The menopause Flashcards

1
Q

how should menopause be defined?

when are you perimenopause?

A

> 12 consecutive months of spontaneous amenorrhoea

time of first symptoms until 12 months after LMP

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2
Q

what is the mean age of menopause in UK? what causes it?

when is menopause premature?

A
  • 51
  • occurs when there is loss of ovarian follicular activity
  • majority of oestrogen generated from testosterone and androstenedione (granulosa and thecae cells)
  • <40 years
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3
Q

what do granulosa cells produce?

what happens with regards to oocytes in the menstrual cycle? and progesterone?

A
  • oestradiol
  • progesterone production decreases
  • number of anovulatory menstrual cycles increases
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4
Q

what can be looked at to clinically clarify menopause?

what is the predominant form of oestrogen in post-menopausal women? how does it compare to oestradiol?

what happen to androgen production?

A
  • FSH levels above 30 IU/L
  • androstenedione made by adrenals, converts to oestrone by fat cells
  • less potent
  • stays the same
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5
Q

what occurs in premature ovarian failure?

A
  • ovaries don’t produce enough oestrogen

- causes secondary amenorrhoea

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6
Q

what are signs and symptoms of menopause?

A
  • vaginal bleeding: irregular periods, menopause can be recognised in retrospect after 2 months amenorrhoea
  • hot flushes: (50-85%), lasts around 3 mins associated nausea and palpitations, lack of sleep
  • genitourinary atrophy: genitals, urethra and bladder gradually atrophy after menopause
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7
Q

what can genitourinary atrophy cause?

A
  • dyspareunia, dryness and bleeding,
  • loss of vaginal glycogen causes a rise in pH, predisposing infection
  • urinary symptoms: urgency, frequency, dysuria from atrophic change in trigone
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8
Q

What are the cardiovascular effects of menopause?

A
  • oestrogen protect against vascular disease
  • decreased oestrogen causes changes to lipid profile so atherosclerosis
  • estradiol promotes vasodilation so higher BP
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9
Q

how does it cause osteoporosis?

what is a dowagers hump?

A
  • trabecular bone oestrogen sensitive (vertebrae, femoral neck, distal radius)
  • bone resorption accelerated by menopause
  • oestrogen receptors demonstrated on bone cells, oestrogen stimulates osteoblasts directly
  • compression fracture of the spine
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10
Q

what hormone can be used as a better marker of follicular reserve than FSH?

what is treatment of menopause? why give progesterones?

A
  • anti-mullerian hormone
  • HRT (oral tablets, transdermal, SC, IUS, vaginal rings, nasal spray)
  • progesterones have a role in vasomotor symptoms prevent endometrial hyperplasia
  • also prevents unopposed oestrogen therapy to avoid endometrial cancer
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11
Q

what are the risks/ SE of HRT?

A
  • nausea and breast tenderness
  • endometrial carcinoma (unopposed) 4 fold risk
  • mirena protects endometrium in oestrogen only HRT
  • breast cancer
  • stroke
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12
Q

what are the contraindications to HRT?

A
  • pregnancy
  • thromboembolic disease
  • history of recurrent thromboembolism
  • liver disease
  • undiagnosed vaginal bleeding
  • following Breast cancer and advanced endometrial cancer
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13
Q

how long should HRT last?

A
  • 2-3 years then stopped, review symptoms and weigh up risks benefit of osteoporosis
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14
Q

what non-hormonal treatment can be given for HRT?

A
  • SSRIs (depression, loss of libido/ self confidence)
  • B-blockers for palpitations and tachycardia
  • bisphosphonates for osteoporosis
  • Vit D and calcitonin
  • progestogens for hot flushes)
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15
Q

what are the causes of primary premature ovarian failure?

A
  • chromosome abnormalities (Turners, fragile X)
  • FSH receptor gene polymorphism
  • enzyme deficiencies/ autoimmune disease
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16
Q

secondary causes of premature ovarian failure?

A
  • chemo/radiotherapy
  • bilateral oophorectomy
  • hysterectomy
  • infection
17
Q

what diseases is it commonly associated with?

A
  • Addisons, DM, hypothyroid, chromosome abnormalities
18
Q

What is the most common causes of PMB? (4)

A
  • atrophic vaginitis
  • endometrial/ ovarian cancer
  • cervical pathology
  • endometrial hyperplasia or polyps
19
Q

what should endometrial thickness be in a postmenopausal woman? How is it measured?

what must you do if thicker?

what drug apart from unopposed HRT will cause thickened endometrium?

A
  • <4mm, transvaginal ultrasound
  • biopsy and hysteroscopy if >4mm
  • tamoxifen, oestrogen proliferates it, therefore should be hysteroscopy and biopsy
20
Q

how would you treat:

  • atrophic vaginitis
  • cervical polyp
  • endometrial polyp
  • simple/ complex hyperplasia
  • atypical hyperplasia/ endometrial ca
A
  • topical oestrogen
  • removal via polyp forceps
  • hysteroscopy removal
  • IUD progesterone (mirena)
  • TAH + BSO