Secondary amenorrhoea + Menopause Flashcards
What hormone causes menopausal symptoms?
The lack of oestrogen (no follicles with theca cells to secrete it)
What is menopause?
When a women has had no periods for 12 months.
What is perimenopause?
The time around menopause, when symptoms first begin up until menopause occurs.
What are the symptoms of perimenopause?
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
What is vaginal atrophy?
Vaginal wall thins, its pale, dry, smooth, vaginal canal has shortened
What is premenstrual syndrome?
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
What is the management of perimenopausal symptoms?
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)
What are the risks associated with HRT?
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.
What is post menopause?
Any time after 1yr since the last menstrual period.
What age is classed as premature menopause? What is the main cause?
Below 40yrs.
Premature ovarian insufficiency.
What are the causes of premature menopause?
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
How is menopause/perimenopause diagnosed?
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)
How long should contraception be used for after menopause?
> 50 - 1 yr after last period
< 50 - 2 yrs after last period
What age can the combined pill be used until?
Until 50yrs
What advantages and disadvantages are there to having too much/little oestrogen?
Too much:
breast cancer
Uterine/endometrial cancer
ovarian cancer
Too little: osteoporosis Cardiovascular disease stroke pelvic organ prolapse urinary incontinence
What age can the depot injection be used till?
45yrs
Increased risk of weight gain and osteoporosis.
What is menarche?
The first period
What is considered heavy bleeding (menorrhagia)?
> 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
What is the average blood loss during menstruation?
30-40mls per cycle.
What are the two phases of menstruation?
Follicular/proliferation phase.
Luteal/secretory phase.
What are the causes of heavy menstrual bleeding?
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
When is oestrogen only HRT recommended?
When you DONT have a uterus (after a hysterectomy)
When is oestrogen only HRT recommended?
When you DONT have a uterus (after a hysterectomy)
What is oestrogen HRT used for?
To reduce perimenopausal symptoms.
+ Progesterone if the women has a uterus.
Can HRT be given to <50yrs?
Under 50yrs (if menopausal) you should give HRT as you are just replacing the hormones which should be there.
What are fibroids (myopia/lieomyoma)?
Non-cancerous growths made of muscle and fibrous tissue
How are fibroids diagnosed?
Ultrasound - abdominal/transvaginal
What is the treatments for fibroids?
Small: (+HMB)
combined oral contraceptive pill
Progesterone only pill
Mirena
Large:
Myomectomy
Fibroid embolisation
Submucosal:
Hysteroscopic fibroid resection
Other:
Hysterectomy (if fertilisation not required)
What is the treatments for fibroids?
Small: (+HMB)
combined oral contraceptive pill
Progesterone only pill
Mirena
Large:
Myomectomy
Fibroid embolisation
Submucosal:
Hysteroscopic fibroid resection
Other:
Hysterectomy (if fertilisation not required)
What is adenomyosis?
Where the endometrium becomes embedded in the myometrium
What are the signs/symptoms of adenomyosis?
Menorrhagia
Dysmenorrhoea
What is the treatment of adenomyosis?
Hormone treatment
Definitive - hysterectomy
What are endometrial polyps?
Overgrowth of the endometrial lining which can lead to pediculated structures that extend into the endometrium.
What is the investigation for endometrial polyps?
Ultrasound
Hysteroscopy
What is the treatment for uterine polyps?
Polypectomy
What age should raise concern for heavy menstrual bleeding?
> 44yrs
ENDOMETRIAL BIOPSY SHOULD BE DONE
What age should raise concern for heavy menstrual bleeding?
> 44yrs
ENDOMETRIAL BIOPSY SHOULD BE DONE
Which non-hormonal medications can be used to treat HMB?
Tranexamic acid (helps blood clot) Mefenamic acid (reduce bleeding and PAIN)
What is the surgical management of HMB?
Endometrial ablation - permanent destruction of the endometrium
Hysterectomy
What are the types of hysterectomy?
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
What are the causes of amenorrhoea?
Eating disorders obesity intense exercise stress PCOS primary ovarian insufficiency hyperprolactinaemia Prolactinoma Thyroid disorders (Graves) Obstruction Hormones: POP, Mirena, depot
