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1 - Obs and Gynae AE > The menopause and post-reproductive health > Flashcards

The menopause and post-reproductive health Flashcards

1
Q

What is the menopause?

A

The permanent cessation of menstruation resulting from loss of ovarian follicular activity.

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2
Q

What is the average age of menopause?

A

51 years

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3
Q

How can you tell is someone is in the menopause?

A

After 12 months of amenorrhoea

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4
Q

What is the perimenopause?

A

The time beginning with the first features of the approaching menopause, such as vasomotor symptoms and menstrual irregularity, and ends 12 months after the LMP.

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5
Q

What is premature menopause?

A

Menopause occurring before the age of 40. In most women, no cause is found.

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6
Q

What is post-menopausal bleeding?

A

Vaginal bleeding occurring at least 12 months after the LMP.

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7
Q

What are the causes of post-menopausal bleeding?

A 
Endometrial carcinoma
Endometrial hyperplasia
Cervical carcinoma
Atrophic vaginitis
Cervicitis
Ovarian carcinoma
Cervical polyps
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8
Q

How would you investigate post-menopausal bleeding?

A

All women should undergo a bimanual and speculum examination and a cervical smear. TVS measures endometrial thickness and gives info on other pelvic pathologies.

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9
Q

What would indicate an increased risk of malignancy or other pathology on TVS in post-menopausal bleeding?

A

A thickened endometrium or cavity filled with fluid.

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10
Q

What are the different systems effected by menopause?

A

Vasomotor, urogenital, sexual problems and osteoporosis

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11
Q

What are the vasomotor symptoms of menopause?

A

Hot flushes and night sweats are the most common symptoms.

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12
Q

What are the complications of night sweats?

A

They can cause sleep disturbances leading to tiredness and irritability.

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13
Q

When do night sweats start?

A

They may begin before periods stop and usually are present for less than 5 years. However, in some women they may continue

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14
Q

What are the genital problems associated with menopause?

A

Oestrogen deficiency can cause vaginal atrophy and urinary problems.

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15
Q

What are the complications of vaginal atrophy?

A

It can be extremely uncomfortable and can result in dyspareunia, cessation of sexual activity, itching, burning and dryness.

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16
Q

What urinary symptoms are associated with menopause?

A

Frequency, urgency, nocturia, incontinence and recurrent infection.

17
Q

What sexual problems are associated with menopause?

A

Decreased interest in sex, loss of sexual desire, loss of sexual arousal, problems with orgasm and sexual pain.

18
Q

What are the two main features of bone strength?

A

Bone density and bone quality

19
Q

What is bone density?

A

It is expressed as grams of mineral per area or volume and, in any given individual, is determined by peak bone mass and amount of bone loss

20
Q

What is bone quality?

A

Architecture, turnover, damage accumulation (microfractures) and mineralization

21
Q

What is the T score?

A

The number of standard deviations by which a particular bone differs from the young normal mean.

22
Q

Where are the most common sites for osteoporotic fractures?

A

The wrist or Colles’ fracture, the hip and the spine.

23
Q

What are the risk factors for the development of osteoporosis?

A

Parental history of fracture (particularly hip), early menopause, chronic use of corticosteroids (oral and possibly inhaled), prolonged immobilisation and prior fracture

24
Q

What environmental risk factors are there for osteoporosis?

A

Cigarette smoking
Alcohol abuse
Low calcium intake
Sedentary lifestyle

25
Q

What are the diseases that increase the risk of osteoporosis?

A 
Rheumatoid arthritis
Neuromuscular disease
Chronic liver disease
Malabsorption syndromes
Hyperparathyroidism
Hyperthyroidism
Hypogonadism
26
Q

How is FSH used to investigate menopause?

A

Increased levels suggest fewer oocytes remain in the ovaries. It is useful in women with premature menopause. They are measured on days 2-5 of the cycle

27
Q

How is anti-Mullerian hormone used to investigate menopause?

A

AMH gives a direct measurement of ovarian reserve, low levels being consistent with ovarian failure.

28
Q

What HRT is given to women?

A

HRT consists of oestrogen alone in women who have had a hysterectomy, but is combined with a progestogen in those who have not.

29
Q

How are the progestogens given in HRT?

A

Cyclically or continuously with the oestrogen. They can be delivered orally, transdermally or directly into the uterus (IUS).

30
Q

How are the oestrogens given in HRT?

A

It can be delivered orally, transdermally (patch or gel) or subcutaneously (implant). Topical oestrogens are given vaginally

31
Q

What are some examples of oestrogens used in HRT?

A

They are natural oestrogens: oestradiol, oestrone and oestriol.

32
Q

What are some examples of progestogens in HRT?

A

Leonorgestrel (mirena) or norethisterone.

33
Q

What is the benefit of using the mirena IUS?

A

It provides a solution to the problem of contraception in the perimenopause ad is also the only way in which a ‘no bleed’ HRT regimen can be achieved in perimenopausal women.

34
Q

What is tibolone?

A

A synthetic steroid compound that is inert but is converted in vivo to metabolites with oestrogenic, progestogenic and androgenic actions.

35
Q

When is tibolone used?

A

In post-menopausal women who desire amenorrhoea and treats vasomotor, psychological and libido problems. It also conserves bone mass.

36
Q

What are the benefits of oestrogen-based HRT?

A

It is an effective treatment for hot flushes, usually within 4 weeks. It may also help urogenital problems. It reduces the risk of bone problems.

37
Q

How does HRT affect cancer risks?

A

Increased risk: breast (not if oestrogen only) and endometrial. Also increases risk of VTE and gallbladder disease
Decreased risk: colon

38
Q

How long do women take HRT for?

A

Treatment is continued for up to 5 years and then stopped to evaluate whether symptoms recur with sufficient severity to warrant continuation

1 - Obs and Gynae AE (29 decks)

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