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Reproduction > Secondary Amenorrhoea and Menopause > Flashcards

Secondary Amenorrhoea and Menopause Flashcards

1
Q

What is the menopause?

A

The last ever period a female has

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2
Q

When does the menopause usually occur?

A
  • Average age is 51

- Menopause is considered early when it occurs in women <40 years old

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3
Q

How long is the perimenopause?

A

Occurs for approximately 5 years before the menopause occurs

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4
Q

What is the physiology of the menopause?

A

Ovarian insufficiency

  • Oestradiol falls
  • FSH rises
  • Still some oestriol from periphery
  • Conversion of adrenal androgens in fat
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5
Q

What may trigger the menopause?

A

Can occur naturally/spontaneously or following oophorectomy, chemotherapy or radiotherapy

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6
Q

What are the ‘seven dwarves’ of menopause?

A
  • Itchy
  • Bitchy
  • Sweaty
  • Sleepy
  • Bloated
  • Forgetful
  • Psycho
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7
Q

What are the symptom of menopause?

A
  • Vasomotor symptoms including hot flushes
  • Vaginal dryness/soreness
  • Low libido
  • Muscle and joint aches
  • Mood changes/poor memory
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8
Q

What silent change can occur with the menopause?

A

Osteoporosis

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9
Q

How can osteoporosis be detected?

A

Reduced bone mass

  • DEXA scan
  • T score
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10
Q

What is there significant risk of in osteoporosis?

A

Fractured hip/ vertebra leading to significant morbidity and mortality

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11
Q

What are the risk factors for osteoporosis?

A
  • Thin
  • Caucasian
  • Smokers
  • EtOH
  • Family history
  • Amenorrhoea
  • Malabsorptioon
  • Steroids
  • Hyperthyroidism
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12
Q

How can osteoporosis be prevented and managed?

A
  • Exercise
  • Adequate calcium and vitamin D
  • HRT
  • Bisphosphonates
  • Denosumab (monoclonal antibody to osteoclasts)
  • Teriparatide
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13
Q

How can HRT be administered for menopaus?

A
  • Locally: vaginal oestrogen in the form of pessary, ring or cream
  • Systemically: transdermal or oral (transdermal avoids first pass so less risk of VTE)
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14
Q

What combination of HRT can be given?

A
  • Oestrogen only, if no uterus

- Oestrogen + progesterone, if uterus present (progesterone can be oral, transdermal of LNG IUS)

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15
Q

What are the contraindications to HRT?

A
  • 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
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16
Q

What are the features of the cyclical combined oestrogen and progesterone HRT?

A
  • 14 days of O and 14 days of O+P
  • Get withdrawal bleed
  • Use if still some ovarian function (perimenopause)
17
Q

What are the features of the continuous combined oestrogen and progesterone HRT?

A
  • 28 days of O+P
  • Bleed free after 3 months
  • Use if no ovarian function (>1 year after menopause or age 54+)
18
Q

Who can use Mirena LNG IUS and daily oestrogen?

A

Any age

19
Q

What OTHER menopause symptomatic treatments are there?

A
  • 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
20
Q

What are the benefits of HRT?

A
  • Effect on vasomotor symptoms
  • Effect on local genital symptoms
  • Decreases risk of osteoporosis
21
Q

What are the risks of HRT use?

A
  • Risk of breast cancer if combined HRT
  • Risk of ovarian cancer
  • VTE if oral route
  • CVA if oral rote
22
Q

When does the risk of breast cancer correct following HRT use?

A

Excess breast cancer risk as for never users after 5 years off HRT

23
Q

When should HRT be used in menopause according to NICE guidelines?

A
  • 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
24
Q

What occurs in andropause?

A
  • Testosterone falls by 1% a year after the age of 30
  • DHEAS falls
  • Fertility remains and no sudden change occurs in the male
25
Q

What is primary amenorrhoea?

A

Never having had a period

26
Q

When can primary amenorrhoea be diagnosed?

A
  • > 14 years with no secondary sexual characteristics

- <16 years if secondary sexual characteristics present

27
Q

What is secondary amenorrhoea?

A

When there has been periods in the past but nothing for the past 6 months

28
Q

What are the causes of secondary amenorrhoea?

A
  • Pregnancy / Breast feeding
  • Contraception related- current use or for 6-9 months after depoprovera
  • Polycystic ovaries
  • Early menopause
  • Thyroid disease/ Cushings/ Any significant illness
  • Raised prolactin- prolactinoma/ medication related
  • Hypothalamic- stress/ wt change / exercise
  • Androgen secreting tumour- testosterone >5mg/l
  • Sheehans syndrome- pituitary failure
  • Ashermans syndrome- intrauterine adhesions
29
Q

How is secondary amenorrhoea investigated?

A

Examination

  • BP, BMI, hirsutism, acne, Cushingoid
  • Enlarged clitoris/deep voice= virilised
  • Abdominal/bimanual exam

Investiagtions

  • Urine pregnancy test and glucose dipstick
  • Bloods including: FSH, LH, oestradiol, prolactin, TFTs, testosterone
  • Pelvic ultrasound (PCO)
30
Q

How should secondary amenorrhoea be treated?

A
  • Treat specific cause
  • Aim for BMI 20-25
  • Assume fertile and need contraception unless 2 yrs after confirmed menopause
  • If premature ovarian insufficiency offer HRT till 50, emotional support , Daisy network, check for Fragile X
31
Q

How can polycystic ovary syndrome present?

A
  • Oligo/amenorrhoea
  • Androgenic symptoms: excess hair/acne
  • Anovulatory infertility
32
Q

What risks are there with polycystic ovary syndrome?

A
  • Higher risk diabetes & cardiovascular disease for any given BMI
  • Risk of endometrial hyperplasia if < 4 periods a year ( not on hormones)
33
Q

What do polycystic ovaries NOT cause?

A

Weight gain or pain

34
Q

What are the features of polycystic ovary syndrome?

A
  • Irregular ovulation so irreg cycle
  • Plenty oestrogen but also high androgens
  • Underlying insulin resistance
35
Q

What are polycystic ovaries?

A
  • Small peripheral ovarian cysts x10/ovary or ovarian volume>12cm^3 seen on scan
  • 20% have this with no other features (no PCOS)
  • Multicystic ovaries are common in adolescents and often have no implications
36
Q

How is polycystic ovary syndrome managed?

A
  • Weight loss/exercise to help symptoms as less free androgens
  • Anti-androgen (CHC, spironolactone, eflonithine cream facial hair
  • Endometrial protection (CHC, progresterones, mirena IUS)
  • Fertilityr treatment clomiphene/metformin
37
Q

What role does metformin play in PCOS?

A

Helps ovulation and therefore fertility

Reproduction (34 decks)

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