Menopause Flashcards

1
Q

Symptoms of menopause

A

Early
• Vasomotor, period change, insomnia, mood change, cognitive function, loss of collagen, fat redistribution, hair loss

Medium
• Vagina: dryness, soreness, dyspareunia
• Bladder: Frequency, urgency, dysuria, UTIs

Late
• Bone deficiency, 1/3 after 20 years (loss of oestrogen causes calcium loss) causing osteoporosis
• Increased risk of cardiovascular disease and stroke after menopause

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2
Q

Examination findings in menopause?

A

Amenorrhoea universal, hot flushes, fatigue, insomnia, poor concentration, vaginal dryness and atrophy, urinary problems, sexual dysfunction

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3
Q

Risk factors and management of premature ovarian failure?

A

Risk Factors
• Bilateral salpingoopherectomy (BSO), mumps, pelvic TB, automimmune disorders, chemotherapy, ovarian degenesis, myotonic dystrophy

Management
• Give HRT until the age of 51 (average age of menopause)

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4
Q

Risk factors for osteoporosis?

A
  • Fam hx
  • Steroid usage
  • Low BMI
  • Early BMI
  • Increased age
  • Smoking
  • Alcohol
  • Low calcium intake
  • Sedentary lifestyle
  • Chronic disease
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5
Q

Investigations in menopause?

A
  • LH and FSH only useful if diagnosis in doubt as they fluctuate daily in the climetaric (pre-menstrual period)
  • Post menopause FSH <30
  • Mammography advised every 3 years following menopause
  • Endometrial biopsy for PMB
  • Bone density assessment for women at increased risk of osteoporosis
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6
Q

What is HRT?

A
  • Oestrogen + progesterone (if not had hysterectomy) – only oestrogen if they have (progestogen reduces risk of endometrial hyperplasia  cancer)
  • Oral, patch, gel, implant, spray or vaginal ring
  • Up to 5 years for menopausal symptoms, can be lifelong for osteoporosis. With premature, should take up to median age of natural menopause (52).
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7
Q

Contraindications to HRT?

A
  • Absolute: current breast or endometrial cancer, undiagnosed vaginal bleeding, thrombosis, breast mass, active liver disease
  • Relative: endometriosis, fibroids, fam or past hx of breast cancer or thrombotic disease, liver disease
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8
Q

Advantages of HRT?

A
  • Short term relief from symptoms
  • May regulate irregular bleeding
  • Protective against osteoporosis
  • Reduces sensory urgency
  • Improved hair and skin appearance
  • Protective against Alzheimer’s, tooth loss and bowel cancer
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9
Q

Disadvantages of HRT?

A
  • Menstruation unless period free preparation
  • Oestrogenic and progestogenic side effects
  • Increased risk of breast Ca
  • VTE and possible CVD
  • Risk of endometrial Ca
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10
Q

Causes of PMB?

A
Atrophic vaginitis (most)
Endometrial ca and hyperplasia (20%)
Cervical ca, cervicitis, ovarian ca, cervical polyps
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11
Q

Risk factors for endometrial cancer?

A
  • Early menarche, late menopause (prolonged oestrogen exposure results in greater proliferation of endometrium – more likely to become Ca)
  • HRT (unopposed oestrogen)
  • Polycystic ovaries – each cyst in an ovary is a follicle, stimulated but not released. Never get corpus luteum or release of progesterone – reduced ovulation and repeated oestrogen
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12
Q

History and examination in PMB?

A

History - Menopause diagnosed by 12 months of no bleeding – bleeding after 12-month gap considered PMB.

Exam - Bimanual examination of pelvis
Speculum and cervical smear

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13
Q

Investigations in PMB?

A

FAST TRACK, 10% of women with PMB have endometrial cancer
• Urgent USS
o 5mm thickness or above
o Urgent hysteroscopy and biopsy.

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14
Q

Management of endometrial hyperplasia?

A
  • With atypical cells seen – immediate hysterectomy
  • No atypical cells seen – high dose progestogens
    o Oral or Oral and Mirena coil
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15
Q

Management of endometrial cancer?

A

Refer to gynae oncology

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16
Q

Management of vaginal atrophy?

A
  • Reassure
  • Lubricants
  • Oestrodial creams (local oestrogen replacement)
    o Even if ER+ve breast cancer can use cream locally