Menopause/ premature ovarian failure Flashcards
What happens to the hormones in the hypothalamus pituitary during menopause?
FSH and LH increase, progesterone and oestrogen decrease (P more so)
Progesterone falling faster than oestrogen leads to what?
Endometrial hyperplasia and dysfunctional uterine bleeding
what signifies menopause and what signifies postmenopausal
menopause is the date of your last period and postmenopausal is a year after your last period
Symptoms of dropping oestrogen
Hot flushes, night sweats, mood swings, dry skin, loss of concentration, tired, tachycardia, loss of libido, depression, osteoporosis
How do you diagnose menopause clinically and using blood tests?
no period for 1 year plus FSH above 30iu/l and oestrogen below 50pmol/l
Why is it important to give combined HRT in those with intact uterus?
Prevent endometrial hyperplasia
difference between sequential vs continuous HRT therapy and when is it given?
sequential- 12 days progesterone and continuous oestrogen allowing monthly withdrawal bleeding, continuous has oestrogen and low dose progesterone with no withdrawal bleeds for postmenopausal
Risk factors associated with HRT?
Breast cancer, endometrial cancer, CV risk (stroke, coronary HD, VTE)
Risk of breast cancer per 1000 for 5 years on HRT vs 12 years
6, 12
Contraindications for HRT?
Thrombophlebitis, oestrogen dependant cancer, undiagnosed uterine bleeding, endometrial hyperplasia, angina, liver disease, breast feeding
Side effects from oestrogen administration?
Headaches, leg cramps, nausea, bloating, nipple sensitivity
SE from progesterone administratino?
depression, poor concentration, acne, headache, breast tenderness, fluid retention, dysmenorrhoea
How long should contraception be used in those experienced menopause>
1 year after menopause in over 50s and 2 years in those experiencing menopause under 50
What age is premature ovarian failure able to be classified?
Under 35
Types of hypothalamic pituitary dysfunctions that can lead to Irregular and infrequent periods?
Stress, anorexia, intense and regular exercise, hyperprolactinaemia, pituitary tumours, thyroid issues
Ovarian causes of irregular or infrequent periods?
PCOS, POF, hormonal, perimenopausal, breastfeeding, adrenal hyperplasia
2 genetic causes of premature ovarian failure?
Familial premature ovarian failure and galactosaemia
Iatrogenic causes of premature ovarian failure?
Pelvic surgery, cancer treatment, ovarian radiotherapy, chemotherapy
What autoimmune diseases are often concurrent with premature ovarian failure?
SLE, Addisons, Myasthenia gravis, hypothyroidism, Autoimmune polyendocrinopathy syndrome type 1 or 2
Which 2 chromosomal abnormalities lead to gonadal dysgenesis and therefore premature ovarian failure?
Turner syndrome XO, fragile X syndrome, 46 XY
What infections can cause oophoritis and therefore premature ovarian failure?
Mumps
2 blood tests to diagnose premature ovarian failure?
FSH above 30IU/L and oestrogen below 50pmol/l
In very young girls with premature ovarian failure what genetic karyotype are you looking for?
Turner syndrome
If you suspect POF what questions and what investigations need to be performed?
Pedigree inquiry, medical history, autoimmune check for SLE/diabetes/arthritis, serum TSH/T4
What hormone replacement is needed if the premature ovarian failure is caused by Addisons disease?
HRT and testosterone
What hormone replacement is needed if patient has POF but wants chance to conceieve?
HRT no cOCP
Difference between combined sequential and combined continuous
Continuous is low dose progesterone and oestrogen every day no withdrawal bleed whereas combined sequential is oestrogen every day and last 12 days of cycle take progesterone for withdrawal bleed
How often are HRT implants inserted, what do they contain?
6 monthly, only contain oestrogen
What does nasal spray HRT contain?
Oestrogen only
What does HRT gel contain?
Oestrogen only
Contraindications of HRT?
Hormone dependant cancer, breast or endometrial cancer, undiagnosed bleeding, endometrial hyperplasia, VTE history, active thrombophlebitis, liver disease, breastfeeding, porphyria
HRT for POF - what check ups and monitoring are required?
Breast checks, smear checks 3 yearly, any odd bleeding needs reported, annual assessment, GP check ups, 6 monthly BP, 3 yearly mammogram
