of sequential HRT, would warrant further investigation?
> 7mm
Where sinister causes of bleeding whilst on HRT have been excluded, what should be done?
Increase or change the type of progesterone
What is the mechanism of action of bisphosphonates in the treatment of oestrogen deficiency osteoporosis?
- Bind to the hydroxyapatite binding sites at the bone surface inhibiting their breakdown
- Also inhibit osteoclast mediated bone resorption
- May inhibit apoptosis of osteoblasts and osteocytes
When should progestogen only methods of contraception be used until?
Age 55
or
Check FSH levels - if FSH levels >30IU/L, can stop using contraception in 12 months
What is the most common cause of PMB?
Atrophic endometritis and vaginitis - accounts for 60-80% of cases
What type of progestogen may reduce the risk of VTE?
Micronised progesterone
How does osteoporosis occur in someone NOT using HRT?
An imbalance between osteoclastic and osteoblastic activity
Lack of oestrogen results in increased osteoclast activity, and therefore increased bone resorption
How does the bone structure change in osteoporosis?
- Fewer trabeculae
- Thinning of cortical bone
- Widening of hervasian canals
How should a low FRAX score be managed?
Lifestyle advice + HRT
How should a intermediate FRAX score be managed?
DEXA scan
How should a high FRAX score be managed?
Offer treatment
What are the possible DEXA scores?
+1 - -1 = normal
-1 - -2.5 = osteopenia
< -2.5 = osteoporosis
What dose of calcium/vit D should be offered as part of lifestyle management in relation to bone health?
Calcium 1000mg + Vit D 1000 IU
What is the definition of menopause?
12 months after last period
What is the burden of menopause Sx?
75% experience menopausal Sx,
25% describe severe Sx, 1/3rd experience long-term Sx
What proportion of women experience genitourinary Sx during menopause?
50%
Over what period do menopausal Sx last?
Median duration= 7 years
20% of women = Sx up to 15 years
What is the average age of early peri-menopause?
47
What is the average age of late peri-menopause?
49
What are the most common menopausal Sx?
Hot flushes and night sweats - 70-80%
When >45 y/o, which diagnoses can be made without laboratory testing?
Perimenopause - based on vasomotor symptoms and irregular periods
Menopause - not had a period for at least 12 months and are not using hormonal contraception
Menopause - based on symptoms in women w/out a uterus
In whom may an FSH be used to aid diagnosis of menopause?
Women aged 40-45 y/o with menopausal Sx, INCLUDING a change in their menstrual cycle
Women <40 y/o in whom menopause (POI) is suspected
What proportion of women may experience menopause between the ages of 40-45?
5%
In whom should FSH NOT be used to diagnose menopause?
Women using CHC or high-dose progestogen
At what age is menopause considered premature/diagnosis of premature ovarian insufficiency?
<40 y/o
What is happening physiologically in the perimenopause?
Fewer functional follicles
Cycles often anovulatory as follicles not responsive enough to LH and FSH
This causes irregular periods
Less oestrogen from granulosa
Less progesterone – leads to increased GNRH, LH and FSH but more erratic
Decreased inhibin B – less negative feedback on pituitary
What proportion of cases of premature ovarian insufficiency are idiopathic?
85-90%
What proportion fo POI are genetic?
10-13%
What are the genetic causes of POI?
- Turner’s syndrome - test someone for if presenting at <30y/o with POI
- BRCA1
- Fragile X
How is POI diagnosed?
<40 y/o
AND
Menopausal symptoms, including no or infrequent periods
AND
x2 FSH >30 (>40 BMS) on two occasions, 4-6 weeks apart
What is the spontaneous conception rate with POI?
5%
What treatment options should be offered to women with POI (because of the osteoporosis or cardiovascular risk)?
Either HRT or a CHC, and continue until at least the age of natural menopause