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Reproduction Pathology > Secondary Amenorrhoea and Menopause > Flashcards

Secondary Amenorrhoea and Menopause Flashcards

1
Q

Definition of menopause

A

When a women aged 45 or over has amenorrhoea for 12 months

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2
Q

Average age of menopause

A

51

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3
Q

Perimenopause lasts for how long before menopause?

A

5 years before

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4
Q

What age is classified as premature menopause?

A

40 years or less

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5
Q

What physiological change occurs during menopause?

A

Ovarian insuffiency

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6
Q

Ovarian insufficiency of menopause involves….

A

Oestradiol falls
FSH rises - telling brain to produce more oestrogen
Still some oestradiol from peripheral
Conversion of adrenal androgens in fat (women with more body fat will have fewer hot flushes/sweats)

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7
Q

Causes of menopause

A

Natural
Follow oophorectomy
Follow chemotherapy
Follow radiotherapy

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8
Q

Symptoms of menopause

A 
Itchy 
Irritable 
Sweaty
Sleepy
Bloated
Mood changes
Possibly forgetful 
Vasomotor symptoms - "hot flushes"
Vaginal dryness/soreness
Low libido 
Muscle and joint aches
Silent change of osteoporosis
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9
Q

Risks of osteoporosis in menopause

A 
Thin
Caucasian 
Smokers
EtOH
Positive FH of amenorrhoea 
Malabsorption 
Oral steroids
Hyperthyroid
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10
Q

Prevention/treatment of osteoporosis

A 
exercise 
adequate calcium + vit D
HRT
Bisphosphonates
Denosumab 
Teriparatide
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11
Q

What does denosumab do?

A

It is a monoclonal antibody to osteoclasts

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12
Q

Symptom treatment of menopause

A

Hormone replacement therapy (HRT)
Selective oestrogen receptor modulators (SERMS)
SSRI SNRI antidepressants
Natural methods e.g. herbs, exercise
Non-hormonal lubricants e.g. Reptes, Sylk

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13
Q

Types of HRT

A

Local vaginal oestrogen pessary/ring/cream

Systemic transdermal/oral transdermal

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14
Q

Systemic transdermal/oral transdermal HRT - which hormones are indicated?

A

Oestrogen ONLY if no uterus

Oestrogen AND progesterone if uterus present

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15
Q

Contraindications to HRT

A

Current hormone dependent cancer of breast/endometrium
Current active liver disease
Uninvestigated abnormal bleeding

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16
Q

Seek advise before giving HRT if….

A 
Previous VTE
Thrombophilia
FH VTE
Previous breast cancer 
BRCA carrier
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17
Q

Benefits of HRT

A

Vasomotor
Local genital symptoms
Osteoporosis

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18
Q

Risks of HRT

A 
Breast cancer if combined HRT 
Ovarian cancer
VTE if oral route
CVA if oral route
after 60 y/o can affect CVS
19
Q

Natural methods for the treatment of menopause

A 
Phytooestrogen 
Herbs e.g. red clover
Hypnotherapy 
Exercise
CBT - high placebo effect
20
Q

Testosterone falls by 1% a year after what age in males?

A

30 y/o

21
Q

Definition of primary amenorrhoea

A

Never had a period

22
Q

Definition of secondary amenorrhoea

A

Has had periods in the past but none for 6 months

23
Q

Causes of secondary amenorrhoea

A

Pregnancy/breast feeding
Contraception related (current use or 6 months after DP)
Polycystic ovaries
Early menopause
Thyroid disease/cushings
Any significant illness
Raised prolactin (prolactinoma, medication related)
Hypothalamic
Androgen screening tumour (testosterone >5mg/l)
Sheehan’s syndrome (pituitary failure)
Asherman’s syndrome (intrauterine adhersions)

24
Q

Investigations for secondary amenorrhoea

A 
BP
BMI
Acne
Hirsituism 
Cushingoid 
Enlarged clitoris/deep voice = virulised
Abdominal/bimanual 
Urine pregnancy test + urine glucose dipstick 
Bloods (FSH, LH, oestrogen, prolactin, TFTs, testosterone)
Pelvic USS for PCO
25
Q

Treatment for secondary amenorrhoea

A

treat specific cause
Aim BMI 20-25
Assume fertile and need contraception unless 2 years after confirmed menopause
if premature ovarian insuffiency offer HRT until 50
Emotional support - daisy network
Check for fragile X

26
Q

Presentation spectrum for polycystic ovarian syndrome (PCOS)

A

Oligo/Amenorrhoea
Androgenic symptoms; excess hair/acne
Anovulatory fertility

27
Q

What do polycystic ovaries NOT cause

A

weight gain

pain

28
Q

Treatment of polycystic ovarian syndrome (PCOS)

A 
Weight loss/exercise
Antiandrogen 
- combined hormonal contraception (CHC)
- Spironolactone 
- Eflornithine cream facial hair
Endometrial protection 
- CHC
- Progesterones 
- Mirena IUS
Fertility treatment
- clomiphene/metformin
29
Q

Definition of polycystic ovaries

A

Small peripheral ovarian cysts x10/ovary or ovarian volume >12cm3

30
Q

Perimenopause definition

A

The time leading up to menopause. Many women experience menopausal symptoms during this

31
Q

Blood values indicative of menopause

A

Low oestrogen

High FSH and LH

32
Q

In order to find the correct HRT regime, what 3 things must be addressed?

A
  1. Is there a uterus?
  2. Is the patient perimenopausal or menopausal?
  3. Is a systemic or a local effect required?
33
Q

Is continuous or cyclical HRT recommended in perimenopausal HRT?

A

Cyclical

34
Q

Why is systemic oestrogen only HRT not appropriate for women with a uterus?

A

Increased risk of endometrial cancer

35
Q

What % of women of reproductive age are affected by PCOS?

A

5 - 20%

36
Q

Investigations of PCOS

A

Pelvic USS (multiple cysts on ovaries)
FSH, LH, prolactin, TSH, testosterone
Glucose tolerance

37
Q

Diagnostic criteria for PCOS

A

2/3 out of;

  • Infrequent or no ovulation
  • Clinical or biochemical signs of hyperandrogenism or elevated levels of total or free testosterone
  • polycystic ovaries on ultrasonography or increased ovarian volume
38
Q

What test is done to confirm menopause?

A

FSH

39
Q

Describe sheehans syndrome

A

Hypopituitarism caused by ischaemic necrosis due to blood loss and hypovolaemic shock

40
Q

Features of sheehans syndrome

A 
Agalactorrhoea
Amenorrhoea
Symptoms of 
- hypothyroidism 
- hypoadrenalism
41
Q

What is ashermans syndrome?

A

Intrauterine adhesions

42
Q

What can ashermans syndrome occur after?

A

Dilatation and curettage

43
Q

How can ashermans syndrome cause secondary amenorrhea?

A

Prevent the endometrium responding to oestrogen as it normally would

Reproduction Pathology (28 decks)

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