secondary amenorrhoea and menopause Flashcards

1
Q

what is the menopause?

A

last ever period a female has

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2
Q

when does the menopause usually occur?

A

51 years

early: <40 years old

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3
Q

how long is the perimenopause?

A

5 years before the menopause occurs

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4
Q

what is the physiology of the menopause?

A

ovarian insufficiency
- oestradiol falls
- FSH rises
(still some oestriol from conversion of adrenal androgens in adipose tissue)

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5
Q

what may trigger the menopause?

A
  • naturally/spontaneously

- oophorectomy, chemotherapy or radiotherapy

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6
Q

what are the ‘seven dwarves’ of menopause?

A
  • itchy
  • bitchy
  • sweaty
  • sleepy
  • bloated
  • forgetful
  • psycho
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7
Q

what are the symptom of menopause?

A

vasomotor symptoms: hot flushes, night sweats

vaginal symptoms: dryness/soreness, low libido

more: muscle/joint aches, mood changes, poor memory

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8
Q

what silent change can occur with the menopause?

A

osteoporosis: reduced bone mineral density

detected with DEXA scan - described as T score

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9
Q

what is there significant risk of in osteoporosis?

A

fractured hip/ vertebra

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10
Q

what are the risk factors for osteoporosis?

A

heavy: smokers, steroids
health: hyperthyroidism, amenorrhoea, malabsorption
history: caucasian, thin, family history

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11
Q

how can osteoporosis be prevented and managed?

A

exercise: weight bearing
supplements: calcium and vitamin D
medical: HRT, bisphosphonates, denosumab (monoclonal antibody to osteoclasts), teriparatide

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12
Q

how can HRT be administered for menopause

A

locally: vaginal oestrogen (pessary, ring or cream)
systemically: transdermal or oral

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13
Q

what combination of HRT can be given?

A
  • oestrogen only, if no uterus

- oestrogen + progesterone, if uterus present (progesterone can be oral, transdermal of LNG IUS)

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14
Q

what are the contraindications to HRT?

A

breast/endometrium cancer: hormone dependent

liver disease

abnormal bleeding

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15
Q

what are the features of the cyclical combined oestrogen and progesterone HRT?

A

use if still some ovarian function (perimenopause)

14 days of O and 14 days of O+P

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16
Q

what are the features of the continuous combined oestrogen and progesterone HRT?

A

use if no ovarian function (>1 year after menopause or age 54+)

28 days of O+P

17
Q

who can use Mirena LNG IUS and daily oestrogen?

18
Q

what OTHER menopause symptomatic treatments are there?

A

SERM: selective oestrogen receptor modulators

SSRI/SNRI antidepressants: venlafaxine or clonidine

natural methods: phytoestrogen/ herbs/ hypnotherapy/ exercise/ CBT, lubricants

19
Q

what are the benefits of HRT?

A
  • effect on vasomotor symptoms
  • effect on local genital symptoms
  • decreases risk of osteoporosis
20
Q

what are the risks of HRT use?

A
  • breast/ovarian cancer

- VTE/CVA if oral rote

22
Q

when should HRT be used in menopause according to NICE guidelines?

A

treatment of:

  • severe vasomotor symptoms
  • premature ovarian insufficiency
23
Q

what occurs in andropause?

A

testosterone falls after the age of 30

DHEAS falls

fertility remains and no sudden change occurs in the male

24
Q

what is primary amenorrhoea?

A

never having had a period

25
when can primary amenorrhoea be diagnosed?
>14 years with no secondary sexual characteristics <16 years if secondary sexual characteristics present
26
what is secondary amenorrhoea?
there has been periods in the past but nothing for the past 6 months
27
what are the causes of secondary amenorrhoea?
pregnancy, breast feeding, premature ovarian insuffiency, PCOS medications: contraceptions hypothalamic: weight, exercise, stress thyroid,: cushings, prolactinoma, CAH, tumours (androgen secreting), sheehanS/ashermans syndrome
28
how is secondary amenorrhoea investigated?
examination - BMI, cushingoid - acne, hirsutism, virilised (enlarged clitoris/deep voice) - abdominal/bimanual exam: pelvic mass, uterus/ovarian cyst investigations - urine pregnancy test - bloods: FSH, oestradiol, prolactin, TFTs, testosterone, SHBG (free androgen index), 17-hydroxy progesterone (CAH) - pelvic ultrasound: polycystic ovaries
29
how should secondary amenorrhoea be treated?
treat specific cause | if premature ovarian insufficiency offer HRT till 50
30
how can polycystic ovary syndrome present?
oligo/amenorrhoea androgenic symptoms: excess hair/acne
31
what risks are there with polycystic ovary syndrome?
- diabetes - cardiovascular disease - reduced fertility - endometrial hyperplasia
32
what do polycystic ovaries NOT cause?
weight gain or pain
33
what are polycystic ovaries?
small peripheral ovarian cysts | ovary x10 or ovarian volume >12cm^3
34
how is polycystic ovary syndrome managed?
weight loss/exercise - increases shbg -> less free androgens anti-androgens - CHC, spironolactone, eflonithine cream endometrial protection - CHC, mirena IUS, oral provera fertility treatment - clomiphene/metformin
35
what role does metformin play in PCOS?
treats underlying cause - insulin resistance encourages ovulation