Menopause and Secondary Amenorrhoea Flashcards
Define menopause and premature menopause
- Menopause, last ever period (12mth period free)
- Premature menopause, menopause at 40yrs or less
UK average age at menopause
51
What is perimenopause and how long doe it last for
- Beginning of menopause
- Ovaries begin to produce less oestrogen, therefore less/smaller periods
- ~5 yrs prior to menopause
3 iatrogenic causes of menopause
- Oophorectomy
- Chemotherapy
- Radiotherapy
2 hormonal changes during menopause
- Oestradiol falls
- Follicle Stimulating Hormone (FSH) rises
Symptoms of menopause
- Vasomotor symptoms (hot flushes)
- Vaginal dryness/soreness
- Low libido
- Muscle and joint aches
- ? Mood changes/poor memory
“Silent change” of menopause and risk factors for it
Osteoporosis
- Thin
- Smoking and alcohol
- FHx of Amenorrhea
- Malabsorption
- Steroids
- Hyperthyroid
Prevention + treatment of osteoporosis
- Weight bearing exercise
- Adequate Ca + Vit D
- HRT
- Bisphosphonates
- Calcitonin
- Monoclonal antibody to osteoclasts (Denosumab)
Contraindication for Calcitonin + Denosumab
Low blood calcium levels
2 types of HRT
- Local, vaginal oestrogen pessary/ring/cream
- Systemic, transdermal/oral
(?combined? ?E+P?)
Benefit of transdermal HRT vs oral
Transdermal avoids first pass metabolism, reducing risk of VTE
3 contraindications for HRT
- Current hormone dependent cancer (breast/endometrium)
- Current active liver disease
- Uninvestigated abnormal bleeding
When do seek advice before HRT
- Previous/FHx VTE, thrombophilia
- Previous breast cancer or BRCA carrier
Risk of HRT
- Breast cancer if combined HRT
- Ovarian cancer
- VTE if oral route
- CVA if oral route
NICE guidelines for HRT use
- For severe vasomotor symptoms, review annually
- Premature ovarian insufficiency, HRT benefits outweigh risks till 50yrs
- Not 1st line for osteoporosis prevention/treatment (Bisphosphonates instead)
- Vaginal oestrogen for vaginal symptoms (dryness)
Define secondary amenorrhoea
Has had periods in past but none for 6 months
Causes of secondary amenorrhoea
- Pregnancy/breast feeding
- Contraceptive use
- Polycystic ovaries
- Early menopause
- Thyroid disease/Cushing’s
- Raised prolactin (Prolactinoma)
- Androgen secreting tumour (testosterone)
Exams and investigations for secondary amenorrhoea
- BP + BMI
- Hirsutism, acne, striae
- Enlarged clitoris/deep voice
- Abdo + bimanual exam
- Pelvic US
- Urine dipstick (for glucose) + urine pregnancy test
- FSH
- LH
- Thyroid function tests
- Prolactin
- Oestradiol + Testosterone
Treatment for secondary amenorrhoea
- Treat specific cause, aim BMI 20-25
- If premature ovarian insufficiency offer HRT till 50
What is a DEXA scan used for and what does it stand for
- Dual Energy X-ray Absorptiometry
- Bone density
3 characteristics of polycystic ovary syndrome
- Irregular ovulation so irregular cycle
- Plenty of oestrogen but also high androgens
- Underlying insulin resistance
Treatment of Polycystic Ovary Syndrome (PCOS)
- Weight loss/exercise
- Combine hormonal contraception (Antiandrogen)
- Endometrial protection (progesterone, mirena IUS)
- Fertility Rx metformin/clomiphene
