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Reproduction > Menopause + Secondary Amenorrhoea > Flashcards

Menopause + Secondary Amenorrhoea Flashcards

1
Q

What is the menopause?

A

Womans last ever period

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2
Q

Average age for menopause?

A

51

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3
Q

What is premature menopause?

A

Last menstural period at 40 or less

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4
Q

What happens to oestrogen levels at the menopause and what effect does this have on FSH?

A

Oestrogen levels fall so FSH levels rise

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5
Q

Is there any remaining oestrogen even though its not being made by the ovaries?

A

Some oestriol from conversion of adrenal androgens in adipose tissue

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6
Q

Why is a ‘snapshot’ FSH level not used to diagnose menopause?

A

Ovaries fail gradually and so FSH levels fluctuate daily

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7
Q

What can cause menopause?

A
  • Natural failure of ovaries
  • Damage by:
    > oophorectomy
    > chemotherapy
    > radiotherapy
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8
Q

Menopause symptoms?

A
  • Most common > hot flushes/night sweats
  • Vaginal dryness/soreness
  • Low libido
  • Muscle and joint aches
  • Mood changes/poor memory (possible due to affected sleep)
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9
Q

Why do women experience osteoporosis due to menopause?

A

Reduced oestrogen

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10
Q

Prevention and treatment of osteoporosis in menopause?

A
  • wt bearing exercise
  • adequate calcium + vitD
  • HRT
  • Bisphosphonates
  • Denosumab
  • Calcitonin
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11
Q

What local vaginal HRT methods are used to treat menopausal symptoms and benefits/disadvantages?

A
  • Oestrogen pessary/ring/cream
  • Has good local effects but minimal systemic absorption
  • Need to use longterm to maintain benefit
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12
Q

What systemic treatments are used to treat menopausal symptoms and benefits/disadvantages?

A
  • Oestrogen transdermal patch/gel or oral

- Transdermal avoids first pass (less risk of VTE)

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13
Q

When would you give oestrogen alone, and oestrogen and progesterone together?

A
  • Alone = no uterus

- Combined = uterus present

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14
Q

Why is progesterone used alongside oestrogen if the uterus is present?

A

Prevents endometrial hyperplasia from unopposed oestrogen

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15
Q

What is the regime of combined HRT in women with some natural ovarian function?

A

cyclical with 14 days oestrogen then 14 days combined

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16
Q

What should women on cyclical combined HRT expect after the progesterone?

A

withdrawal bleed

17
Q

What is the regime of HRT in women >1yr after LMP or age 54+?

A

Continuous combined 28days oestrogen and progesterone gel/patch

18
Q

Who can use the Mirena IUS (+ daily oestrogen) and what kind of bleeding can they expect?

A

Any age, bleed free

19
Q

Contraindications to systemic HRT?

A
  • Current hormone dependent breast cancer/endometrium
  • Current active liver disease
  • Uninvestiagted abnormal vaginal bleeding
20
Q

Contraindications to vaginal HRT?

A
  • Women taking aromatase inhibitor treatment for breast cancer
21
Q

Risks of HRT?

A
  • Breast cancer (combined HRT)
  • Ovarian cancer
  • Venous thrombosis if oral route
  • CVA if oral route
22
Q

What is secondary amenorrhoea?

A

Has had periods but none for past 6 months

23
Q

Most common causes for secondary amenorrhoea?

A
  • Pregnancy/breast feeding
  • Contraception related
  • PCOS
24
Q

History of amenorrhea?

A
  • Possibility of pregnancy
  • Breastfeeding?
  • Medicines including contraception
  • Galactorrhoea/visual change
  • Acne/hirsutism/voice change
  • Weight change
  • Exercise/stress
  • Significant illness
25
Q

Exams/tests for secondary amenorrhoea?

A
  • Abdominal + bimanual exam?
  • Urine pregnancy test
  • Bloods (FSH, oestrogen, TFT, Testosterone, CAH)
  • Pelvic US
26
Q

Criteria for PCOS?

A

2/3 of the following:

  • oligo/amenorrhoea
  • androgenic symptoms (excess hair/acne)
  • Polycystic ovarian morphology on scan
27
Q

Complications with PCOS?

A
  • Endometrial hyperplasia if <4 periods/year
  • Reduced fertility if not ovulating regularly
  • Higher risk of diabetes and CVD even with BMI <25
  • Weight gain con worsen symptoms
28
Q

Management of PCOS?

A
  • Weight loss/exercise to BMI 20-25
  • Support and information
  • Antiandrogen (combined hormonal contraception, spironolactone, eflornithine cream reduces facial hair)

Reproduction (20 decks)

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