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Reproductive System > Menopause/Secondary Amenorrhoea > Flashcards

Menopause/Secondary Amenorrhoea Flashcards

1
Q

What is the menopause?

A

Ceasing of menstruation

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2
Q

What is the average age of menopause?

A

51

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3
Q

For how long does perimenopause typically occur?

A

Approximately 5 years before menopause

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4
Q

What is premature menopause?

A

Menopause 40 years or younger

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5
Q

What is the cause of menopause?

A

Ovarian insufficiency

  • oestradiol falls
  • FSH rises

Menopause may be natural or may follow oophorectomy, chemotherapy or radiotherapy

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6
Q

What are the symptoms of menopause?

A 
Vasomotor symptoms - hot flushes
Vaginal dryness/soreness
Low libido 
Muscle and joints aches 
Mood changes 
Poor memory
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7
Q

What percentage of women are affected by hot flushes?

A

80% affected

45% find them a problem

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8
Q

How long can a woman experience hot flushes for?

A

Usually last 2-5 years

Can be 10+ years

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9
Q

What are the features of osteoporosis due to menopause?

A

Reduced bone mass

Fractured hip/vertebra in 1% of women 50-69 with significant morbidity/mortality

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10
Q

How can you detect osteoporosis?

A

DEXA scan, T score will compare BMD to rest of population

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11
Q

What are the risks for osteoporosis due to menopause?

A 
Thin 
Caucasian 
Smoker
Heavy drinking 
\+ve FH 
Amenorrhoea 
Malabsorption 
Steroids 
Hyperthyroid
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12
Q

What is the prevention and treatment of osteoporosis due to menopause?

A

Weight bearing exercise
Adequate calcium and vitamin D
HRT
Bisphosphonates - calcitonin, strontium, denosumab

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13
Q

What is the symptomatic treatment of menopause?

A

Hormone replacement therapy (HRT)
Selective oestrogen receptor modulators
Ospemifene - dyspareunia
Tibolone - synthetic steroid for hormone treatment
Natural methods e.g. phytoestrogen, herbs, hypnotherapy, exercise, CBT
Non-hormonal lubricants if symptoms of vaginal dryness only

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14
Q

What are the modes of HRT?

A

Local - vaginal oestrogen pessary/ring/cream
Systemic - transdermal or oral, transdermal avoids first pass metabolism and carries less risk of VTE
Oestrogen - oestrogen only in women who have had a hysterectomy as this will be the only hormone missing
Oestrogen and progestogen if uterus present
Progestogen oral, transdermal or LNG IUS

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15
Q

What are the contraindications for HRT?

A

Current hormone dependent cancer of breast/endometrium
Current active liver disease
Uninvestigated abnormal bleeding
Seek advice if previous VTE or thrombophilia, or FH of VTE
Seek advice if previous breast cancer or BRCA carrier

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16
Q

What are the benefits and risks of HRT?

A

Benefits

  • vasomotor symptoms
  • local genital symptoms
  • osteoporosis

Risks

  • breast Ca if combined HRT
  • ovarian Ca
  • venous thrombosis if oral route
  • CVA if oral route
17
Q

HRT carries no cardiovascular risk if started before what age?

A

60

18
Q

When does the excess risk of breast cancer become the same as never-users after HRT treatment?

A

After 5 years off treatment

19
Q

According to NICE Guidance, 2015, when is HRT indicated?

A

For treatment of severe vasomotor symptoms - review annually
For women with premature ovarian insufficiency, HRT benefits > risks until age 50
Not as first line for osteoporosis prevention/treatment - bisphosphonates
Vaginal oestrogen for vaginal symptoms

20
Q

What are the features of combined oestrogen and progesterone HRT?

A

Cyclical combined 14 days oestrogen and 14 days oestrogen and progestogen
Get a withdrawal bleed
Use if there is still some ovary function e.g. peri menopause

or

Continuous combined 28 days oestrogen and progestogen
Will settle to amenorrhoea
Use if > 1 year after menopause or > 54 years old

21
Q

What age group can use Mirena LNG IUS and daily oestrogen?

A

Any age group

22
Q

What is andropause?

A 
"male menopause" 
Testosterone falls by 1% a year after 30 
Fertility remains 
No sudden change 
DHEAS falls
23
Q

What is primary amenorrhoea?

A

A female who has never had a period - 16 or older with secondary sexual characteristics

24
Q

What percentage of girls are affected by amenorrhoea?

A

5%;
> 14 years and no secondary sexual characteristics
> 16 years if secondary sexual characteristics

25
Q

What is secondary amenorrhoea?

A

No periods in a female who has had periods in the past but has had none for 6 months

26
Q

What are the causes of secondary amenorrhoea?

A

Pregnancy
Breast feeding
Contraception related
Polycystic ovaries
Early menopause
Thyroid disease/Cushing’s/any significant illness
Raised prolactin e.g. prolactinoma, medication-related
Hypothalamic - stress, weight change, exercise
Androgen-secreting tumour
Sheehan’s syndrome
Asherman’s syndrome

27
Q

What are the examinations and investigations for amenorrhoea?

A 
BP 
BMI 
Hirsutism 
Acne 
Cushingoid features 
Enlarged clitoris/deep voice
Abdominal/bimanual pelvic examination 
Urine pregnancy test 
Urine dipstick 
Bloods - FSH, LH, oestradiol, prolactic, thyroid function, testosterone 
Pelvic ultrasound
28
Q

What are the treatments for secondary amenorrhoea?

A

Treat the specific cause
Aim for BMI 20-25
Assume fertile and need contraception unless 2 years after confirmed menopause
If premature menopause, offer HRT until age 50 and emotional support
Check for fragile X

29
Q

What is the presentation spectrum for polycystic ovary syndrome?

A

Higher risk of diabetes and cardiovascular disease for any given BMI
Risk of endometrial hyperplasia if < 4 periods per year and not on hormones
Polycystic ovaries do not cause pelvic pain or weight gain
Oligo/amenorrhoea
Androgenic symptoms - facial hair, acne
Anovulatory infertility
First trimester miscarriage
Diabetes
Cardiovascular disease
Irregular ovulation so irregular menstrual cycle
Plenty of oestrogen but also high androgens
Underlying insulin resistance

30
Q

What are the features of polycystic ovaries?

A

Small peripheral ovarian cysts - 10 per ovary or ovarian volume > 12 call me asap^3
20% of women will have this on scan but no other features - this is not PCOS
Multicystic ovaries are common in adolescents and often settle down without implications

31
Q

What is the management of polycystic ovary syndrome?

A

Weight loss/exercise can help all symptoms and increase sex hormone binding globulins so less free androgens
May be increased NIDDM risk so may need to offer glucose tolerance test
Anti-androgen - combined hormonal contraception, spironolactone, eflornithine cream for facial hair
Endometrial protection - combined hormonal contraception, progestogens, Mirena IUS
Fertility treatment with clomiphene/metformin
Metformin helps ovulation but no good evidence that it helps androgenic side effects or weight loss

Reproductive System (33 decks)

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