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becks gynaecology qs > Menopause and postreproductive health > Flashcards

Menopause and postreproductive health Flashcards

1
Q

What is menopause?

A

The permanent cessation of menstruation, resulting from a loss of ovarian follicular activity. Natural menopause is recognised to have occurred after 12 consecutive months of amenorrhoea.

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2
Q

What is the median age of menopause?

A

51 years old

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3
Q

What is perimenopause?

A

Time beginning with the first features of menopause, and ends 12 months after the last menstrual period.

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4
Q

What is postmenopause?

A

Defined as dating from the last menstrual cycle (cannot be determined until 12 months after)

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5
Q

What is premature menopause?

A

When menopause occurs before the age of 40 years old.

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6
Q

What are the causes of post-menopausal bleeding?

A 
Endometrial carcinoma
Endometrial hyperplasia +/- atypia and polyps 
Cervical carcinoma
Atrophic vaginitis 
Cervicitis 
Ovarian carcinoma
Cervical polyps
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7
Q

Explain the investigations and management in post-menopausal bleeding?

A
  1. Bimanual and speculum
  2. Cervical smear if not had one
  3. Transvaginal sonography - measures endometrial thickness and can tell you if they have polyps or ovarian cysts.
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8
Q

What are the guidelines for endometrial thickness and number of bleeds?

A

If they don’t have endometrial thickening >4mm and one PMB, they do not need endometrial biopsy/hysteroscopy.

If they are found to have endometrial thickening (>4mm) or they have had multiple PMB then they have a biopsy +/- hysteroscopy.

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9
Q

What happens once malignancy has been excluded?

A

They are given topical oestrogen or oral ospemifene (selective oestrogen receptor modulator) for atrophic vaginitis.

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10
Q

What are the symptoms and consequences of menopause in women?

A

Cardiovascular disease
Vasomotor symptoms - hot flushes/night sweats (70%)
Urogenitcal problems - atrophic vaginitis can cause painful sex, stopping sex, itching, burning and dryness. Urinary symptoms include frequency, urgency, nocturia, incontinence and recurrent infection.
Osteoporosis.

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11
Q

What is osteoporosis?

A

A skeletal disorder characterised by compromised bone strength predisposing to an increased risk of fracture.

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12
Q

What are the most common osteoporotic fractures?

A

Wrist (Colles’ fracture), hip and spine.

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13
Q

What tool is used to calculate the 10 year probability of a fracture based on individual patient clinical factors.

A

FRAX

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14
Q

What are the risk factors for osteoporosis?

A 
Smoking
Low BMI 
Early menopause
Alcohol abuse
Low calcium intake 
Sedentary lifestyle
Corticosteroid usage 
Hyperthyroidism/rheumatoid arthritis/NMD/chronic liver disease/malabsorption syndromes
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15
Q

What tests are used to confirm menopause?

A

FSH - high due to no oestrodiol/inhibin having a negative feedback on pituitary. Measured between days 2-5 to avoid the peak.
AMH - produced by small follicles and therefore would be low in menopause. Can be measured whenever.

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16
Q

What non-invasive method can be used to check bone density for suspected osteoporosis?

A

DEXA scan.

17
Q

What are the different ways to administer HRT?

A

Pills, patches, implants, gels

18
Q

What are the components of HRT?

A

Oestrogen and progesterone

19
Q

What HRT is given to perimenopausal women?

A

You need to consider contraception as they are not post menopausal yet. Therefore, you need to use the intrauterine progesterone IUD with an oestrogen component or a cyclical or sequential preparation.

20
Q

What HRT is given to women without a uterus?

A

Oestrogen only because there is no uterus to worry about it being unopposed.

21
Q

What is tibolone?

A

Tibolone is a synthetic steroid with weak estrogenic, progestogenic, and androgenic activity, and hence is an agonist of the estrogen, progesterone, and androgen receptors.
It treats post-menopausal women who desire amenorrhoea and treats vasomotor, psychological and libido problems. It conserves bone mass.

22
Q

What can be used to help libido in post-menopausal women?

A

Androgens (testosterone)

23
Q

Why is oestrogen alone not used to prevent bone density loss in menopause?

A

Progesterone reduces the risk of endometrial hyperplasia and carcinoma, which occurs with unopposed oestrogen

24
Q

What HRT is given to women who have a uterus?

A

Progesterone can be given cyclically for 10-14 days every 4 weeks, for 14 days every 3 months or continuously (monthly, 3 monthly and no bleeds respectively).

25
Q

What HRT is given to women post-menopausal?

A

Unlike perimenopause, HRT should not be used cyclically and should be used continuously. This does not need to be a contraceptive HRT.

26
Q

What are topical oestrogens used for? Do they require progesterone?

A

Topical oestrogens are used to treat urogenital symptoms. These low-dose preparations do not elevate systemic oestrogen levels, so there is no requirement for progesterone to protect the endometrium.

27
Q

What are the types of topical oestrogens and what do women take when they cannot take thing?

A

Cream, pessary, ring.

They can have oral ospemifene (SERM)

28
Q

What symptoms of the menopause can oestrogen help with?

A

Vaginal dryness/soreness/atophic vaginitis
Urinary problems
Hot flushes
Superficial dyspareunia

29
Q

How is low libido treated in menopause?

A

Oestrogen alone might be effective enough, but usually testosterone is needed in addition.

30
Q

What are the cancer increased risks of HRT?

A 
Endometrial (unopposed oestrogen)
Breast cancer (combined increases risk, not oestrogen alone)
31
Q

What are the non-cancer increased risks of HRT?

A

Gallbladder disease

Venous thromboembolism

32
Q

How long are women generally treated for HRT?

A

5 years and then they are taken off and reassessed.

33
Q

How long are premature menopausal women advised to continue HRT for?

A

Until the median menopausal age.

34
Q

What non-hormonal class of drug can be used in prevention and treatment of osteoporosis?

A

Bisphosphonates

becks gynaecology qs (14 decks)

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