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Obs&Gynae > menopause > Flashcards

menopause Flashcards

1
Q

when can you diagnosis the menopause?

A

Menopause is a retrospective diagnosis and can be made after a woman has had no peroids for 12mths
- Average age is 51yrs
- Can vary

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2
Q

what is post-menopause?

A

describes the period from 12mth after final menstrual period onwards

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3
Q

what is perimenopause?

A

Perimenopause: refers to the time around menopause  experiencing vasomotor symptoms and irregular periods
- Includes time leading up ot last menstrual period and then 12mths following

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4
Q

what is premature menopause?

A

: menopause before aged 40

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5
Q

which hormones drop in menopause?

A

oestrogen and progesterone

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6
Q

which hormones are high during menopause?

A
  • LH and FSH are high  response in negative feedback to of absence of oestrogen
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7
Q

what causes the changes in sex hormones?

A

Menopause is caused by lack of ovarian follicular function and results in changes in sex hormones associated with cycle

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8
Q

describe the process of primordial follicles maturing?

A

Inside ovaries: process of primordial follicles maturing
- Mature into primary and secondary follicles
- FSH stimulates futher development of secondary
- As follicles grow  granulosa that surround them secrete increasing amounts of oestrogen

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9
Q

describe the hormonal process of menopause?

A

Process of menopause:
- Decline in development of ovarian follicles
- No development = reduced production of oestrogen
- No oestrogen = no negative feedback loop to pituitary  increases levels of FSH and LH

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10
Q

how does failing follicular development lead to anovulation?

A

Failing follicular development = anovulation
- Resulting in irregular menstrual cycles
- Without oestrogen  endometrium does not develop  leading to lack of menstruation
- Lower levels of oestrogen also cause perimenopausal symptoms

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11
Q

how many recognised menopausal symptoms are there?

A

36

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12
Q

name some perimenopausal symptoms?

A
  • Hot flushes
  • Emotional lability or low mood
  • Premenstrual syndrome
  • Irregular periods
  • Joint pains
  • Heavier/ lighter periods
  • Vaginal dryness and atrophy
  • Reduced libido
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13
Q

what does the menopause put you more at risk of?

A

lack of oestrogen also increases risks of other conditions:
- CVS and stroke
- Osteoporosis
- Pelvic organ prolapse
- Urinary incontinence

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14
Q

how do you diagnosis menopause is those <45?

A

need FSH blood test to aid diagnosis when:
- Under 40yrs and suspected premature menopause
- Women aged 40-45 with menopausal symptoms or change in menstrual cycle

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15
Q

when do you need contraception til?

A
  • 2yrs after LMP in <50
  • 1yr after LMP >50
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16
Q

when does fertility majorly decline?

A

40
these pregnancies are incredibly high risk

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17
Q

what might hormonal contraception do through the menopause?

A

mask symptoms
make diagnosis hard

18
Q

what methods of contraception are recommended during menopause?

A
  • Use barrier, mirena coil/ copper coil, POP, Progesterone implant, depo injection, sterilisation
19
Q

why should depo only be used by those <45?

A

under 45 due to risk of decreasing bone density

20
Q

if hormonal pill, which can be used for contraception?

A
  • COCP: can be used <50 if no contra-indications, but should use POP as less likely for VTE
21
Q

what are treatment options of menopause?

A
  • No treatment
  • HRT
  • Tibolone:
  • clonidine
    CBT
    SSRI
    testosterone
    vaginal oestrogen
    vaginal moisturisers
22
Q

what is tibolone?

A

synthetic steroid hormone that acts as continuous combined HRT

23
Q

when can tibolone be started?

A

 only after 12 mths of amenorrhoea

24
Q

what is clonidine?

A

acts as agonists of alpha-adrenergic and imidazoline receptors

25
Q

why may testosterone be used within menopause?

A

help reduce libido
used as gel/ cream –> no systemic effects

26
Q

why would vaginal oestrogen be used?

A

cream/ tablets to help with vaginal dryness and atrophy (can be used alongside HRT)

27
Q

what is premature ovarian insufficiency?

A

menopause before 40

28
Q

how is POI characterised?

A
  • Hypergonadotropic hypogonadism  under activity of gonads and therefore lack of feedback on pituitary gland  excess of gonadotropins
  • Raised LH and FSH
  • Low oestradiol levels
29
Q

what are the causes of POI?

A

idiopathic
iatrogenic
autoimmune
genetic
infections

30
Q

what makes up half of the causes of POI?

A

idiopathic

31
Q

what iatrogenic methods can cause POI?

A

due to interventions such as chemo, radiotherapy/ surgery

32
Q

what AI conditions have been linked to POI?

A

linked to coeliac, adrenal insufficiency, T1DM, thyroid

32
Q

how does POI present?

A

Presents with irregular menstrual periods, lack of menstrual periods (secondary amenorrhoea), symptoms of low oestrogen, hot flushes, night sweats and vaginal dryness

32
Q

what infections have been linked to POI?

A

mumps, TB, cytomegalovirus

33
Q

what is the diagnosis criteria for POI?

A

<40 + typical menopause symptoms + elevated FSH

34
Q
A
35
Q

how does FSH need to be measured in order to confirm POI?

A
  • Needs to be persistently raised by more than 25IU/L on two samples more than 4weeks apart
  • Results are hard to interpret if taking hormonal contraception
36
Q

what conditions are then at risk due to lack of oestrogen?

A
  • CVS disease, stroke
  • Osteoporosis
  • Cognitive impairment, dementia, parkinsonism
37
Q

how do you manage POI?

A

HRT until women go through normal age of menopause at least
COCP

38
Q

what are risk of HRT within POI?

A
  • Reduces risks from associated conditions
  • Small risk of pregnancy despite ovarian failure  still need contraception
    HRT: associated with lower BP
  • Starting before age of 50 is not linked to increase breast cancer risk
  • Higher increases rate of VTE
39
Q

why may COCP be beneficial within POI?

A
  • May be more liked due to less stigma and socially acceptable for that age
  • Acts as contraception as well
40
Q
A

Obs&Gynae (17 decks)

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