The menopause and post-reproductive health Flashcards
Define Menopause
Permanent cessation of menses resulting from loss of ovarian follicular activity, 12 months of amenorrhoea. med age 51 yrs.
Define Perimenopause
Time of first features of menopause (vasomotor/menses irregular). Ends 12 months after last period
Premature menopause
Before 40
Surgical menopause
Post BSO/infection/AI disease/ovarian dysgenesis/metabolic disease
Define PMB
Vaginal bleeding 12 months after LMP
Causes of PMB
Endometrial carcinoma Endometrial hyperplasia +/- atypia/polyps Cervical carcinoma Atrophic vaginitis Cervicitis Ovarian carcinoma Cervical polyps
Investigations and management of PMB
Bimanual
Speculum (Pipelle biopsy)
TVS- endometrial thickness/pelvic pathology
Hysteroscopy +/- Biopsy- Paracervical LA as outpatient /GA day case
Symptoms of menopause
Cardiovascular (CHD/CVA), Vasomotor symptoms (Hot flushes night sweats-sleep disturbance/fatigue/irritability), Vaginal atrophy, Urinary problems, sexual problems, Osteoporosis
How does Vaginal atrophy present
Dyspareunia, Cessation of sexual activity, itching, burning and dryness.
Urinary symptoms of menopause
Frequency urgency nocturia incontinence recurrent infection
Sexual problems of menopause
FSD (Female sexual dysfunction)- loss of desire, arousal, orgasm problems, dyspareunia
Why does menopause=osteoporosis
Oestrogen protects bone resorption
What to ask in a menopause history about osteoporosis?
Parental history of fractures hip, early menopause, chronic use of corticosteroids, prolonged immobilization and prior fracture.
How do you investigate for menopause management
- -FSH levels indicate degree of ovarian reserve remaining. high=less remaining. Best measured between day 2-5.
- -AMH- antimullerian hormone.
- -TFTs/catecholamines- HRT helps symptoms or is it Thyroid/phaeo/carcinoid
- -LH/Oestradiol/Progesterone-
What test indicates anovulation?
Low progesterone, usually PCOS
Bone density tests are best performed on the
hip or lumbar spine
HRT treatment doesnt include progesterone when
patient has had a hysterectomy
Methods of HRT admin
Oestrogens-Oral, transdermal (patch/gel), subcut implant.
Progesterone- Oral, transdermal, IUS
Tibolone is
Synthetic steroid compound that is inert but converts to natural oestrogen/prog/androgen action.
Women after hysterectomy are given what HRT?
Oestrogen alone
Women with a uterus are given what HRT?
Combined oestrogen/progesterone
Perimenopausal women are given what HRT?
Sequential/cyclical therapy
Post menopausal women are given what HRT?
Continuous combined therpay
Sequential therapies cause the risk of
endometrial cancer. continous causes endometrial atrophy
Topical oestrogens are used to treat
“Urogenital symptoms”?
Vaginal
-oestriol by cream or pessary
-oestrodiol by tablet or ring
Risks of HRT (4)
Breast cancer
Endometrial cancer
Venous thromboembolism
Gallbladder disease
Possible risks of HRT that theyre not sure about (4)
Cardiovascular disease
Dementia and cognition
Ovarian cancer
Qalys
HRT helps with what 3 factors
Menopausal symptoms
Osteoporosis
Colorectal cancer
What do you give women for menopausal symptoms that refuse HRT
Progestagens
Clonidine
SSRIs
Gabapentin
Prevention and treatment of osteoporosis
Bisphosphonates Strontium ranelate- reduces vertebral and hip fracture risk Raloxifene- oestrogen receptor modulator Parathyroid hormone peptides Denosumab- mab against rankl calcium and vitD supplements
