Menopause and secondary amenorrhoea Flashcards
What causes menopause?
Ovarian insufficiency- oestradiol falls and FSH rises
What are the signs and symptoms of the menopause?
Hot flushes Vaginal dryness/soreness Low libido Joint and muscle aches Mood changes Poor memory
What are the symptomatic treatment options for the menopause?
HRT
Selective oestrogen receptor modulators
Non hormonal lubricants
Whatare the options of HRT?
Local vaginal oestrogen cream/pessary/ring
Systemic transdermal/oral oestrogen and progesterone
Mirena IUD
Selective oestrogen receptor modulators (SERMs)
What oral HRT would be given to a woman who is 54+ or >1 year without a period?
28 day continuous oestrogen and progesterone
What oral HRT would be given to a woman who still has ovarian function?
14 days oestrogen, 14 days oestrogen nd progesterone
What are the contraindications for HRT?
Current hormone dependent breast/endometrial cancer
Curent active liver disease
Uninvestigated abnormal bleeding
What are the possible complications of HRT?
VTE if oral
Breast cancer
Ovarian cancer
What is secondary amenorrhoea?
HAs had previous periods but none for 6 months
What are the causes of secondary amenorrhoea?
Pregnancy/breastfeeding Contraception Polycyctsic ovaries Early menopause Thyroid disease Cushings Raised prolactin Stress Weight change Sudden increase in exercise Androgen secreting tumour Sheehans syndrome Ashermans syndrome
What is Sheehans syndrome?
Pituitary failure
What is Ashermans syndrome?
Intrauterine adhesions
What investigations are done for secondary amenorrhoea?
Exam- BP. BMI, hirsutism, Cushingoid, enlarged clitoris, deep voice Pregnancy test Urine lipstick for glucose Bloods Pelvic US
What bloods are done for secondary amenorrhoea?
FSH, LH Oestradiol Prolactin Thyroid function Testosterone
What is the treatment of secondary amenorrhoea?
Treat specific cause
What is the treatment of premature ovarian insufficiency?
HRT
When is menopause classed as premature?
If woman experiences menopause before the age of 40
What % of woman are affected by premature menopause?
1%
What happens approximately 5 years before the menopause?
Perimenopause where FSH levels begin to fluctuate
What is a silent but bad change during menopause?
Osteoporosis
What can increase your risk of post-menopusal osteoporosis?
Smoking Thin Caucasian Previous eating disorder Vit D malabsorption Steroids Hyperthyroidism
Prevention of osteoporosis
Weight bearing exercise Calcium and Vit D supplements HRT Bisphosphonates Denosumab
What can HRT help with?
Vasomotor symptoms
Local genital symptoms
Osteoporsis (reduces risk from 10/1000 to 4/1000)
Colon cancer risk reduction (from 11/1000)
HRT NICE guidelines
For treatment of severe vasomotor symptoms
For women with premature ovarian insufficiency
HRT benefits outweigh risk until age 50
