Menopause/ premature ovarian failure

Question 1

What happens to the hormones in the hypothalamus pituitary during menopause?

Answer 1

FSH and LH increase, progesterone and oestrogen decrease (P more so)

Question 2

Progesterone falling faster than oestrogen leads to what?

Answer 2

Endometrial hyperplasia and dysfunctional uterine bleeding

Question 3

what signifies menopause and what signifies postmenopausal

Answer 3

menopause is the date of your last period and postmenopausal is a year after your last period

Question 4

Symptoms of dropping oestrogen

Answer 4

Hot flushes, night sweats, mood swings, dry skin, loss of concentration, tired, tachycardia, loss of libido, depression, osteoporosis

Question 5

How do you diagnose menopause clinically and using blood tests?

Answer 5

no period for 1 year plus FSH above 30iu/l and oestrogen below 50pmol/l

Question 6

Why is it important to give combined HRT in those with intact uterus?

Answer 6

Prevent endometrial hyperplasia

Question 7

difference between sequential vs continuous HRT therapy and when is it given?

Answer 7

sequential- 12 days progesterone and continuous oestrogen allowing monthly withdrawal bleeding, continuous has oestrogen and low dose progesterone with no withdrawal bleeds for postmenopausal

Question 8

Risk factors associated with HRT?

Answer 8

Breast cancer, endometrial cancer, CV risk (stroke, coronary HD, VTE)

Question 9

Risk of breast cancer per 1000 for 5 years on HRT vs 12 years

Answer 9

6, 12

Question 10

Contraindications for HRT?

Answer 10

Thrombophlebitis, oestrogen dependant cancer, undiagnosed uterine bleeding, endometrial hyperplasia, angina, liver disease, breast feeding

Question 11

Side effects from oestrogen administration?

Answer 11

Headaches, leg cramps, nausea, bloating, nipple sensitivity

Question 12

SE from progesterone administratino?

Answer 12

depression, poor concentration, acne, headache, breast tenderness, fluid retention, dysmenorrhoea

Question 13

How long should contraception be used in those experienced menopause>

Answer 13

1 year after menopause in over 50s and 2 years in those experiencing menopause under 50

Question 14

What age is premature ovarian failure able to be classified?

Answer 14

Under 35

Question 15

Types of hypothalamic pituitary dysfunctions that can lead to Irregular and infrequent periods?

Answer 15

Stress, anorexia, intense and regular exercise, hyperprolactinaemia, pituitary tumours, thyroid issues

Question 16

Ovarian causes of irregular or infrequent periods?

Answer 16

PCOS, POF, hormonal, perimenopausal, breastfeeding, adrenal hyperplasia

Question 17

2 genetic causes of premature ovarian failure?

Answer 17

Familial premature ovarian failure and galactosaemia

Question 18

Iatrogenic causes of premature ovarian failure?

Answer 18

Pelvic surgery, cancer treatment, ovarian radiotherapy, chemotherapy

Question 19

What autoimmune diseases are often concurrent with premature ovarian failure?

Answer 19

SLE, Addisons, Myasthenia gravis, hypothyroidism, Autoimmune polyendocrinopathy syndrome type 1 or 2

Question 20

Which 2 chromosomal abnormalities lead to gonadal dysgenesis and therefore premature ovarian failure?

Answer 20

Turner syndrome XO, fragile X syndrome, 46 XY

Question 21

What infections can cause oophoritis and therefore premature ovarian failure?

Answer 21

Mumps

Question 22

2 blood tests to diagnose premature ovarian failure?

Answer 22

FSH above 30IU/L and oestrogen below 50pmol/l

Question 23

In very young girls with premature ovarian failure what genetic karyotype are you looking for?

Answer 23

Turner syndrome

Question 24

If you suspect POF what questions and what investigations need to be performed?

Answer 24

Pedigree inquiry, medical history, autoimmune check for SLE/diabetes/arthritis, serum TSH/T4

Question 25

What hormone replacement is needed if the premature ovarian failure is caused by Addisons disease?

Answer 25

HRT and testosterone

Question 26

What hormone replacement is needed if patient has POF but wants chance to conceieve?

Answer 26

HRT no cOCP

Question 27

Difference between combined sequential and combined continuous

Answer 27

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

Question 28

How often are HRT implants inserted, what do they contain?

Answer 28

6 monthly, only contain oestrogen

Question 29

What does nasal spray HRT contain?

Answer 29

Oestrogen only

Question 30

What does HRT gel contain?

Answer 30

Oestrogen only

Question 31

Contraindications of HRT?

Answer 31

Hormone dependant cancer, breast or endometrial cancer, undiagnosed bleeding, endometrial hyperplasia, VTE history, active thrombophlebitis, liver disease, breastfeeding, porphyria

Question 32

HRT for POF - what check ups and monitoring are required?

Answer 32

Breast checks, smear checks 3 yearly, any odd bleeding needs reported, annual assessment, GP check ups, 6 monthly BP, 3 yearly mammogram