Secondary Amenorrhoea and Menopause Flashcards
what is the menopause?
last ever period
average age of menopause
51
how long does the perimenopause last approx
5 yrs
what is premature menopause
<40
what causes the menopause
Menopause is a result of primary ovarian insufficiency. Oestradiol falls and FSH rises. There is still
some oestriol from peripheral sources such as the conversion of adrenal androgens in fat. Therefore,
fatter people will experience worse symptoms. Menopause may be natural or follow
oophorectomy/chemotherapy/radiotherapy.
symptoms of the menopause
hot flushes vaginal dryness/soreness low libido muscle and joint aches ? mood changes/poor memory
prevention and treatment of osteoporosis
weight bearing exercise
adequate calcium and vit d
HRT
bisphosphonates
discuss HRT
- Local
a. Vaginal oestrogen pessary/ring/cream - Systemic
a. Transdermal/oral
b. Transdermal avoids first pass – less risk of VTE - Oestrogen only if no uterus
- Oestrogen and progesterone if uterus present
contraindications for HRT
- Current hormone dependent cancer – breast/endometrium
- Current active liver disease
- Uninvestigated abnormal bleeding
Seek advice from the haematologist in previous VTE, thrombophilia, and family history of VTE. If the
patient had previously had breast CA or a BRCA carrier seek advice.
combined oestrogen and progestogen HRT
Cyclical combined 14 days oestrogen and 14 days oestrogen and progestogen. These patients will get
a withdrawal bleed. Use if these is still some ovarian function e.g. perimenopause.
Continuous combined 28 days oestrogen and progestogen. Settle to amenorrhoea. Use if > 1 year
after menopause or aged 54+. This has a lower risk of endometrial cancer.
At any age can use Mirena LNG IUS and daily oestrogen.
benefits of HRT
vasomotor
local genital symptoms
osteoporosis
risks of HRT
breast ca if combined
ovarian ca
VTE and CVA if oral
HRT use NICE guidelines
- For treatment of severe vasomotor symptoms review annually
- For women with premature ovarian insufficiency HRT benefits outweigh the risks till age 50
- Not as first line for osteoporosis treatment/prevention (bisphosphonates instead)
- Vaginal oestrogen for vaginal symptoms
excluding HRT, what else could you use to treat symptoms of menopause
SERMS (selective estrogen receptor modulators) such as tibolone. This exerts its effect on selected
organs and can help hot flushes, prevent osteoporosis and breast CA.
SSRI and SNRI antidepressants e.g. venlafaxine or clonidine are not helpful due to their side effects
and few benefits.
Natural methods such as phytoestrogen/herbs e.g. red clover/hypnotherapy/exercise/CBT are purely
placebo and come at cost to a women.
what is secondary amenorrhoea?
no periods in the last 6 motnhs
