Menopause/ Secondary Amenorrhoea/PCOS Flashcards
what is this?
last ever period
average age ?
51
when can you start being pre-menopausal?
5 years before
what age is termed as premature menopause?
40 years or less
physiology of menopause?
Ovarian insufficiency
- reduced oestradiol
- increased FSH
what allows there to still be some oestradiol circulating in the body?
peripheral conversion of adrenal androgens in fat
symptoms?
- vaginal dryness / soreness
- vasomotor symptoms - hot flushes
- reduced libido
- mood changes
- muscle and joint aches
- silent change–> osteoporosis
what is osteoporosis and what does it lead to?
reduced bone mass –> increased risk of fractures
how do you prevent / treat osteoporosis in a menopausal woman?
- bisphosphonates + HRT
- weight bearing exercise
- Vit D + Calcium supplements
what are the treatment options for menopause?
- HRT
- Non-HRT
describe the HRT route options
- Local
- vaginal oestrogen pessaries / cream
- Systemic
- transdermal / oral
why is transdermal route better than oral?
avoids first-pass metabolism so less chance of VTE
what is given in HRT?
- if uterus not present - only oestrogen
- if uterus present - oestrogen & progesterone
- pre-menopausal
- 14 days oestrogen + 14 days oestrogen + progesterone
- post-menopausal
- 28 days both O+P
- pre-menopausal
what are the Non-HRT options?
- Selective Oestrogen RECEPTOR Modulators (SERM)
- SSRI / SNRI
- Natural methods:
- Phytooestrogen
- herbal ie red clover
- hypnotherapy
- exercise
benefits of HRT?
- symptomatic relief
- both vaginal symptoms and vasomotor
- reduces osteoporosis risk
- reduced colon cancer risk
Risks of HRT?
- increased risk in breast and ovarian cancer
- increased risk of VTE (with oral HRT)
- incrased risk of stroke (with oral HRT)
what is secondary amenorrhoea?
had periods in past but not had any in last 6 months
causes of secondary amenorrhoea?
- pregnancy
- contraception
- early menopause
- PCOS
- endocrine - thyroid abnormality / malignancy
investiagtion of secondary amenorrhoea?
- BMI / BP
- bimanual examination of uterus and abdo examination
- investigations:
- pregnancy test
- LH and FSH levels in blood
- pelvic US
treatment of secondary amenorrhoea?
- treat cause
- assume fertile- give contraception
what is the presentation of PCOS?
Hirsutism / acne - androgenic symptoms
Amenorrhoea
Irregular periods
Reduced fertility & miscarriage
SYSTEMIC- diabetes & CVS disease
features of PCOS?
- high oestrogen and androgens
- insulin resistance
what is PCO?
small peripheral ovarian cysts
Management of PCOS?
- Weight loss
- COCP/ progesterone
- fertility
- clomiphene
- METFORMIN
