Secondary Amenorrhoea and Menopause

Question 1

How is early menopause defined?

Answer 1

<40 years

Question 2

What hormonal changes are seen in menopause?

Answer 2

Ovarian insufficiency
Estradiol falls
FSH rises

Question 3

What are the causes of menopause?

Answer 3

Natural
Oophorectomy
Chemotherapy
Radiotherapy

Question 4

What are the symptoms of menopause?

Answer 4

Hot flushes
Vaginal dryness
Dyspareunia
Low libido
Muscle and joint aches
Mood changes
Osteoporosis

Question 5

What score is used for osteoporosis?

Answer 5

FRAX score

Question 6

What are the risk factors for osteoporosis?

Answer 6

Thin
White
Smokers
Alcohol
FH
Amenorrhoea
Steroids
Malabsorption
Hyperthryoid

Question 7

How is osteoporosis prevented?

Answer 7

Exercise
Calcium + Vit D
Bisphosphonates
Denosumab
Teriparatide

Question 8

What is the symptomatic management of menopause?

Answer 8

HRT
Transdermal/oral (systemic)
Estrogen (no uterus)
Estrogen + Progesterone (if uterus)
Vaginal estrogen (Local)
SERMs
SSRI
Phytoestrogens
Lubricants

Question 9

What is the role of progesterone in hormone therapy for menopause?

Answer 9

Prevents endometrial hyperplasia

Question 10

What are the contraindications to systemic HRT?

Answer 10

Current hormone dependent cancer
Current liver disease
Abnormal bleeding
Hx VTE, cancer?

Question 11

What are the benefits of HRT?

Answer 11

Vasomotor
Local genital symptom improvement
Osteoporosis
Reduce risk Colon Ca

Question 12

What are the risks of HRT?

Answer 12

Combined - Breast Ca
Ovarian cancer
VTE, MI (oral)

Question 13

What is the first line management of osteoporosis in menopause?

Answer 13

Bisphosphonates

Question 14

When is progesterone not indicated in menopausal HRT?

Answer 14

If the patient does not have a uterus

Question 15

How can risk of fracture be assessed?

Answer 15

FRAX score

DEXA scan

Question 16

What are the benefits of vaginal estrogen?

Answer 16

Minimal systemic absorption
No increased risk VTE or Breast Ca
No need for progestogen

Question 17

When is vaginal estrogen contraindicated?

Answer 17

Women on aromatase inhibitors for Breast Ca

Question 18

What is primary amenorrhoea?

Answer 18

Never had a period

Question 19

What is secondary amenorrhoea?

Answer 19

No periods in last 6mo

Question 20

What are the causes of secondary amenorrhoea?

Answer 20

Pregnancy/breast feeding
Contraception
PCOS
Early menopause
Thyroid disease
Cushings
Hyperprolactinaemia
Androgen secreting tumour
Sheehan's/Asherman's syndrome

Question 21

What examinations are indicated in secondary amenorrhoea?

Answer 21

Look at BMI
Cushingoid features
Androgenic signs
Abdominal exam
Pregnancy test
FSH
Estrogen
Prolactin
TSH
Testosterone

Question 22

How is secondary amenorrhoea treated?

Answer 22

BMI 20-25
Assume fertile and need contraception unless 2y after confirmed menopause
Premature ovarian insufficiency - HRT til 50
Check for fragile X

Question 23

How is PCOS diagnosed?

Answer 23

2 out of 3 of:

1. PCO morphology on scan
2. Clinical/biochemical hyperandrogenism
3. Oligo/anovulation

Question 24

When are PCOS patients at increased risk of endometrial hyperplasia?

Answer 24

Not on hormones

<4 periods a year

Question 25

Why are PCOS patients at increased risk of diabetes?

Answer 25

Increased insulin resistance

Question 26

How is PCOS managed?

Answer 26

Weight loss (symptoms) 
Antiandrogens (combined pill, spironolactone)
Endometrial protection (CHC, progesterones, Mirena IUS)
Fertility Rx (metformin)