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gynae > menopause > Flashcards

menopause Flashcards

1
Q

What is menopause?

A

-Cessation of menses.

-Diagnosis is made 12 months after the last period (Retrospective Clinical Diagnosis)
in a pt who is in the average age of 49-55

-The average age is 51

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2
Q

What do you call menopause that happens between 40-48year of age?

A

-Early Menopause

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3
Q

What if menopuase starts from 30-40?

A
  • Primary Ovarian Insufficiency/

- Premature ovarian failure.

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4
Q

What is perimenopause?

A
  • Refers to the variable time
  • Starts a few years before and
  • Continues a for a year after the menopause.

*Variable Cycle Length (+/- 7 days different from normal)
*>/= 2 skipped cycles
and a interval of amenorrhoea (>60 days)

-Perimenopause includes the Climacterium.

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5
Q

What does Climacterium mean?

A
  • Refers to the time after the cessation of reproductive function.
  • Marked by a change in menstrual cycle.
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6
Q

What causes Iatrogenic/Premature Menopause?

A
  • Hystrectomy
  • Oophorectomy
  • Chemo Radiation

causes iatrogenic/premature menopause.

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7
Q

What is the physiology of menopause?

A
  1. In human body there is Finite Ovarian
    Follicular Capacity.
  2. During the average age of menopause, follicles run out
  3. There is cessation of Folliculo-genesis.
  4. This results in reduced oestrogen circulation.
  5. Reduced oestrogen circulation causes menopausal symptoms.
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8
Q

What will reduced oestrogen circulation in blood cause?

A

Acute
Intermediate and
Long term Sx

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9
Q

What are the acute Sx of decrease in oestrogen circulation in menopuase?

A
  1. Acute Symptoms (within months of hypo-oestrogenism)
    - Vasomotor Symptoms (Hot Flushes)
  • Night sweats
  • Insomnia
  • Mood Changes
  • Headaches
  • Anxiety and irritability
  • Poor memory and concentration
  • Loss of self esteem.
  • Amenorrhoea
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10
Q

What are the intermediate Sx?

A
  • Genital tract Atrophy
  • Dyspareunia and loss of libido
  • Urethral Syndrome
  • Skin thinning
  • Urinary incontinence ?
  • Joint pain?
  • Uterine vaginal prolapse.
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11
Q

What are the long term Sx?

A
  • Osteoporosis
  • Coronary heart disease
  • Cerebrovascular accidents
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12
Q

What are the commonest sx that pt in menopauase present with?

A
  1. Vasomotor Sx
    - Hot flushes (commonest)
  2. Menstrual Irregularity
  3. Urogenital Sx
    - Dryness
    - Incontinence
    - Urgency
    - Prolapse
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13
Q

Menstrual Irregularity in peri-menopause:

A

-Anovulatory type
(Skips period and has heavy bleeding)

-Exclude organic cause
*Do Pap smear
*Do endometrial sample
to exclude non-benign cause

Management:
-Menopause Hormonal Therapy.

  • Progestogens if contraception requires.
    3. NSAIDs
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14
Q

Urogenital Atrophy in perimenopause:

A
  • Vaginal dryness and Atrophy
  • Urinary incontinence
  • Urogenital prolapse

Management:

If only vaginal dryness and atrophy, can give topical vaginal oestrogen

if prolapse= conservative vs surgical options

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15
Q

What are the indications of Menopausal Hormonal Therapy?

A
  1. Severe vasomotor Symptoms.
  2. Topical form for Urogenital atrophy.
  3. Osteopaenia/osteoporosis
    * Controversial
  4. Premature Ovarian failure
  5. Early Menopause
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16
Q

What are the contraindications of MHT?

A
  1. Breast Cancer, family history
  2. Previous venous thromboembolus
  3. Inherited thrombophilias
  4. Active Liver disease
  5. Undiagnosed Abnormal vaginal bleeding
  6. Cradiovascular disease
17
Q

Types of MHT:

A
  1. Estrogen only Therapy (ET)
    - For pts without uterus
  2. Estrogen-Progestin Therapy (EPT)
    - For patients with intact uterus.

*Sequential EP
(Progestin will come, later on on day 14, till day 28 and then will be withdrawan,
pt will get withdrawal bleeding)
-useful in early perimenopausal age group.

If pt has vasomotor sx and ireegularity bleeding then sequential EPT.

*Continuous Combined EPT.
(Have equal dosages of oestrogen and progestin)

18
Q

at what age should MHT not be used?

A

> 60 years of age

19
Q

What is the mx of menopause?

A

1.Lifestyle Modification
-healthy diet, moderate excercise,
smoking

  1. Menopausal Hormonal Therapy.
  2. Clonidine (for vasomotor sx)
  3. Biphosphonates
    SERMs (for osteoporosis)
  4. Psychotheraphy for selected pts.
  5. Annual f/u and review.
20
Q

Complementary Treatment for menopause:

A
  1. Vitamin D and
    Calcium supplementation
  2. Herbal Remedies and phyto-eostrogens
    - Significant or unproven risk profile
21
Q

What is the contraindication of unopposed oestrogen/ estrogen only therapy?

A
  • Contraindicated in pt with an intact uterus
  • Unopposed oestrogen will lead to endometrial cancer
  • Dont just repeat prescriptions
22
Q

dd of post menopausal bleeding:

A
  • Cervical cancer (do pap smear)
  • Endometrial cancer (do endometrial sampling)
  • Endometrial hyperplasia (do transvaginal u/s to get ET)
  • Endometrial polyps
  • Vulvovaginal atrophy
  • Can use topical oestrogen cream (Premarin)

can be used even if oral oestrogen contrindicated.

gynae (12 decks)

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