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Exam - M - Reproduction System (Megan and Rachel) > Secondary amenorrhoea + Menopause > Flashcards

Secondary amenorrhoea + Menopause Flashcards

1
Q

What hormone causes menopausal symptoms?

A

The lack of oestrogen (no follicles with theca cells to secrete it)

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2
Q

What is menopause?

A

When a women has had no periods for 12 months.

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3
Q

What is perimenopause?

A

The time around menopause, when symptoms first begin up until menopause occurs.

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4
Q

What are the symptoms of perimenopause?

A 
Hot flush
Low mood 
irregular periods 
Joint pain
Heavier/lighter period 
Emotional lability (rapid/exaggerated mood changes)
Vaginal dryness
Vaginal Atrophy 
Reduced libido
Premenstrual syndrome
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5
Q

What is vaginal atrophy?

A

Vaginal wall thins, its pale, dry, smooth, vaginal canal has shortened

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6
Q

What is premenstrual syndrome?

A 
A group of symptoms which usually occur 1-2 weeks before menstruation. Can occur at any age.
Mood swings (upset/anxious)
tiredness
trouble sleeping
greasy hair 
change in appetite
change in sex drive 
spotty skin
stomach pain
breast tenderness
bloating
headache
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7
Q

What is the management of perimenopausal symptoms?

A

Do nothing (resolves 2-5yrs)

Hormonal:
HRT (combined, oestrogen only)
Tibolone (combined steroid hormone)
Testosterone (for reduced libido)
Vaginal oestrogen (dryness/atrophy)

Non-Hormonal:
SSRI (fluoxetine)
Clonidine (Hot flushes)

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8
Q

What are the risks associated with HRT?

A 
Ovarian cancer (risk goes back to normal once stopped)
Breast cancer (doesn't include vaginal only HRT, the longer you're on it, the longer the risk lasts
Endometrial cancer - oestrogen only HRT Increases the risk, Combined HRT decreases the risk

They should be stopped once menopausal symptoms pass.

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9
Q

What is post menopause?

A

Any time after 1yr since the last menstrual period.

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10
Q

What age is classed as premature menopause? What is the main cause?

A

Below 40yrs.

Premature ovarian insufficiency.

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11
Q

What are the causes of premature menopause?

A

Premature ovarian insufficiency (familial, as early as 20s/30s)
Autoimmune disease
Turners syndrome
Cancer treatment - radio/chemo (can be temporary or permanent)
Infections - TB, malaria
Hysterectomy
Salphingo-oophorectomy

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12
Q

How is menopause/perimenopause diagnosed?

A

Women of normal age - diagnosed clinically.
<40 and suspected menopause - FSH blood test
<45 and menopausal symptoms/changes in period - FSH blood test

Menopause - FSH will be high (No negative feedback of oestrogen)

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13
Q

How long should contraception be used for after menopause?

A

> 50 - 1 yr after last period

< 50 - 2 yrs after last period

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14
Q

What age can the combined pill be used until?

A

Until 50yrs

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15
Q

What advantages and disadvantages are there to having too much/little oestrogen?

A

Too much:
breast cancer
Uterine/endometrial cancer
ovarian cancer

Too little:
osteoporosis
Cardiovascular disease
stroke
pelvic organ prolapse 
urinary incontinence
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16
Q

What age can the depot injection be used till?

A

45yrs

Increased risk of weight gain and osteoporosis.

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17
Q

What is menarche?

A

The first period

18
Q

What is considered heavy bleeding (menorrhagia)?

A

> 80mls
ANY amount which is more than usual for the patient and/or changes QOL.
Blood clots >2.5cm
changing menstrual products every 1-2 hrs

19
Q

What is the average blood loss during menstruation?

A

30-40mls per cycle.

20
Q

What are the two phases of menstruation?

A

Follicular/proliferation phase.

Luteal/secretory phase.

21
Q

What are the causes of heavy menstrual bleeding?

A 
Fibroids/leiomyoma
Polyps
Adenomyosis 
UID
Misscarriage
Placenta praveia 
Von Willebrand's disease
PCOS
Hypothyroidism
Endometriosis
Pelvic inflammatory disease
ovulation dysfunction

Especially if older/post menopausal:
Endometrial cancer/hyperplasia
cervical cancer

22
Q

When is oestrogen only HRT recommended?

A

When you DONT have a uterus (after a hysterectomy)

22
Q

When is oestrogen only HRT recommended?

A

When you DONT have a uterus (after a hysterectomy)

23
Q

What is oestrogen HRT used for?

A

To reduce perimenopausal symptoms.

+ Progesterone if the women has a uterus.

24
Q

Can HRT be given to <50yrs?

A

Under 50yrs (if menopausal) you should give HRT as you are just replacing the hormones which should be there.

25
Q

What are fibroids (myopia/lieomyoma)?

A

Non-cancerous growths made of muscle and fibrous tissue

26
Q

How are fibroids diagnosed?

A

Ultrasound - abdominal/transvaginal

27
Q

What is the treatments for fibroids?

A

Small: (+HMB)
combined oral contraceptive pill
Progesterone only pill
Mirena

Large:
Myomectomy
Fibroid embolisation

Submucosal:
Hysteroscopic fibroid resection

Other:
Hysterectomy (if fertilisation not required)

27
Q

What is the treatments for fibroids?

A

Small: (+HMB)
combined oral contraceptive pill
Progesterone only pill
Mirena

Large:
Myomectomy
Fibroid embolisation

Submucosal:
Hysteroscopic fibroid resection

Other:
Hysterectomy (if fertilisation not required)

28
Q

What is adenomyosis?

A

Where the endometrium becomes embedded in the myometrium

29
Q

What are the signs/symptoms of adenomyosis?

A

Menorrhagia

Dysmenorrhoea

30
Q

What is the treatment of adenomyosis?

A

Hormone treatment

Definitive - hysterectomy

31
Q

What are endometrial polyps?

A

Overgrowth of the endometrial lining which can lead to pediculated structures that extend into the endometrium.

32
Q

What is the investigation for endometrial polyps?

A

Ultrasound

Hysteroscopy

33
Q

What is the treatment for uterine polyps?

A

Polypectomy

34
Q

What age should raise concern for heavy menstrual bleeding?

A

> 44yrs

ENDOMETRIAL BIOPSY SHOULD BE DONE

34
Q

What age should raise concern for heavy menstrual bleeding?

A

> 44yrs

ENDOMETRIAL BIOPSY SHOULD BE DONE

35
Q

Which non-hormonal medications can be used to treat HMB?

A 
Tranexamic acid (helps blood clot)
Mefenamic acid (reduce bleeding and PAIN)
36
Q

What is the surgical management of HMB?

A

Endometrial ablation - permanent destruction of the endometrium
Hysterectomy

37
Q

What are the types of hysterectomy?

A

Total - cervix and uterus
Subtotal - uterus removed, cervix left
Total + Salpingo-oophorectomy - cervix, uterus, Fallopian tubes and ovaries
Wertheim’s - total + sapling-oophorectomy + pelvic lymph nodes, parametric

38
Q

What are the causes of amenorrhoea?

A 
Eating disorders
obesity
intense exercise
stress
PCOS
primary ovarian insufficiency
hyperprolactinaemia 
Prolactinoma
Thyroid disorders (Graves)
Obstruction
Hormones: POP, Mirena, depot

Exam - M - Reproduction System (Megan and Rachel) (45 decks)

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