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Y5 Gynae & Obstetrics > Menopause > Flashcards

Menopause Flashcards

1
Q

What is menopause?

A

permanent cessation of the menstrual cycle for 12 months (diagnosed retrospectively)

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2
Q

What is perimenopause?

A

The time from the onset of ovarian dysfunction to diagnosis of menopause

(the time around menopause)

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3
Q

What is the average age for menopause in UK?

A

51

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4
Q

What is the age interval for menopause?

A

45-55

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5
Q

What occurs to GnRH during menopause?

A

First increases in perimenopause

Then decreases > overall reduction long term

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6
Q

What occurs to LH and FSH during menopause?

A

Increases

Progressive decline as person becomes elderly

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7
Q

What occurs to oestrogen and progesterone during menopause?

A

DECLINE

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8
Q

What are oestrogen levels like in the elderly?

A

Very low

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9
Q

What are progesterone levels like in the elderly=?

A

Undetectable

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10
Q

What occurs to inhibit during menopause?

A

Declines to an undetectable level

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11
Q

What is premature ovarian insufficiency?

A

Menopause before the age of 40

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12
Q

What is the option for conception in premature ovarian insufficiency=

A

Egg donation

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13
Q

What are causes of premature ovarian insufficiency?

A

Primary:

  • chromosomal abnormalities (Turner’s, fragile X)
  • Autoimmune disease (hypothyroid, Addisons, myasthenia graves)
  • Enzyme deficiency

Secondary:
- Chemotherapy/radiotherapy
Infections

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14
Q

What is the main cause of POI?

A

UNKNOWN in 90% of patients = IDIOPATHIC

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15
Q

How is POI diagnosed?

A

2 FSH readings 4-6 weeks apart

FSH will be high in both

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16
Q

What is treatment for POI?

A

Supportive care and counselling

  • HRT/COCP for bone health and CVD protection
  • ART(egg donation + IVF) for infertility
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17
Q

What are immediate symptoms of menopause?

A

vasomotor - hot flushes, night sweats
psychological - labile mood, anxiety, tearfulness
neuro - poor memory, loss of concentration
MSK - joint aches and pains
derm - dry and itchy skin
decreased libido

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18
Q

Whatare intermediate symptoms of menopause=

A

vaginal dryness, dysparaeunia
urgency of urine
Recurrent UTI
urogenital prolapse

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19
Q

What are long term symptoms of menopause?

A

osteoporosis
CVD
dementia

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20
Q

Why do vasomotor symptoms occur in menopause?

A

due to exaggerated peripheral vasodilation to slight changes in external temperature

21
Q

What are triggers for vasomotor symptoms?

A

alcohol, caffeine, sweating

22
Q

How does fat distribution change in menopause?

A 
from gyanecoid (breast and hip fat) 
to android (abdominal fat)
23
Q

How do CVD risk factors change in menopause?

A

reduction in HDL

Increase in triglycerides, cholesterol, LDL

24
Q

What is conservative management of menopause?

A

normal BMI
stop smoking
reduce alcohol consuptption

25
Q

What are non hormonal treatments for menopause?

A 
alpha agonist e.g. clonidine 
beta-blocker e.g. propanolol 
SSRI (for vasomotor symptoms) 
vaginal moisturiser /lubricant 
osteoporosis treatment (buphosphonate, raloxifene)
26
Q

What kind of hormones are used in HRT, and in what combination?

A

OESTROGEN ONLY if no longer has a uterus

OESTROGEN + PROGESTERONE otherwise (can be CYCLICAL or CONTINOUS COMBINED)

27
Q

What is the function of progesterone in HRT?

A

Protects the endometrium from cancer

28
Q

What are routes of hormone therapy administration?

A

Oral / transdermal / coil / gel

29
Q

What is the benefit of transdermal route?

A

It bypasses the liver

30
Q

What are absolute contraindications for HRT?

A 
Suspected pregnancy 
Breast cancer
Endometrial cancer 
Active liver disease
Uncontrolled HTN 
LVTE 
Thrombophilia 
Otosclerosis
31
Q

How does HRT affect cancer?

A

It does not drastically increase breast cancer

It just promotes growth of the cancer cells

32
Q

What is the hormone that increases risk of breast cancer?

A

Progesterone

33
Q

What is the hormone that increases risk of endometrial cancer?

A

Oestrogen

34
Q

Why do you need to give progesterone in HRT ?For which women is this necessary?

A

In women who have a uterus / with endometriosis tissue

It protects against endometrial cancer

35
Q

What is cyclical HRT composed of?

A

Oestrogen continuously

Progesterone only on day 0-12

36
Q

What women is cyclical HRT appropriate for’

A

LMP <1 yr prior / still having periods

Good for POI to preserve fertility

37
Q

What women is continuous combined HRT appropriate for

A

Women with LMP >2 yrs prior

38
Q

What is the benefit of continuous combined HRT compared to cyclical?

A

Continuous progesterone reduces risk of endometrial cancer
BUT
It increases risk of breast cancer

39
Q

What is the impact of HRT on CVD?

A

Depends on women’s age

  • younger;: protective
  • older: increases risk
40
Q

What women can HRT be prescribed to ?

A

Women in the WINDOW OF OPPORTUNITY

  • <60 years old
  • within 10 years of menopause onset
41
Q

How. do you follow up a woman after her first HRT dose?

A

Recall 3 months after starting - to see if trial works

Every 12 months review (BP; breast exam, vaginal exam, mammograpy)

42
Q

How long do you leave a woman on HRT for?

A

The least duration of time possible

43
Q

What kind of HRT does not have increased VTE risk?

A

TRANSDERMAL

44
Q

what is the effect of adding a progesterone to HRT on VTE?

A

Adding a Progesterone will INCREASE VTE risk

45
Q

What kind of progesterone in HRT will reduce risk of endometrial cancer

A

CONTINUOUS combined (so continuous progesterone)

46
Q

What kinds of cancer does estrogen cause

A

Endometrial

Ovarian

47
Q

What kinds of cancer does progesterone cause

A

Breast, cervical

48
Q

What cancer is progesterone protective for

A

Endometrial

Y5 Gynae & Obstetrics (34 decks)

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