Menopause & Secondary Amenorrhoea

Question 1

what is the average age of menopause in the UK?

Answer 1

51

Question 2

what age is classed as premature menopause?

Answer 2

40 years or less

Question 3

what happens to hormones in ovarian insufficiency?

Answer 3

oestradiol falls

FSH rises

Question 4

menopause may be natural or follow?

Answer 4

oophrectomy/chemo/radiotherapy

Question 5

symptoms of menopause (5)?

Answer 5

vasomotor - hot flushes
vaginal dryness/dyspareunia
low libido 
muscle and joint aches 
mood/poor memory

Question 6

silent change in menopause?

Answer 6

osteoporosis

reduced bone mineral density

Question 7

what score for osteoporosis?

Answer 7

FRAX score

Question 8

prevention and treatment of osteoporotic changes?

Answer 8

excercise
calcium + vitD
bisphosphonates

denosumab - monoclonal AB

Question 9

HRT modes? best?

Answer 9

systemic: gel/oral, 
transdermal patch (less risk VTE)

local: vaginal oetrogen only via pessary/ring/cream

Question 10

when do you use oestrogen only or oestrogen + progestogen?

Answer 10

oestrogen only if no uterus

oestrogen + progestogen if uterus present to prevent endometrial hyperplasia

Question 11

contraindication to systemic HRT? (3)

Answer 11

current hormone dependent cancer of breast/endometrium

current active liver disease

un-investigated abnormal bleeding

Question 12

combined E + P cycle?

Answer 12

taken daily

14 days E + 14 days E+P

withdrawal bleeding after stop P

Question 13

menopause symptom treatment? (3)

Answer 13

Selective Estrogen Receptor Modulators (SERMs)

SSRI antidepressants

Naturel

Question 14

HRT risks? (5)

Answer 14

breast cancer with combined
ovarian cancer
VTE if oral route of admin
Fractures
Ca colon

Question 15

NICE guidance on HRT?

Answer 15

severe vasomotor symptoms

women with premature ovarian insufficiency (benefits till 50)

not as first line for osteoporosis

vaginal estrogen for vaginal symptoms

Question 16

what is andropause?

Answer 16

testosterone falls by 1% a year after age 30

fertility remains, no sudden change

Question 17

What is primary amenorrhoea?

Answer 17

never had a period

more than 14yrs and no secondary sexual characteristics

more than 16 if they have secondary sexual characteristics

Question 18

What is secondary amenorrhoea?

Answer 18

has had periods in the past but none for 6 months?

Question 19

Secondary amenorrhoea causes?

Answer 19

pregnancy
contraceptions (depoprovera)
POCS
early menopause
Thyroid diseases
raised prolactin
hypothalamic stress
androgen secreting tumour

Question 20

Secondary amenorrhoea exam and tests?

Answer 20

BMI + Cushingoid
Androgenic signs
Abdo exam
Urine pregnancy test
pelvic US
bloods

Question 21

what bloods in secondary amenorrhoea? (5)

Answer 21

FSH
Oestradiol
Prolactin
Thyroid
Testosterone

Question 22

what is PCOS?

Answer 22

a set of symptoms due to elevated androgens (male hormones) in females

Question 23

diagnosis of PCOS?

Answer 23

PCO morphology on scan

clinical/biochemical hyperandrogegism

oligo/anovulation - amenorrhoea or infertility

(2 out of 3 of the above)

Question 24

main underlying problem in PCOS?

Answer 24

increased insulin resistance

Question 25

PCOS management?

Answer 25

weight loss
antiandrogen - CHC
endometrial protection
fertility - clomiphene