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GYNAECOLOGY > Menopause > Flashcards

Menopause Flashcards

1
Q

What is it?

A

A period of menstrual irregularity followed by the cessation of menstruation

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2
Q

Mean age of onset

A

52 yrs in UK

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3
Q

How long after LMP can it be diagnosed if:

<50

> 50

A

< 50 - 2 yrs after LMP

> 50 - 1 yr after LMP

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4
Q

Causes of premature menopause:

Genetic - 2

Endocrine:

  • adrenal glands
  • pancreas

Metabolic galactosaemia is also one. What is it?

A

Turners and Fragile X

Addison’s Disease

Diabetes

Metabolic galactosaemia

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5
Q

Presentation:

Vasomotor disturbance - 3

Atrophy of oestrogen-dependent tissue:

  • What happens to these tissues?
  • What happens to the vagina? What may this increase the risk of?
  • Urinary - 2
  • What 3 types of tissue may atrophy?
  • Why do they get prolapses?
A

Sweat
Palpitations
Hot flushes (brief and severe)

Tissues lose their elasticity and the lining thin.

Vaginal dryness leading to infections and UTIs

Dyspareunia
Stress incontinence - no longer able to control

Vagina
Breasts
Skin

The lack of estrogen during menopause thins the support structures and tissue that hold pelvic organs in place, causing them to fall.

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6
Q

Presentation:

Mood - 2

Cognitive and psychological triad?

What effect does menopause have on bones?
What does this increase the risk of?

A

Irritable
Tearful

Tired and sleep disturbance
Poor concentration
Memory problems

Menopause accelerates bone loss leading to OSTEOPOROSIS

Increased risk of femur neck and vertebrae fractures

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7
Q

Mnemonic for remembering issues:

FEM CHANGES

A

Flushes
Emotional
Memory problems

Concentration problems 
Hidrosis (night sweats) 
Atrophy 
No sleep 
Genitourinary (incontinence)
Extra beats (palpitations)
Skin changes
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8
Q

DDx

A

Thyroid disease
DM
Anaemia
Psychological problems

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9
Q

Investigations:

It is rarely needed!!!!!!

What hormone is measured?

How many times is it measured?

What else can be examined?

A

FSH

Twice - 1 month apart - confirms M

PV exam +/- speculum
Abdo exam

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10
Q

Management:

Many women do not need Rx - this is just for those who are symptomatic!!!!!!!

Main Rx?
For how long should they be on contraception if > 50 and < 50?

Alternatives or adjuncts to main Rx:

  • Vasomotor symptoms:
    - Clonidine - what is it?
    - Other meds used - typically seen in psych
  • Vaginal atrophy - what can be used topically?
A 
HRT 
-------
>50 yrs - continue for 1 yr
<50 - continure for 2 yrs 
----

Alpha agonist - helps with flushing
SSRIs or SNRIs
Gabapentin

Moisturisers
Lubricants

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11
Q

Management:

Lifestyle changes

Rx for vaginal dryness?

Rx for osteoporosis? - 3

A

Diet and exercise

Oestrogen cream

Vit D
Calcium
Biphosphonates

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12
Q

HRT:

2 TYPES:

A

Combined O and P

Oestrogen only

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13
Q

HRT:

When is the only time a patient should use oestrogen-only HRT? WHY?

Dose and monitoring:

  • How long should women be on HRT?
  • How do you start it?
  • What should you warn women?

Formulation and route:

What is meant by cyclic HRT?
When is it used?

What is meant by continuous combined HRT?
When is it used?

A

5 yrs - stopped after

Vaginal bleeding in the first 3 months

Daily O but P only late in cycle

If there is still irregular periods, <1 yr since LMP

O and P daily

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14
Q

HRT:

Route given?

Route for those with vaginal symptoms - 3

Other routes for systemic symptoms

A

PO

Creams
Pessaries
Rings

  • Transdermal patches (better if VTE worry - increases plasma concentrations of these clotting factors by increasing gene transcription.)
  • Implants
  • Gel
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15
Q

HRT:

Side effects of oestrogen:

  • Main one
  • Pain where?
  • Why do they get high BP?
A

Nausea

Headache
Tender breasts
Leg cramps

Sodium and fluid retention

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16
Q

HRT:

Side effects of progesterone:

  • Abdo
  • Mood
  • Skin
A

Bloating

Irritability
Depression

Acne
Facial hair

17
Q

HRT - Risks:

Cancer - where?

VTE risk:

  • What hormone is responsible for this?
  • What route can be used to stop risk?

Does the risk remain the same if you stop after 5 yrs?

A

Endometrial (unopposed O only - combined reduces risk)
Breast
Ovarian

Oestrogen - increases plasma concentrations of these clotting factors by increasing gene transcription.

Transdermal HRT

No, risk returns to normal!!!

18
Q

HRT - Contraindications:

  • What may there be a history of?
  • Other gynae conditions?
  • Non-gynae conditions?
A

Personal or FH of the breast (breast lump), endometrial and ovarian cancer

Fibroids
Endometriosis
Undiagnosed vaginal bleeding

Migraine with aura 
SLE 
Liver disease 
Uncontrolled HTN 
Personal or FH of VTE

GYNAECOLOGY (35 decks)

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