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Year 3: Reproduction > Menopause - secondary Amenorrhoea > Flashcards

Menopause - secondary Amenorrhoea Flashcards

1
Q

what is menopause?

average age?

A

a woman’s last ever period

average age 51

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2
Q

what is perimenopause?

A

occurs for approx 5 years before

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3
Q

Menopause -What happens?

- what falls and what rises?

A

Ovarian insufficiency -oestradiol falls

Follicle stimulating hormone (FSH) rises

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4
Q

How is there still some oestriol?

A

from the conversion of adrenal androgens in adipose tissue

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5
Q

when do FSH levels fluctuate?

A

in perimenopause- a premenopausal level does not exclude perimenopause as a cause for symptoms

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6
Q

Menopausal transition may follow unnaturally after..?

A

oophorectomy/chemotherapy/radiotherapy

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7
Q

Menopause-symptoms - vasomotor

A

hot flushes / night sweats

  • Vaginal dryness / soreness
  • Low libido
  • Muscle and joint aches
  • Mood changes / poor memory – possibly related to vasomotor symptoms affecting sleep
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8
Q

Menopause-silent change- Osteoporosis - what is this?

  • problems that can occur from this?
A
  • reduced bone mass
  • DEXA scan bone density described as T score
  • fractured hip / vertebra 1% women 50-69 significant morbidity+mortality
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9
Q

risk factors for osteoporosis? (9)

A

: thin/caucasian/smoking/ high EtOH/+ve FH /malabsorption Vit D or Calcium / prolonged low oestrogen amenorrhoea /oral corticosteroids / hyperthyroid

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10
Q

prevention and treatment of osteoporosis? (6)

A

wt bearing exercise , adequate calcium & Vit D, HRT, bisphosphonates, denosumab -monoclonal antibody to osteoclasts, calcitonin

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11
Q

Menopause- symptom treatment Hormone replacement therapy (HRT)

  • Local vaginal HRT
A

oestrogen pessary/ring/cream

  • Local effects -minimal systemic absorption
  • Need to use longterm to maintain benefit
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12
Q

Systemic oestrogen transdermal / oral medications avoids?

A

first pass- less risk VTE

a/oestrogen only if no uterus

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13
Q

Combined Estrogen ( E) and Progestogen (P) HRT

  • how is this combined?
  • when will there be a withdrawal bleed?
A

cyclically - 14 days E + 14 days E+P

  • P use if there may still be some ov function to avoid
    irregular bleeding
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14
Q

What is andropause?

A

Testosterone falls by 1% a year after 30

DHEAS falls

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15
Q

What is primary amenorrhoea?

- who does this affect?

A

never had a period

> 14yrs and no 2ndry sexual characteristics
16 years if 2ndry sexual characteristics

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16
Q

Secondary amenorrhoea means?

A

has had periods in past but none for 6 months

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17
Q

Secondary amenorrhoea causes (11) - give a few

A
  • Pregnancy / Breast feeding
  • Contraception related- current use or for 6-9 months after depoprovera
  • Polycystic ovary syndrome
  • Premature ovarian insufficiency
  • Thyroid disease/ Cushings/ Any significant illness
  • Raised prolactin- prolactinoma/ medication related
  • Congenital adrenal hyperplasia
  • Hypothalamic- stress/ 10% wt change / excess exercise
  • Androgen secreting tumour- testosterone >5mg/l
  • Sheehans syndrome- pituitary failure
  • Ashermans syndrome- intrauterine adhesions
18
Q

Secondary amenorrhoea: exam and tests?

A
  • BP, BMI, hirsutism, acne , Cushingoid
    enlarged clitoris/deep voice =virilised
    -abdominal/bimanual
urine pregnancy test   + dipstick for glucose
bloods  FSH oestradiol (menopause)
prolactin
thyroid function    testosterone
17 hydroxy progesterone ( CAH)
pelvic ultrasound-  ?polycystic ovaries
19
Q

with secondary amenorrhoea you should treat?

BMI aimed for ovulation?

A

specific cause

Aim BMI >20 <30 for ovulation

20
Q

If a patient has premature ovarian insufficiency - what should you do?

A

insufficiency offer HRT till 50

emotional support Daisy network

21
Q

what do you need to diagnose PCOS - 2 out of 3 criteria

A
  • oligo/amenorrhoea
  • androgenic symptoms: excess hair/acne
  • Polycystic ovarian morphology on scan

Normal/high oestrogen levels
Increased androgens
? Underlying cause insulin resistance

22
Q

when do patients have a risk of endometrial hyperplasia?

why do you assume they are fertile?

A

< 4 periods a year (and not on hormones)

  • Reduced fertility if not ovulating regularly- BUT assume fertile and use contraception if not plan pregnancy
    Reduced fertility if not ovulating regularly- BUT assume fertile and use contraception if not plan pregnancy
23
Q

endometrial hyperplasia have a higher risk if they have what 2 conditions ?

A

diabetes & cardiovascular disease even if lean

24
Q

Polycystic ovaries do NOT cause ? (2)

A

weight gain or pain.
- Weight gain can worsen PCOS symptoms as ↓SHBG
levels ↑ androgens

25
Q

Polycystic ovaries – ultrasound scan

  • what would you see (size)
A

Small peripheral ovarian cysts x 10/0vary or

- ovarian volume>12cm3

26
Q

what ovaries are common in adolescents?

A

Multicystic ovaries

27
Q

management of PCOS?

- what is there an increase risk of even if they are slim?

A

Weight loss/exercise to BMI 20-25

  • increased NIDDM risk even if slim consider GTT
28
Q

what does weight loss in PCOS do?

A

can help all symptoms

- increases SHBG so less free androgens

29
Q

treatment/management of PCOS?

A

Antiandrogen - combined hormonal contraception if no CI spironolactone
eflornithine cream reduces facial hair growth

30
Q

what may metformin encourage in PCOS?

A
  • ovulation but no consistent evidence of benefit for androgenic symptoms or helping weight loss
31
Q

Fertility Rx for PCOS?

A

Rx clomiphene / metformin ovulation induction

32
Q

PCOS - endometrial protection

- what to give if no period

A

CHC, Mirena IUS

Oral provera 10/90 if no period

33
Q

When would you use the continuous combined 28 days E+P oral/patch?

  • when would you expect patients to be bleed free?
A

use if > 1yr after menopause or age 54+

  • ( after 1st 3 months)
34
Q

Contraindications to Systemic HRT? (3)

  • what should you seek advice for before prescribing HRT? (2)
A

1 - Current Hormone dependent cancer breast/endometrium
2 - Current active liver disease
3 - Uninvestigated abnormal bleeding

  • if prev VTE, thrombophilia, FH VTE
  • if previous breast cancer or BRCA carrier
35
Q

Symptom treatment - what should you give?

give an example?

A
  • Selective Estrogen Receptor Modulators (SERMs)

- tibolone

36
Q

non-pharmalogical treatment ?

A

hypnotherapy/ exercise / Cognitive behavioural therapy

37
Q

HRT benefits - can help against? (3)

A

vasomotor
local genital symptoms
osteoporosis

38
Q

HRT risks?

things taken the oral route?

A

breast Ca if combined HRT

  • ovarian Ca
  • venous thrombosis if oral route
  • CVA if oral route
39
Q

For women with premature ovarian insufficiency HRT benefits outweigh risk until what age?

A

50

40
Q

first line treatment for osteoporosis prevention?

A

bisphosphonates

41
Q

what should you give for vaginal symptoms?

A

vaginal oestrogen

Year 3: Reproduction (40 decks)

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