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Obstetrics and gynaecology > Menopause and premature ovarian insufficiency > Flashcards

Menopause and premature ovarian insufficiency Flashcards

1
Q

What is menopause

A

Retrospective diagnosis
When a woman has not had any periods for 12 months
Permanent end to menstruation

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2
Q

What age on average do women experience the menopause?

A

51yrs

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3
Q

What is postmenopause

A

From 12 months after the final period onwards

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4
Q

What is perimenopause

A

Time around the menopause - time leading up to the last menstrual period and the 12 months afterwards

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5
Q

At what age do most women start experiencing perimenopause

A

45 onwards

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6
Q

What is premature menopause

A

Menopause <40yrs

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7
Q

What is premature menopause caused by?

A

Premature ovarian insufficiency

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8
Q

What causes the menopause?

A

Lack of ovarian follicular function, resulting in changes in the sex hormones associated with the menstrual cycle

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9
Q

What happens to oestrogen and progesterone due to the menopause?

A

Low

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10
Q

What happens to LH and FSH due to the menopause

A

High - in response to an absence of negative feedback from oestrogen

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11
Q

Describe the physiology of the menopause

A

Decline in the development of the ovarian follicles
Without the growth of follicles, reduced production of oestrogen. Oestrogen has a negative feedback effect on the pituitary gland, suppressing the quantity of LH and FSH produced
As the level of oestrogen falls in the perimenopausal period, there is an absence of negative feedback on the pituitary gland and increasing levels of LH and FSH

The failing follicular development means ovulation does not occur, resulting in irregular menstrual cycles.
Without oestrogen the endometrium does not develop leading to amenorrhoea.
Low oestrogen levels also cause perimenopausal symptoms

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12
Q

List some perimenopausal symptoms

A 
Hot flushes
Emotional lability or low mood
Premenstrual syndrome 
Irregular periods
Joint pains
Heavier/lighter periods
Vaginal dryness and atrophy 
Reduced libido
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13
Q

What does a lack of oestrogen increase the risk of?

A

CVD and stroke
Osteoporosis
Pelvic organ prolapse
Urinary incontinence

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14
Q

How is a diagnosis of perimenopause made

A

Women >45yrs with symptoms, without performing investigations

FSH to help diagnose women <40 yrs with suspected perimenopause and women 40-45 with menopausal symptoms or a change in the menstrual cycle

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15
Q

What happens to fertility after age 40?

A

Declines gradually, however women should still consider themselves fertile

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16
Q

How long do women need to use effective contraception for when they think they are going through perimenopause

A

2 years after LMP in women <50 and 1 year after LMP in women >50

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17
Q

Describe the effect of hormonal contraceptives on menopause

A

Do not affect the menopause, when it occurs or how long it lasts, although they may suppress and mask the symptoms - makes diagnosing menopause more difficult

18
Q

List some good contraceptive options (UKMEC1) for women approaching the menopause

A 
Barrier methods
Mirena or copper coil
Progesterone only pill 
Progesterone implant
Progesterone depot injection (<45yrs) 
Sterilisation
19
Q

Name a UKMEC2 contraceptive method used during perimenopause and describe how long it can be used for and which versions are the best for this population

A

COCP - norethisterone or levonorgestrel in women >40 due to lower risk of VTE
Can be used <50 yrs if no other CIs

20
Q

What are the two key side effects of the progesterone depot injection?

A

Weight gain

Reduced bone mineral density

21
Q

Which women is the progesterone depot unsuitable in?

A

Women >45yrs

22
Q

How long do the vasomotor symptoms of perimenopause last for?

A

2-5 years without treatment

23
Q

Describe the management of perimenopausal symptoms

A

No treatment
HRT
Tibolone - acts as continuous combined HRT
Clonidine
CBT
SSRIs - fluoxetine or citalopram
Vaginal oestrogen - vaginal dryness and atrophy, used alongside systemic HRT
Testosterone - treat reduced libido
Vaginal moisturisers - sylk, replens, YES

24
Q

What is premature ovarian insufficiency

A

Menopause before age 40

25
Q

What is premature ovarian insufficiency a result of?

A

Decline in the normal activity of the ovaries at an early age
Presents with early onset of the typical symptoms of menopause

Hypergonadotropic hypogonadism

26
Q

Describe hypergonadotropic hypogonadism

A

Under activity of the gonads means there is a lack of negative feedback on the pituitary gland, resulting in an excess of the gonadotropins

27
Q

What will hormonal analysis of premature ovarian failure show?

A

Raised LH and FSH

Low oestrogen

28
Q

What are the causes of premature ovarian insufficiency

A

Idiopathic
Iatrogenic - chemo, radiotherapy, surgery
Autoimmune - Coeliac disease, adrenal insufficiency, T1DM, Thyroid disease
Genetic - FH, turners syndrome
Infections - Mumps, TB or CMV

29
Q

Describe the presentation of premature ovarian insufficiency

A

Irregular menstrual periods
Lack of menstrual periods
Symptoms of low oestrogen levels - hot flushes, night sweats and vaginal dryness

30
Q

Describe the diagnosis of premature ovarian insufficiency

A

Woman <40yo
Typical menopausal symptoms
Elevated FSH (persistently raised on 2 occasions separated by more than 4 weeks apart)

31
Q

When are FSH levels difficult to interpret?

A

Women taking hormonal contraception

32
Q

What is premature ovarian insufficiency associated with?

A 
CVD
Stroke
Osteoporosis
Cognitive impairment
Dementia
Parkinsonism
33
Q

Describe the management of premature ovarian insufficiency

A

HRT until at least age 50

34
Q

Describe the benefits of HRT

A

Reduces CVD, osteoporosis, cognitive and psychological risks

35
Q

Why is contraception needed in women with premature ovarian failure?

A

Small risk of pregnancy

36
Q

Describe the two options for HRT in women with Premature ovarian insufficiency

A

Traditional hormone replacement

Combined oral contraceptive pill

37
Q

Why is HRT a better option than the COCP in people with premature ovarian insufficiency?

A

Lowers BP

38
Q

Why is COCP better than HRT in women with premature ovarian insufficiency?

A

Less stigma - more socially accepted

Acts as a contraception

39
Q

Describe HRT and the risk of breast cancer

A

Not considered to increase the risk as women would ordinarily produce the same hormones at this age

40
Q

How can the risk of VTE in women <50 on HRT be reduced?

A

Transdermal methods

Obstetrics and gynaecology (67 decks)

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