Secondary Amenorrhoea and Menopause Flashcards
What is the menopause?
The last ever period a female has
When does the menopause usually occur?
- Average age is 51
- Menopause is considered early when it occurs in women <40 years old
How long is the perimenopause?
Occurs for approximately 5 years before the menopause occurs
What is the physiology of the menopause?
Ovarian insufficiency
- Oestradiol falls
- FSH rises
- Still some oestriol from periphery
- Conversion of adrenal androgens in fat
What may trigger the menopause?
Can occur naturally/spontaneously or following oophorectomy, chemotherapy or radiotherapy
What are the ‘seven dwarves’ of menopause?
- Itchy
- Bitchy
- Sweaty
- Sleepy
- Bloated
- Forgetful
- Psycho
What are the symptom of menopause?
- Vasomotor symptoms including hot flushes
- Vaginal dryness/soreness
- Low libido
- Muscle and joint aches
- Mood changes/poor memory
What silent change can occur with the menopause?
Osteoporosis
How can osteoporosis be detected?
Reduced bone mass
- DEXA scan
- T score
What is there significant risk of in osteoporosis?
Fractured hip/ vertebra leading to significant morbidity and mortality
What are the risk factors for osteoporosis?
- Thin
- Caucasian
- Smokers
- EtOH
- Family history
- Amenorrhoea
- Malabsorptioon
- Steroids
- Hyperthyroidism
How can osteoporosis be prevented and managed?
- Exercise
- Adequate calcium and vitamin D
- HRT
- Bisphosphonates
- Denosumab (monoclonal antibody to osteoclasts)
- Teriparatide
How can HRT be administered for menopaus?
- Locally: vaginal oestrogen in the form of pessary, ring or cream
- Systemically: transdermal or oral (transdermal avoids first pass so less risk of VTE)
What combination of HRT can be given?
- Oestrogen only, if no uterus
- Oestrogen + progesterone, if uterus present (progesterone can be oral, transdermal of LNG IUS)
What are the contraindications to HRT?
- Current Hormone dependent cancer breast/endometrium
- Current active liver disease
- Uninvestigated abnormal bleeding
- Seek advice if prev VTE, thrombophilia, FH VTE
- Seek advice if previous CA breast or BRCA carrier
What are the features of the cyclical combined oestrogen and progesterone HRT?
- 14 days of O and 14 days of O+P
- Get withdrawal bleed
- Use if still some ovarian function (perimenopause)
What are the features of the continuous combined oestrogen and progesterone HRT?
- 28 days of O+P
- Bleed free after 3 months
- Use if no ovarian function (>1 year after menopause or age 54+)
Who can use Mirena LNG IUS and daily oestrogen?
Any age
What OTHER menopause symptomatic treatments are there?
- Selective oestrogen receptor modulators (SERM), Oestrogen effect on selected organs (tibolone)
- SSRI/SNRI antidepressants (venlafaxine or Clonidine, NOT helpful side effects and few benefits
- Natural methods phytoestrogen/ herbs/ hypnotherapy/ exercise/ CBT
- Non hormonal lubricants
What are the benefits of HRT?
- Effect on vasomotor symptoms
- Effect on local genital symptoms
- Decreases risk of osteoporosis
What are the risks of HRT use?
- Risk of breast cancer if combined HRT
- Risk of ovarian cancer
- VTE if oral route
- CVA if oral rote
When does the risk of breast cancer correct following HRT use?
Excess breast cancer risk as for never users after 5 years off HRT
When should HRT be used in menopause according to NICE guidelines?
- For treatment of severe vasomotor symptoms, review annually
- For women with premature ovarian insufficiency HRT benefits outweigh risks till age 50
- Not as first line for osteoporosis prevention / treatment (bisphosphonates instead)
- Vaginal Oestrogen for vaginal symptoms
What occurs in andropause?
- Testosterone falls by 1% a year after the age of 30
- DHEAS falls
- Fertility remains and no sudden change occurs in the male
