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Obs & Gynae > Menopause > Flashcards

Menopause Flashcards

1
Q

What is menopause?

A

Permanent cessation of menstruation following loss of ovarian follicular activity
Median = 51 years
Recognised after 12 months of amenorrhoea

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2
Q

What is perimenopause?

A

First features of approaching menopause - vasomotor symptoms are menstrual irregularity

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3
Q

What is premature menopause and what are causes?

A

Menopause before 40

Bilateral ooephoroectomy
Infections
Autoimmune
Chemotherapy

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4
Q

What is post-menopausal bleeding?

A

Bleeding 12 months after last menstrual period

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5
Q

What are causes of PMB?

A 
Carcinoma of endometrium or cervix
Premalignant endometrial hyperplasia
Withdrawal bleeds from HRT
Atrophic vaginitis
Cervicitis
Ovarian carcinoma
Cervical polyps
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6
Q

How is PMB managed?

A

Bimanual and speculum examination
Cervical smear
Transvaginal USS - measure endometrial thickness, rule out fibroids, cervical cysts

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7
Q

At what endometrial thickness are more investigations done?

A

> 4mm or multiple episodes of bleeding

Endometrial biopsy +/- hysteroscopy

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8
Q

What are consequences of the menopause?

A

Early

  • psychological symptoms
  • vasomotor symptoms (hot flushes/night sweats)

Intermediate

  • skin atrophy
  • genital and urinary tract atrophy (vaginal atrophy)

Late

  • CV accidents
  • cardiac disease
  • bony fracture
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9
Q

What is osteoporosis?

A

1/3 women over 50

Bone density - peak bone mass/amount of bone loss

Bone quality - architecture, turnover, microfracture

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10
Q

What fractures occur with osteoporosis?

A

Wrist

Colles’ fracture - hip and spine

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11
Q

What are risk factors for osteoporosis?

A

Genetic: FH of hip fracture

Constitutional: low BMI, early menopause

Environmental: smoking, alcohol, low calcium intake, sedentary lifestyle

Drugs: corticosteroids

Disease: RA, neuromuscular disease, liver disease, malabsorption

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12
Q

What blood tests can be done for the menopause?

A

FSH - >30 increased levels suggest fewer oocytes
Anti-Mullerian hormone - low levels suggest ovarian failure
TSH - if hot flushes occur on HRT as can be another cause

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13
Q

What other investigations can be done for the menopause?

A

Bone density estimation at lumbar spine and hip (DEXA) - compare to T score or Z score

Biochemical markers of bone metabolism - can be used to monitor response to bisphosphonates

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14
Q

What are indications for using HRT?

A

Treatment of symptoms where benefits outweigh risks for 5 years
Early menopause until age of natural menopause - around 51
Women under 60 years at risk of osteoporotic fracture who are unsuitable for non-oestrogen

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15
Q

Who should receive cyclical or sequential HRT?

A

Peri-menopausal

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16
Q

Who should receive continuous HRT?

A

Post-menopausal

17
Q

When can oestrogen be used by itself?

A

Post-hysterectomy

Topically for urogenital symptoms but need long term treatment

18
Q

What are benefits of HRT?

A

Treats hot flushes within 4 weeks
Improvement in vaginal dryness, soreness, superficial dyspareunia, frequency and urgency
Sexuality may need testosterone as well for improvement
Reduces risk of fractures and colorectal cancer

19
Q

What are risks of HRT?

A

Breast cancer - combined HRT, not in treatment for early menopause and back to normal 5 years post HRT

Endometrial cancer - oestrogen only

VTE - trandermal and gel may decrease risk

Gallbladder disease

20
Q

What non-oestrogen based therapy is used in HRT?

A

Hot flushes/night sweats

  • progestogens
  • clonidine
  • SSRIs
  • gabapentin
21
Q

What medication is used to prevent and treat osteoporosis?

A

Bisphosphonates - inhibits bone reabsorption

  • causes upper GI irritation
  • not advised in pregnancy

Calcium and vit D supplements

22
Q

What are side effects of oestrogen?

A 
Fluid retention and bloating
Breast tenderness/swelling
Nausea and headaches
Leg cramps
Indigestion
23
Q

What are side effects of progestogen?

A 
Fluid retention
Breast tenderness
Headaches and mood swings
Depression
Acne
Backache

Obs & Gynae (20 decks)

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