Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Reproductive System > Secondary Amenorrhoea and Menopause > Flashcards

Secondary Amenorrhoea and Menopause Flashcards

1
Q

What is the dentition of menopause?

A

The Menopause is a woman’s last ever period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the average age of the menopause?

A

51

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When does perimenopause start?

A

Approx. 5 years before

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is premature menopause and how common is it?

A
  • Premature menopause = 40 years or less

* Affects 1% of women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What happens in menopause?

A

•Ovarian insufficiency (oestradiol falls)
->Follicle stimulating hormone (FSH) rises

  • Still some oestriol from conversion of adrenal androgens in adipose tissue
  • FSH levels fluctuate in perimenopause - a premenopausal level does not exclude perimenopause as a cause for symptoms
  • Menopausal transition may be natural or sudden following oophorectomy/chemotherapy/radiotherapy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the symptoms of menopause?

A
  • Vasomotor symptoms
  • Vaginal dryness/soreness
  • Low libido
  • Muscle and joint aches
  • Mood changes/poor memory - possibly related to vasomotor effect on sleep
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the vasomotor symptoms in menopause?

A
  • Hot flushes/night sweats - 80% women
  • 45% find them a problem
  • Usually last 2-5 yrs but may be 10 years+
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is a silent change in menopause?

A

Osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is osteoporosis?

A
  • Reduced bone mass

* DEXA scan •Bone density described as T score

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the problems that come with osteoporosis?

A

•Fractured hip/vertebrae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the risk factors for osteoporosis?

A
  • Thin
  • Caucasian
  • Smoking
  • High EtOH - alcoholic
  • +ve FH
  • Malabsorption Vit D or Calcium
  • Prolonged low oestrogen amenorrhoea
  • Oral corticosteroids
  • Hyperthyroidism
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How is osteoporosis prevented in menopausal women?

A
  • Weight-bearing exercise
  • Adequate calcium and vitamin D
  • HRT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How is osteoporosis treated in menopausal women?

A
  • Bisphosphonates
  • Denosumab - monoclonal antibody to osteoclasts
  • Calcitonin (hormone)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the 2 types of HRT?

A
  • Local

* Systemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is local HRT?

A
  • Oestrogen pessary/ring/cream
  • Local effects and minimal systemic absorption
  • Need to use longterm to maintain benefit
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is systemic HRT?

A
  • Oestrogen given transdermally or orally
  • Transdermal - avoids first pass, less risk of VTE
  • No uterus - oestrogen only
  • Uterus - oestrogen and progestogen
  • Progestogen given orally, transdermally and LNG IUS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Why is progestogen treatment required if the patient has a uterus?

A

•Prevents endometrial hyperplasia from unopposed oestrogen

18
Q

What is combined cyclical menopause treatment?

A
  • 14 days E + 14 days E+P
  • Expect withdrawal bleed after the P
  • Used if there may still be some ovarian function to avoid irregular bleeding
19
Q

What is combined continuous menopause treatment?

A
  • 28 days E+P oral/patch
  • Expect to be bleed-free (after 1st 3 months)
  • Used if > 1yr after menopause or age 54+
20
Q

What combined treatment can any age use?

A

Any age can use Mirena LNG IUS + daily E and expect

to be bleed free (and contraceptive cover under age 55)

21
Q

What are the contraindications for systemic HRT?

A

•NOT the same as contraindications to combined
hormonal contraception- very few CI

  1. Current Hormone dependent cancer of breast/endometrium
  2. Current active liver disease
  3. Uninvestigated abnormal bleeding
  4. Seek advice if previous VTE, thrombophilia, FH VTE
  5. Seek advice if previous breast cancer or BRCA carrier
22
Q

How are the symptoms of menopause treated?

A

•Selective Estrogen Receptor Modulators (SERMs)
E effect on selected organs (eg tibolone )

NOT clonidine or SSRI SNRI antidepressants eg venlafaxine common side effects &few benefit

phytooestrogen herbs eg red clover/soya

hypnotherapy/ exercise / Cognitive behavioural therapy

Non hormonal lubricants for vaginal dryness Regular eg Replens TM or Pre sex ‘Sylk’ TM

23
Q

What are the benefits of HRT?

A
  • Vasomotor symptoms
  • Local genital symptoms
  • Osteoprosis
24
Q

What are the risks of HRT?

A
  • Breast cancer if combined HRT
  • Ovarian cancer
  • VT if oral route
  • CVA if oral route (stroke)
25
Q

What does HRT not affect?

A
  • No effect on Alzheimer’s

* No increase in CV risk if started before 60

26
Q

How does HRT affect mortality?

A
  • No overall increased mortality for HRT users recent studies
  • Reduced mortality - not certain enough to recommend HRT for all
27
Q

What are the indications for HRT?

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
28
Q

What is andropause?

A
  • Testosterone falls by 1% a year after 30
  • DHEAS falls
  • Fertility remains
  • No sudden change
  • Different from hypogonadism
29
Q

What is primary amenorrhoea?

A
  • Never had a period
  • Affects 5% of girls
  • > 14yrs and no 2ndry sexual characteristics
  • > 16 years if 2ndry sexual characteristics
30
Q

What is secondary amenorrhoea?

A

Has had periods in past but none for 6 months

31
Q

What are the causes of secondary amenorrhoea?

A
  • Pregnancy / Breast feeding
  • Contraception related - current use or for 6-9 months after depoprovera
  • Polycystic ovary syndrome
  • Premature ovarian insufficiency
  • Thyroid disease/Cushings/Any significant illness
  • Raised prolactin - prolactinoma/medication related
  • Congenital adrenal hyperplasia (CAH)
  • Hypothalamic - stress/10% wt change/excess exercise
  • Androgen secreting tumour - testosterone >5mg/l
  • Sheehans syndrome - pituitary failure
  • Ashermans syndrome - intrauterine adhesions
32
Q

What examinations are carried out in secondary amenorrhoea?

A
  • BP
  • BMI
  • Hirsutism
  • Acne
  • Cushingoid
  • Enlarged clitoris/deep voice =virilised
  • Abdominal/bimanual
33
Q

What investigations are carried out in secondary amenorrhoea?

A 
•Urine pregnancy test + dipstick for glucose
•Bloods  
-FSH        
-oestradiol (menopause)
-prolactin
-thyroid function    testosterone
-17 hydroxy progesterone - congenital adrenal hyperplasia
-pelvic ultrasound - polycystic ovaries
34
Q

How is secondary amenorrhoea treated?

A

•Treat specific cause
•Aim BMI 20-30 for ovulation
•Assume fertile and need contraception unless 2 yrs after confirmed menopause
•If premature ovarian insufficiency offer HRT till 50
-emotional support
-Daisy network (for POI)
-check for Fragile X - relatives may wish testing

35
Q

How is polycystic ovary syndrome diagnosed?

A

Need 2/3:
•Oligo/amenorrhoea
•Androgenic symptoms: excess hair/acne
•Polycystic ovarian morphology on scan

36
Q

How may hormone levels indicate PCOS?

A
  • Normal/high oestrogen levels

* Increased androgens

37
Q

What are the issues associated with PCOS?

A
  • Risk of endometrial hyperplasia if < 4 periods a year (and not on hormones)
  • Reduced fertility if not ovulating regularly BUT assume fertile and use contraception if not plan pregnancy
  • ?Higher risk diabetes & cardiovascular disease even if lean
  • Polycystic ovaries do NOT cause weight gain or pain
  • Weight gain can worsen PCOS symptoms as ↓SHBG levels ↑ androgens
38
Q

How may polycystic ovaries be seen?

A

US, laparoscopy

39
Q

What does PCOS look like on an USS?

A
  • Small peripheral ovarian cysts x 10/ovary or ovarian volume>12cm3
  • N.B. 20% women have this on scan but no other features ie not PCO syndrome
  • N.B. Multicystic ovaries common in adolescents – not associated with PCOS
40
Q

How is PCOS managed?

A

•Weight loss/exercise to BMI 20-25

  • can help all symptoms
  • increases SHBG so less free androgens
  • ?increased NIDDM (non-insulin dependent) risk even if slim - consider GTT
  • Support & information– Verity patient support group
  • Antiandrogen
  • combined hormonal contraception if no CI
  • spironolactone
  • eflornithine cream reduces facial hair growth

•Endometrial protection

  • CHC, Mirena IUS
  • Oral provera 10/90 if no period

•Fertility Rx clomiphene/metformin
-ovulation induction

•Metformin - may encourage ovulation but no consistent evidence of benefit for androgenic symptoms or helping weight loss

Reproductive System (31 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions