Secondary Amenorrhoea and Menopause Flashcards
What is the menopause?
Is a woman’s last ever period:
- Average age is 51
- Perimenopause for 5 years before
What is the average age for menopause?
51 years old
What is premature menopause?
Premature menopause = 40 years or less, affects 1% of woman
What is the prevalence of premature menopause?
1%
Why does menopause occur?
- 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
What hormonal changes occur during menopause?
- 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
What is the presentation of menopause?
- 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
What is the medical term for low sex drive?
Low libido
Describe the management of menopause?
- 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
- Local vaginal HRT – oestrogen pessary/ring/cream
- 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
What are contraindications for using hormonal therapy to manage symptoms during menopause?
- Contraindications – current hormone dependent cancer such as breast or endometrium, current active liver disease, investigated abnormal bleeding
What are some benefits and risks of HRT?
- Benefits
- Vasomotor
- Local genital symptoms
- Osteoporosis
- Risks
- Breast cancer if combined HRT
- Ovarian cancer
- Venous thrombosis if oral route
What does HRT stand for?
Hormonal replacement therapy
What are possible complications of menopause?
- 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
How is reduced bone mass due to menopause investigated?
- Investigated using DEXA scan where bone density is described as T score
What are possible complications of reduced bone mass due to menopause?
- Can lead to fractured hip/vertebra
What are risk factors for reduced bone mass due to menopause?
- Risk factors – thin, Caucasian, smoking, malabsorption of vitamin D or calcium, prolonged low oestrogen, oral corticosteroids, hyperthyroid
Describe the prevention and treatment of reduced bone mass due to menopause?
- Prevention and treatment – weight bearing exercise, adequate calcium and vitamin D intake, bisphosphonates, denosumab
What is andropause?
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
When do testosterone levels begin to fall in males and by how much?
By 1% per year after 30
What is hypogonadism?
Hypogonadism = diminished functional activity of the gonads (testes or ovaries) resulting in diminished production of sex hormones
What are the different kinds of amenorrhoea?
- Primary
- Never had a period
- Affects 5% of girls
- Secondary
- Has had periods in past but none for 6 months
What is amenorrhoea?
Is the absence of menstrual periods in a woman during reproductive age
What is the prevalence of primary amenorrhoea?
5% of girls
What is the aetiology of secondary amenorrhoea?
- Pregnancy/breast feeding
- Contraception related
- Polycystic ovary syndrome
- Premature ovarian insufficiency
- Thyroid disease, Cushing’s
- Raised prolactin – prolactinoma/medication related
- Congenital adrenal hyperplasia
