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obs and gynae > menopause > Flashcards

menopause Flashcards

1
Q

what is menopause ?

A

the last menstrual period

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2
Q

average age of menopause?

A

52

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3
Q

what is peri menopause

A

transition phase from pre to post menopausal and the time in which symptoms are experienced

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4
Q

why do you get reduced circulating levels of oestrogen and progesterone

A

ovaries become less sensitive to FSH and LH

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5
Q

what happens to levels of FSH and LH?

A

they are increased as there is less oestrogen and progesterone

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6
Q

why do you get Reduced proliferation of the endometrium, resulting in oligomenorrhoea and then eventually amenorrhoea?

A

reduced levels of oestrogen

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7
Q

the ain biologically active form of oestrogen?

A

E2

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8
Q

which is the oestrogen produced by the peripheral tissues such as adipose and adrenal glands?

A

E1

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9
Q

why do you get proportional increased levels of E1?

A

as there is reduced E2

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10
Q

what happens to the breast and vaginal tissue medium term?

A

atrophy

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11
Q

what is vaginal atrophy called?

A

atrophic vaginitis

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12
Q

long term complications of low eostrogen?

A

osteoperosis

increased risk of cardiovascular and cerebrovascular disease

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13
Q

what investigation can you do to diagnose menopause?

A

serum FSH >430 twice, 6 weeks apart

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14
Q

conventional management?

A

weight loss, smoking cessation, complimentary therapies

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15
Q

synthetic steroid that can be used as an alternative to HRT and is associated with similar risks

A

tibolone

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16
Q

routes of administration for HRT?

A

oral, transdermal patch, vaginal ring, injections, intrauterine (mirena)

17
Q

when do you use oestrogen only

A

only if patient has had hysterectomy

18
Q

why can oestrogen only not be used in patient with a uterus?

A

unnopposed oestrogen is too big a risk factor for endometrial cancer

19
Q

how can combined HRT be taken?

A

oral/patch/mirena coil

20
Q

combined HRT and need contraception?

A

mirena

21
Q

who gets sequential HRT?

A

peri menopausal women with a uterus

22
Q

what does the sequential regimen involve?

A

getting oestrogen for 28 days and progesterone for the later half of the cycle which mimics the natural production of these hormones

23
Q

what does progesterone do in sequential?

A

protects the endometrium and allows regular bleeds

24
Q

how long can you use the sequential HRT?

A

a maximum of 2 years due to risk of endometrial cancer

25
Q

when do you use continuous HRT?

A

post menopausal women with a womb or peri who have used sequential for 2 years

26
Q

what is post menopausal defined as?

A

LMP>1 year or age over 54

27
Q

do you get a monthly bleed on continous?

A

no monthly bleed after 6 months

28
Q

what can peri menopausal women use for a bleed free regimen ?

A

oestrogen only and mirena

29
Q

benefits of HRT?

A

symptom control
reduced risk of colorectal cancer
prevention and treatment of osteoporosis

30
Q

Risks of HRT?

A

VTE
Stroke
increased risk of breast, ovarian and endometrial cancer

31
Q

highest risk of VTE - which HRT?

A

combined

32
Q

risk of breast cancer only increased in use with ?

A

combined

33
Q

after stopping, when does risk of breast cancer go back to normal ?

A

after 5 years

34
Q

risk of endometrial cancer is only really seen in ?

A

oestrogen only

35
Q

risk of endometrial cancer in women on sequential and continuous?

A

risk reduced with sequential and eliminated with continuous

36
Q

increased risk of ovarian cancer?

A

small increase in risk with any HRT

37
Q

when do you get an increased risk of CVD in combined

A

if its started more than 10 years after the menopasue

38
Q

increased risk of alzheimers if started after age?

A

60

obs and gynae (20 decks)

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