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Menopause and Amenorrhoea Flashcards

1
Q

What is menopause?

A

Lack of menstruation for >1 year and defined as permanent end to menstruation

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2
Q

What is andropause?

A

When testosterone begins to fall by 1% a year after 30, yet there are no sudden changes and fertility remains

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3
Q

What is the average age of menopause onset?

A

51

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4
Q

How long does perimenopause last?

A

Approx 5 years before menopause and the 12 months after

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5
Q

What age does premature menopause occur?

A

<40 years as the result of premature ovarian insufficiency

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6
Q

Describe the pathophysiology of menopause

A

Menopause is caused by the lack of of ovarian follicular function, so oestrogen and progestogen are low and FSH/LH are high and erratic due to negative feedback absence

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7
Q

How does menopause present?

A

Vasomotor symptoms/hot flushes

Vaginal dryness

Dyspareunia

Atrophy and thinning of vaginal epithelium

Low libido

Muscle and joint aches

Mood changes

Poor memory/concentration

Osteoporosis

Overactive bladder symptoms, such as frequency and urgency

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8
Q

What are the two types of hormonal replacement therapy?

A

Systemic Transdermal

  • Oestrogen or oestrogen + progestogen

Local Vaginal

  • Oestrogen only
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9
Q

Why does HRT require progestogen if women has a uterus?

A

To prevent endometrial hyperplasia/overactive uterus, as oestrogen causes endometrium to proliferate

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10
Q

Give contraindications for systemic HRT

A

Current hormone dependent cancer (breast or endometrium)

Current active liver disease

Un-investigated abnormal bleeding

Previous venous thromboembolism, thrombophilia

Previous breast cancer or BRCA carrier

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11
Q

Give benefits of HRT

A

Vasomotor symptom relief

Local genital symptoms relief

Osteoporosis risk reduced

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12
Q

Give complications of HRT

A

CVS if oral

Ovarian cancer

Venous thrombosis (and thrombotic events, such as stroke)

Breast cancer if combined HRT

Gall bladder disease

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13
Q

When is transdermal HRT used?

A

Women at risk of VTE

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14
Q

Give symptomatic management of menopause, other than HRT

A

Selective oestrogen receptor modulators (SERMs), for hot flushes

SSRI antidepressants

Natural methods, due to high placebo effect

Non hormonal vaginal lubricants

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15
Q

What is primary amenorrhoea?

A

Never had a period, >14 years if no secondary sexual characteristics and >16 if secondary sexual characteristics

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16
Q

What is secondary amenorrhoea?

A

Has had period but none for 6 months

17
Q

Give causes of primary amenorrhoea

A

Late puberty

Turner syndrome

Vaginal agenesis

Testicular feminisation

18
Q

What is the most common cause of primary amenorrhoea?

A

Late puberty

19
Q

Give causes of secondary amenorrhoea

A

Pregnancy

Breast feeding

Contraceptive related

PCOS

Early menopause

Thyroid disease/Cushing’s

Raised prolactin

Hypothalamic-Pituitary-Ovarian Dysfunction

Androgen secreting tumour

Sheehan’s syndrome

Ashermans syndrome/Intrauterine adhesions

20
Q

What is the most common cause of secondary amenorrhoea?

A

Hypothalamic-Pituitary-Ovarian Dysfunction (stress, weight change)

21
Q

What investigations are used in trying to find the cause of amenorrhoea?

A

BMI

Urine pregnancy test and dipstick for glucose

FSH bloods

  • Oestradiol
  • Prolactin
  • Thyroid function
  • Testosterone

Pelvic USS: PCOS

22
Q

What is atrophic vaginitis?

A

Atrophy of the vaginal mucosa due to lack of oestrogen, resulting in it becoing thin, dry and less elastic, occuring in menopausal and post-menopausal women

23
Q

How does atrophic vaginitis present?

A

Vaginal dryness

Vaginal itchyness

Dyspareunia (discomfort or pain during sex)

Occasional spotting/bleeding due to localised inflammation

Pale mucosa, erythema and inflammation

Thin and sparse pubic hair

24
Q

How is atrophic vaginitis managed?

A

Vaginal lubricants and moisturisers

Topical oestrogen (ring, cream or pessary)

25
Q

Give contraindications of topical oestrogen

A

VTE

Angina

Breast cancer

26
Q

What is premature ovarian failure?

A

Onset of menopausal symptoms and elevated gonadotrophin levels before the age of 40 years

27
Q

What causes premature ovarian failure?

A

Idiopathic

Chemotherapy

Autoimmune

Radiation

Reproduction (18 decks)

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