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Gynaecology > Menopause and post-reproductive health > Flashcards

Menopause and post-reproductive health Flashcards

1
Q

1st

A

1st

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2
Q

What is the median age for the menopause?

A

51 years

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3
Q

When has menopause occurred?

A

After 12 consecutive months of amenorrhoea

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4
Q

What is the perimenopause?

A

Time beginning with the first features of approaching menopause eg. vasomotor symptoms and menstrual irregularity and ending with 12months after amenorrhoea

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5
Q

When is post-menopause

A

From last menstrual period but cannot be defined until 12months later

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6
Q

When is premature menopause

A

Menopause before age of 40

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7
Q

What % of women have premature menopause

A

1%

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8
Q

What is definition of post-menopausal bleeding?

A

Bleeding occurring at least 12 months after last menstrual period

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9
Q

What is key to exclude with post-menopausal bleeding? x4

A

Endometrial or cervical cancer - or premalignant endometrial hyperplasia
Ovarian carcinoma

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10
Q

Other non-malignant causes of post menopausal bleeding?

A

Atrophic vaginitis
Cervicitis
Cervical polyps

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11
Q

Investigation of post menopausal bleeding?

A

Bimanual and speculum examination
Cervical smear if out of date
TV sonography - measure endometrial thickness and looks for fibroids or ovarian cysts

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12
Q

Management if endometrial thickness 4mm or less + single episode of PMB

A

Endometrial biopsy and hysteroscopy not required

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13
Q

Management if endometrium thicker than 4mm or multiple bleeds

A

Endometrial biopsy +/- hysteroscopy

Outpatient procedure

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14
Q

Treatment of atrophic vaginitis

A

Topical oestrogens

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15
Q

What are the most common symptoms of the menopause?

A

Hot flushes and night sweats - some can continue to have these into their 60s and 70s

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16
Q

Urogenital problems of the menopause

A

Oestrogen deficiency can cause vaginal atrophy (dyspareunia, itching, burning and dryness) and urinary symptoms (frequency, urgency, nocturia, incontinence and recurrent infection)

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17
Q

Incidence of osteoporotic fractures in women >50 years

A

1 in 3 women over 50 have one or more osteoporotic fracture

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18
Q

Normal bone mineral density T score

A

Between -1 and +1 SD of young adult mean

19
Q

Osteopenia bone mineral density T score

A

Between -1 and -2.5 SD of young adult mean

20
Q

Osteoporosis bone mineral density T score

A

> -2.5 SD from young adult mean

21
Q

Most common sites for osteoporotic fractures

A

Wrist or Colle’s fracture, hip and spine

22
Q

What test gives estimate of the degree of ovarian reserve remaining

A

FSH - increased levels suggest fewer oocytes remaining in the ovaries

23
Q

When should FSH levels be tested

A

Between day 2-5 of the cycle to avoid pre-ovulatory increase and luteal phase suppression

24
Q

What test gives a direct measure of the ovarian reserve remaining

A

AMH - produced by small ovarian follicles - stable throughout the menstrual cycle so can be measured on any day

25
Q

What does a low progesterone level indicate?

A

Anovulation - secondary to other causes eg. PCOS

26
Q

What is in HRT for women who have had a hysterectomy

A

Oestrogen

27
Q

What is in HRT for women who have not had hysterectomy

A

Oestrogen and progestogen

28
Q

How can HRT be given?

A

Oestrogen - orally, transdermally (patch), SC (implant)

Progestogens - orally, transdermally or directly into uterus (IUS)

29
Q

What oestrogen is used in HRT?

A

Natural eg. oestradiol, oestrone and oestriol

Not ethinyloestradiol because greater metabolic impact

30
Q

Progestogen used in HRT and its role?

A

Levonorgestrel or norethisterone - it causes no bleed HRT regimen

31
Q

What is Tibolone?

A

Synthetic steroid compound - converted in vivo to metabolites with oestrogenic, progestogenic and androgenic actions
Used in post-menopausal women who desire amenorrhoea and treats vasomotor, psychological and libido problems - conserves bone mass

32
Q

What sort of HRT regimen is good for women experiencing bleeding or are within 12months of last menstrual period

A

Sequential or cyclic therapy

Or intrauterine levonorgestrel with oral oestrogen

33
Q

What is the benefit of continuous regimens over sequential regimens of HRT?

A

Lack of induced bleeding and reduced risk of endometrial cancer

34
Q

How quickly does HRT relieve vasomotor menopausal symptoms?

A

Within 4 weeks

35
Q

What cancer does HRT reduce the risk of whilst taking it?

A

Colorectal cancer reduced by about 1/3

36
Q

What cancer risks are increased with oestrogen only HRT?

A

Endometrial cancer - hence why non-hysterectomised women have progesterone added

37
Q

What cancer risks are increased with combined HRT

A

Breast cancer - slightly increases the risk - risk falls after stopping HRT

38
Q

What vascular disease is increased risk with HRT?

A

Venous thromboembolism (VTE) - transdermal patches and gel HRT may decrease this risk

39
Q

What abdominal problem increases with HRT?

A

Gallbladder disease

40
Q

HRT and ovarian cancer?

A

Conflicting evidence, some say increase risk and some say none, if there is an increased risk it is small and only after 10 years of HRT

41
Q

Duration of average HRT treatment - if to treat menopausal symptoms

A

5 years

42
Q

Premature menopause - duration of HRT?

A

Until median age of menopause - 51 years

43
Q

What non-oestrogen therapy can help vasomotor symptoms x3

A

Progestogens can be effective
SSRIs and SNRIs - effective at treating hot flushes in short term studies
Gabapentin - limited evidence that it is effective

44
Q

What non-oestrogen therapy can help vaginal atrophy

A

Lubricants and moisturisers are available but less effective than oestrogen

Gynaecology (8 decks)

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