Secondary Amenorrhoea and Menopause Flashcards
1
Q
What causes menopause?
A
- Ovarian insufficiency: oestradiol falls, FSH rises
- Can be natural
- Following oopherectomy/ chemo/radiotherapy
2
Q
What are the symptoms of menopause?
A
- Itchiness
- Mood changes
- Sweats
- Sleepiness
- Bloated
- Forgetfulness
- Vaginal dryness
- Dyspareunia
- Low labido
- Muscle and joint aches
3
Q
What are the risks after menopause?
A
-Osteoporosis: increased risk of fractures
4
Q
How can the symptoms of menopause be treated?
A
- HRT: systemic (oestrogen +/- progesterone) or local (oestrogen only pessary/ring/cream)
- Selective oestrogen receptor modulators
- SSRI/SNRI antidepressants
- Natural methods
- Non hormonal vaginal lubricants
5
Q
What are the contraindications for systemic HRT?
A
- Current hormone dependent cancer
- Current active liver disease
- Univestigated abnormal bleeding
- Advice needed if history of VTE, thrombophilia, FH of VTE and previous CA breast or BRCA carrier
6
Q
What are the benefits and risks of HRT?
A
- Benefits: vasomotor, local genital symptoms and osteoporosis
- Risks: breast Ca, ovarian Ca, VTE and CVA
7
Q
What is primary amenorrhoea?
A
Never had a period
8
Q
What is secondary amenorrhoea?
A
Has had periods but none for 6 months
9
Q
What are the causes of secondary amenorrhoea?
A
- Pregnancy/breastfeeding
- Contraception related
- Polycystic ovaries
- Early menopause
- Thyroid disease/Cushings
- Any significant illness
- Raised prolactin
- Hypothalamic stress
- Androgen secreting tumour
- Sheehans syndrome - pituitary failure
- Ashermans syndrome - intrauterine adhesions
10
Q
Which tests should be performed for secondary amenorrhoea?
A
- BMI and cushingoid
- Androgenic signs
- Abdominal/bimanual exam
- Pregnancy test
- Urine dipstick for glucose
- Bloods: FSH, oestradiol, prolactin, TFTs and testosterone
- Pelvic USS
11
Q
How can secondary amenorrhoea be treated?
A
- Treat specific cause
- Assume fertile and need contraception unless 2yrs post-menopausal
- Premature ovarian insufficiency: HRT, emotional support and check for fragile X
12
Q
How can polycystic ovary be diagnosed?
A
2 out of 3 of:
- PCO morphology on scan
- Clinical or biochemical hyperandrogenism (hirsute/acne)
- Oligo/anovulation: amenorrhoea or infertility
13
Q
What are the risks of polycystic ovary syndrome?
A
- Higher risk of diabetes and CVS disease
- Risk of endometrial hyperplasia
- Increased insulin resistance
14
Q
How can polycystic ovary syndrome managed?
A
- Weight loss/exercise
- Antiandrogen: combined hormonal contraception, spironolactone and eflornithine cream
- Endometrial protection: CHC, progestogens and mirena IUS
- Fertility: clomiphene/metformin
