Menopause and secondary amenorrhoea Flashcards
What is the menopause?
A woman’s last ever period
What is the average age for menopause?
51
What is premature menopause?
40 years or less
What are some hormonal changes brought on by menopause?
Oestradiol falls
FSH rises
Still some oestriol from conversion of adrenal androgens in adipose tissue
What are some common symptoms of menopause?
Hot flushes Night sweats Vaginal dryness Low libido Muscle and joint aches Mood changes Poor memory
What are the effects of osteoporosis present in menopause?
Reduced bone mass
Bone density = T score
Risk of hip or vertebral fractures
What are some risk factors associated with osteoporosis in menopause?
Low BMI Caucasian Smoking High FSH VitD/Calcium malabsorption Oral corticosteroids Hyperthyroid
How is osteoporosis managed in menopause?
Weight bearing exercise
Calcium and VitD
Bisphosphonates
Denosumab
What is an advantage of local vaginal HRT (oestrogen pessary/ring/cream)?
Minimal systemic absorption
What is a drawback of local vaginal HRT (oestrogen pessary/ring/cream)?
Need to use long term to maintain benefit
What are some advantages of transdermal systemic oestrogen for HRT?
Avoids first pass metabolism
less risk of VTE
Prevents endometrial hyperplasia from unopposed oestrogen
What are some contraindications to systemic HRT?
Current hormone dependent cancer of breast/endometrium
Active liver disease
Uninvestigated abnormal bleeding
What kinds of antidepressants should be avoided in the symptomatic treatment of menopause?
SSRI
SNRI
E.g. venlaflaxine
What is an SERM?
Selective Estrogen Receptor Modulator
E.g. Tibolone
Used to treat menopause symptoms
What are some non-medical ways to treat menopause symptoms?
Hypnotherapy
Exercise
Cognitive Behavioural Therapy
Non-hormonal lubricants for vaginal dryness
How might menopause induced osteoporosis be treated?
Bisphosphonates (Etidronate, alendronate)
HRT
What are some risks of HRT?
Breast cancer if combined
Ovarian cancer
VTE if oral
How do bisphosphonates work?
Decrease osteoclast mediated bone resorption
What is andropause?
Testosterone falls by 1% every year after 30
Does andropause affect fertility?
No
What is secondary amenorrhoea?
Has had periods in past but none for 6 months
How is premature ovarian insufficiency managed?
Offer HRT until 50
Emotional support
Daisy network
How is polycystic ovary syndrome diagnosed?
2 of the following
Olig0/amenorrhoea
Androgenic symptoms
Polycystic ovarian morphology on scan
How does polycystic ovarian syndrome affect hormones?
Normal/high oestrogen
Increased androgens
Possible insulin resistance
Are polycystic ovaries painful?
No
Can adolescents get polycystic ovaries?
Yes
Common
Not associated with PCOS
What is the management of PCOS?
Weight loss GTT Support and info Antiandrogen Spironolactone
How should you investigate post-menopausal bleeding?
Trans-vaginal USS to look at endometrial thickness
Endometrial biopsy
Hysteroscopy
