Secondary Amenorrhoea and Menopause Flashcards
How is early menopause defined?
<40 years
What hormonal changes are seen in menopause?
Ovarian insufficiency
Estradiol falls
FSH rises
What are the causes of menopause?
Natural
Oophorectomy
Chemotherapy
Radiotherapy
What are the symptoms of menopause?
Hot flushes Vaginal dryness Dyspareunia Low libido Muscle and joint aches Mood changes Osteoporosis
What score is used for osteoporosis?
FRAX score
What are the risk factors for osteoporosis?
Thin White Smokers Alcohol FH Amenorrhoea Steroids Malabsorption Hyperthryoid
How is osteoporosis prevented?
Exercise Calcium + Vit D Bisphosphonates Denosumab Teriparatide
What is the symptomatic management of menopause?
HRT Transdermal/oral (systemic) Estrogen (no uterus) Estrogen + Progesterone (if uterus) Vaginal estrogen (Local) SERMs SSRI Phytoestrogens Lubricants
What is the role of progesterone in hormone therapy for menopause?
Prevents endometrial hyperplasia
What are the contraindications to systemic HRT?
Current hormone dependent cancer
Current liver disease
Abnormal bleeding
Hx VTE, cancer?
What are the benefits of HRT?
Vasomotor
Local genital symptom improvement
Osteoporosis
Reduce risk Colon Ca
What are the risks of HRT?
Combined - Breast Ca
Ovarian cancer
VTE, MI (oral)
What is the first line management of osteoporosis in menopause?
Bisphosphonates
When is progesterone not indicated in menopausal HRT?
If the patient does not have a uterus
How can risk of fracture be assessed?
FRAX score
DEXA scan
What are the benefits of vaginal estrogen?
Minimal systemic absorption
No increased risk VTE or Breast Ca
No need for progestogen
When is vaginal estrogen contraindicated?
Women on aromatase inhibitors for Breast Ca
What is primary amenorrhoea?
Never had a period
What is secondary amenorrhoea?
No periods in last 6mo
What are the causes of secondary amenorrhoea?
Pregnancy/breast feeding Contraception PCOS Early menopause Thyroid disease Cushings Hyperprolactinaemia Androgen secreting tumour Sheehan's/Asherman's syndrome
What examinations are indicated in secondary amenorrhoea?
Look at BMI Cushingoid features Androgenic signs Abdominal exam Pregnancy test FSH Estrogen Prolactin TSH Testosterone
How is secondary amenorrhoea treated?
BMI 20-25
Assume fertile and need contraception unless 2y after confirmed menopause
Premature ovarian insufficiency - HRT til 50
Check for fragile X
How is PCOS diagnosed?
2 out of 3 of:
- PCO morphology on scan
- Clinical/biochemical hyperandrogenism
- Oligo/anovulation
When are PCOS patients at increased risk of endometrial hyperplasia?
Not on hormones
<4 periods a year
Why are PCOS patients at increased risk of diabetes?
Increased insulin resistance
How is PCOS managed?
Weight loss (symptoms) Antiandrogens (combined pill, spironolactone) Endometrial protection (CHC, progesterones, Mirena IUS) Fertility Rx (metformin)
