Secondary Amenorrhoea & Menopause

Question 1

What is the epidemiology of menopause?

Answer 1

Menopause = last ever period

The average age of menopause is 51

Perimenopause - period of approximately 5 years before menopause occurs

Premature menopause = menopause at 40 y.o. or less

Question 2

What happens during the process of menopause?

Answer 2

• The primary cause of menopause is ovarian insufficiency

Hormone levels:

• Oestradiol falls
• FSH rises

Question 3

What are the symptoms of menopause?

Answer 3

1 - Hot flushes (occurs in 80% of woman)

2 - Vaginal dryness/soreness

3 - Low libido

4 - Muscle & joint aches

5 - Mood changes/poor memory

Question 4

What is an important change that occurs in woman bodies during menopause but does not present as a symptom?

Answer 4

Osteoporosis

Question 5

What woman are most at risk from osteoporosis during the menopause, which bones are they most likely to fracture and what investigations can be performed to check on osteoporosis progression?

Answer 5

At risk group:

• Thin
• Caucasian
• Smokers
• +ve FH
• Amenorrhoea
• Steroid use
• Hyperthyroid

Bones commonly fractured:

• Hip
• Vertebra

Investigations:

• DEXA scan

Question 6

What treatments are available to reduce osteoporosis in menopausal woman?

Answer 6

• Exercise
• Adequate calcium & Vit D
• HRT
• Bisphosphonates

Question 7

How are menopause symptoms managed?

Answer 7

HRT

Local treatments:

• Vaginal oestrogen pessary
• Vaginal ring
• Vaginal cream

Systemic treatments:

1 - Oestrogen only if no uterus

2 - Oestrogen + progesterone if uterus present

Question 8

Apart from HRT, what other methods of treatment are available for treatment of menopause symptoms?

Answer 8

• Selective Estrogen Receptor Modulators (SERMs)

Natural methods:

• Phytooestrogen
• Red clover
• Hypnotherapy
• Exercise
• CBT

Question 9

What are some of the common risks associated with HRT?

Answer 9

• Breast cancer if combined HRT is being taken
• Ovarian cancer
• Venous thrombosis (if taken by oral route)

Question 10

What are the definitions of primary and secondary amenorrhoea?

Answer 10

Primary amenorrhoea - Never had a period

Secondary amenorrhoea - Has periods before, but has had none for the last 6 months

Question 11

What are the causes of secondary amenorrhoea?

Answer 11

1) Pregnancy/breast feeding
2) Current use of contraception or 6-9 months after depoprovera
3) Polycystic ovaries
4) Early menopause
5) Thyroid disease/ Cushings

Question 12

What are the findings on examination of a woman with secondary amenorrhoea?

Answer 12

1 - Excess facial hair

2 - Acne

3 - Cushingoid appearance

4 - Enlarged clitoris

5 - Deep voice

6 - Low BMI

Question 13

How is secondary amenorrhoea investigated?

Answer 13

1 - Urine pregnancy test

2 - Dipstick for glucose

3 - Bloods (check FSH & LH, Thyroid function, prolactin, testosterone)

4 - Pelvic USS to check for PCO

Question 14

How does PCOS (Polycystic Ovarian Syndrome) present?

Answer 14

1 - Oligo/amenorrhoea

2 - Excess hair/acne (androgenic symptoms)

Question 15

How can PCOS be managed?

Answer 15

1 - Weight loss & exercise can help all symptoms

2 - Antiandrogen (Combined hormonal contraception, spironolactone)

3 - Endometrial protection