Menopause + Secondary Amenorrhoea Flashcards
What is the menopause?
Womans last ever period
Average age for menopause?
51
What is premature menopause?
Last menstural period at 40 or less
What happens to oestrogen levels at the menopause and what effect does this have on FSH?
Oestrogen levels fall so FSH levels rise
Is there any remaining oestrogen even though its not being made by the ovaries?
Some oestriol from conversion of adrenal androgens in adipose tissue
Why is a ‘snapshot’ FSH level not used to diagnose menopause?
Ovaries fail gradually and so FSH levels fluctuate daily
What can cause menopause?
- Natural failure of ovaries
- Damage by:
> oophorectomy
> chemotherapy
> radiotherapy
Menopause symptoms?
- Most common > hot flushes/night sweats
- Vaginal dryness/soreness
- Low libido
- Muscle and joint aches
- Mood changes/poor memory (possible due to affected sleep)
Why do women experience osteoporosis due to menopause?
Reduced oestrogen
Prevention and treatment of osteoporosis in menopause?
- wt bearing exercise
- adequate calcium + vitD
- HRT
- Bisphosphonates
- Denosumab
- Calcitonin
What local vaginal HRT methods are used to treat menopausal symptoms and benefits/disadvantages?
- Oestrogen pessary/ring/cream
- Has good local effects but minimal systemic absorption
- Need to use longterm to maintain benefit
What systemic treatments are used to treat menopausal symptoms and benefits/disadvantages?
- Oestrogen transdermal patch/gel or oral
- Transdermal avoids first pass (less risk of VTE)
When would you give oestrogen alone, and oestrogen and progesterone together?
- Alone = no uterus
- Combined = uterus present
Why is progesterone used alongside oestrogen if the uterus is present?
Prevents endometrial hyperplasia from unopposed oestrogen
What is the regime of combined HRT in women with some natural ovarian function?
cyclical with 14 days oestrogen then 14 days combined
What should women on cyclical combined HRT expect after the progesterone?
withdrawal bleed
What is the regime of HRT in women >1yr after LMP or age 54+?
Continuous combined 28days oestrogen and progesterone gel/patch
Who can use the Mirena IUS (+ daily oestrogen) and what kind of bleeding can they expect?
Any age, bleed free
Contraindications to systemic HRT?
- Current hormone dependent breast cancer/endometrium
- Current active liver disease
- Uninvestiagted abnormal vaginal bleeding
Contraindications to vaginal HRT?
- Women taking aromatase inhibitor treatment for breast cancer
Risks of HRT?
- Breast cancer (combined HRT)
- Ovarian cancer
- Venous thrombosis if oral route
- CVA if oral route
What is secondary amenorrhoea?
Has had periods but none for past 6 months
Most common causes for secondary amenorrhoea?
- Pregnancy/breast feeding
- Contraception related
- PCOS
History of amenorrhea?
- Possibility of pregnancy
- Breastfeeding?
- Medicines including contraception
- Galactorrhoea/visual change
- Acne/hirsutism/voice change
- Weight change
- Exercise/stress
- Significant illness
Exams/tests for secondary amenorrhoea?
- Abdominal + bimanual exam?
- Urine pregnancy test
- Bloods (FSH, oestrogen, TFT, Testosterone, CAH)
- Pelvic US
Criteria for PCOS?
2/3 of the following:
- oligo/amenorrhoea
- androgenic symptoms (excess hair/acne)
- Polycystic ovarian morphology on scan
Complications with PCOS?
- 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
Management of PCOS?
- Weight loss/exercise to BMI 20-25
- Support and information
- Antiandrogen (combined hormonal contraception, spironolactone, eflornithine cream reduces facial hair)
