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Reproductive (Yan) > Secondary Amenorrhoea and Menopause > Flashcards

Secondary Amenorrhoea and Menopause Flashcards

1
Q

What is the menopause?

A

Is a woman’s last ever period:

  • Average age is 51
  • Perimenopause for 5 years before
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2
Q

What is the average age for menopause?

A

51 years old

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3
Q

What is premature menopause?

A

Premature menopause = 40 years or less, affects 1% of woman

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4
Q

What is the prevalence of premature menopause?

A

1%

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5
Q

Why does menopause occur?

A
  • Occurs due to ovarian insufficiency as oestradiol (strongest of 3 oestrogens) falls
    • FSH rises
    • Some oestriol from conversion of adrenal androgens in adipose tissue
  • FSH level fluctuates in perimenopause
  • Menopausal transition can be natural or sudden following oophorectomy/chemotherapy/radiotherapy
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6
Q

What hormonal changes occur during menopause?

A
  • Occurs due to ovarian insufficiency as oestradiol (strongest of 3 oestrogens) falls
    • FSH rises
    • Some oestriol from conversion of adrenal androgens in adipose tissue
  • FSH level fluctuates in perimenopause
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7
Q

What is the presentation of menopause?

A
  • Vasomotor symptoms – 80% of woman
    • Hot flushes, night sweats
  • Vaginal dryness
  • Low libido (low sex drive)
  • Muscle and joint aches
  • Maybe mood changes/poor memory
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8
Q

What is the medical term for low sex drive?

A

Low libido

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9
Q

Describe the management of menopause?

A
  • Reduce risk of reduced bone mass (seen below)
  • Manage symptoms with hormone replacement therapy (HRT)
    • Local vaginal HRT – oestrogen pessary/ring/cream
      • Has local effects, so minimal systemic absorption
    • Systemic oestrogen transdermal/oral
      • Transdermal avoids first pass
      • a/oestrogen only if no uterus, if uterus present then a and b/oestrogen
    • Combined oestrogen (E) and progestogen (P) HRT
      • Could be cyclical combined – 14 days E and 14 days E and P, expect to bleed after the P use
      • Or continuous combined 28 days E and P oral/patch, except to be bleed free
    • Contraindications – current hormone dependent cancer such as breast or endometrium, current active liver disease, investigated abnormal bleeding
  • Manage symptoms with selective oestrogen receptor modulators (SERMs)
    • Such as tibolone
  • Phytoestrogen hers
    • Such as red clover/soya
  • Hyponotherapy, exercise, CBT
  • Non-hormonal lubricants for vaginal dryness
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10
Q

What are contraindications for using hormonal therapy to manage symptoms during menopause?

A
  • Contraindications – current hormone dependent cancer such as breast or endometrium, current active liver disease, investigated abnormal bleeding
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11
Q

What are some benefits and risks of HRT?

A
  • Benefits
    • Vasomotor
    • Local genital symptoms
    • Osteoporosis
  • Risks
    • Breast cancer if combined HRT
    • Ovarian cancer
    • Venous thrombosis if oral route
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12
Q

What does HRT stand for?

A

Hormonal replacement therapy

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13
Q

What are possible complications of menopause?

A
  • Causes reduced bone mass
    • Investigated using DEXA scan where bone density is described as T score
    • Can lead to fractured hip/vertebra
    • Risk factors – thin, Caucasian, smoking, malabsorption of vitamin D or calcium, prolonged low oestrogen, oral corticosteroids, hyperthyroid
    • Prevention and treatment – weight bearing exercise, adequate calcium and vitamin D intake, bisphosphonates, denosumab
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14
Q

How is reduced bone mass due to menopause investigated?

A
  • Investigated using DEXA scan where bone density is described as T score
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15
Q

What are possible complications of reduced bone mass due to menopause?

A
  • Can lead to fractured hip/vertebra
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16
Q

What are risk factors for reduced bone mass due to menopause?

A
  • Risk factors – thin, Caucasian, smoking, malabsorption of vitamin D or calcium, prolonged low oestrogen, oral corticosteroids, hyperthyroid
17
Q

Describe the prevention and treatment of reduced bone mass due to menopause?

A
  • Prevention and treatment – weight bearing exercise, adequate calcium and vitamin D intake, bisphosphonates, denosumab
18
Q

What is andropause?

A

Known as ‘male menopause’, testosterone levels fall from 1% per year after 30 which eventually can lead to hypogonadism (different thing):

  • Fertility remains
  • No sudden change
19
Q

When do testosterone levels begin to fall in males and by how much?

A

By 1% per year after 30

20
Q

What is hypogonadism?

A

Hypogonadism = diminished functional activity of the gonads (testes or ovaries) resulting in diminished production of sex hormones

21
Q

What are the different kinds of amenorrhoea?

A
  • Primary
    • Never had a period
    • Affects 5% of girls
  • Secondary
    • Has had periods in past but none for 6 months
22
Q

What is amenorrhoea?

A

Is the absence of menstrual periods in a woman during reproductive age

23
Q

What is the prevalence of primary amenorrhoea?

A

5% of girls

24
Q

What is the aetiology of secondary amenorrhoea?

A
  • Pregnancy/breast feeding
  • Contraception related
  • Polycystic ovary syndrome
  • Premature ovarian insufficiency
  • Thyroid disease, Cushing’s
  • Raised prolactin – prolactinoma/medication related
  • Congenital adrenal hyperplasia
25
Q

What investigations are done for secondary amenorrhoea?

A
  • BP, BMI
  • Examination
    • Hirsutism, acne, Cushingoid, enlarged clitoris, abdominal
  • Urine pregnancy test
  • Dipstick for glucose
  • Bloods
    • FSH, oestradial, prolactin, thyroid function, testosterone)
  • Pelvic USS
    • Polycystic ovaries
26
Q

Describe the management for secondary amenorrhoea?

A
  • Treat specific cause
    • If premature ovarian insufficiency, offer HRT until 50 and emotional support
  • Aim BMI>20 and <30 for ovulation
27
Q

What is polycystic ovary syndrome?

A

Ovaries contain large number of follicles, in polycystic ovaries these sacs are unable to release an egg

28
Q

How is polycystic ovarian syndrome diagnosed?

A
  • Oligo/amenorrhoea
  • Androgenic symptoms
    • Excess hair/acne
  • Polycystic ovarian morphology on USS
29
Q

What is the medical term for infrequent periods?

A

Oligoamenorrhoea

30
Q

What are some androgenic symptoms?

A

Excess hair

Acne

31
Q

Describe the management for polycystic ovarian syndrome?

A
  • Weight loss/exercise to BMI 20-25 (excess weight makes condition worse)
  • Support and information
  • Antiandrogen
    • Combined hormonal contraception if no contraindication
    • Eflornithine cream reduces facial hair growth
  • Endometrial protection
    • Combined hormonal contraception, oral provera if no period
  • Fertility treatment
    • Ovulation induction
32
Q

What are possible complications of polycystic ovary syndrome?

A
  • Reduced fertility if not ovulating regularly
  • Risk of endometrial hyperplasia if <4 periods a year

Reproductive (Yan) (34 decks)

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