Menopause and secondary amenorrhea Flashcards
Describe the menopause
Last ever period- average age 51, perimenapause for around 5 years before this.
What is premature menopause?
Menopause before 40 years
Describe the physiology of the menopause?
Ovarian insufficiency Oestradiol falls FSH rises Still some peripheral oestriol Conversion of adrenal androgens in fat
What are some common characteristics of menopause
Hot flushes- last 2-5 years Vaginal dryness/ painful sex Low libido Muscle and joint aches Mood changes/poor memory Osteoperotic changes
How do you prevent osteoporosis?
Exercise, adequate calcium and Vit D, HRT, bisphosphonates, densumab, teripartide
What are the treatments for menopause symptoms?
HRT- oestrogen only if no uterus. If not oestrogen and progesterone.
Local vaginal oestrogen pessary/ring/cream no need for progesterone, no increased VTE or breast cancer risk
What are some contraindications for HRT?
Current hormone dependent cancer (breast/endometrium) Current active liver disease Uninvestigated abnormal bleeding previous VTE, thromophilia, FH VTE previous breast Ca or BRCA gene carrier
Describe the process of taking the combined oestrogen and progesterone HRT
Continuous combined HRT taken daily
Bleed free after 3 months and lower endometrial cancer risk
If in perimenopause likely to have breakthrough bleeding
Any age can use Mirena LG IUS and daily oestrogen
Discuss the effects of selective oestrogen modulators (SERM’s)
Has an effect on selected organs,
SSRI and SNRI can also be used but not or vasomotor symptoms alone. There are side effects and little benefits
What are the benefits to HRT?
What are the risks to HRT?
Vasomotor symptoms reduced
Local genital symptoms improved
osteoperosis less chance
Breast and ovarian cancer increased on combined HRT
Venous thrombosis and stroke if oral route
What are the NICE recommendations on HRT?
For treatment of severe vasomotor symptoms review annually
For woman with premature ovarian insufficiency HRT benefits outweigh risk until age 50
Not used as a first line treatment fr osteoperosis prevention/treatment
Vaginal oestrogen for vaginal symptoms
What is andropause?
The natural lowering of testosterone. DHEAS falls. Fertility remains but there is no sudden change
What is secondary amenorhoea?
Has had previous periods but no periods for past 6 months
What can cause secondary amenorhoea?
Pregnancy/breast feeding Contraception related PCOS Early menopause Thyroid disesase/cushings Raised prolactin Hypothalmic stress (weight change/exercise) Androgen secreting tumour (testosterone>5mg/l)
How do you investigate for secondary amenorrhoea
BMI, Screen for cushingoid, androgenic signs Abdominal/bimanual causes Urine dip and pregnancy test FSH, oestradiol, prolactin, thyroid fucntion, testosterone Pelvic ultrasound
