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Gynaecology > The menopause and post-reproductive health > Flashcards

The menopause and post-reproductive health Flashcards

1
Q

Define Menopause

A

Permanent cessation of menses resulting from loss of ovarian follicular activity, 12 months of amenorrhoea. med age 51 yrs.

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2
Q

Define Perimenopause

A

Time of first features of menopause (vasomotor/menses irregular). Ends 12 months after last period

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3
Q

Premature menopause

A

Before 40

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4
Q

Surgical menopause

A

Post BSO/infection/AI disease/ovarian dysgenesis/metabolic disease

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5
Q

Define PMB

A

Vaginal bleeding 12 months after LMP

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6
Q

Causes of PMB

A 
Endometrial carcinoma
Endometrial hyperplasia +/- atypia/polyps
Cervical carcinoma
Atrophic vaginitis
Cervicitis 
Ovarian carcinoma
Cervical polyps
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7
Q

Investigations and management of PMB

A

Bimanual
Speculum (Pipelle biopsy)
TVS- endometrial thickness/pelvic pathology
Hysteroscopy +/- Biopsy- Paracervical LA as outpatient /GA day case

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8
Q

Symptoms of menopause

A

Cardiovascular (CHD/CVA), Vasomotor symptoms (Hot flushes night sweats-sleep disturbance/fatigue/irritability), Vaginal atrophy, Urinary problems, sexual problems, Osteoporosis

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9
Q

How does Vaginal atrophy present

A

Dyspareunia, Cessation of sexual activity, itching, burning and dryness.

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10
Q

Urinary symptoms of menopause

A

Frequency urgency nocturia incontinence recurrent infection

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11
Q

Sexual problems of menopause

A

FSD (Female sexual dysfunction)- loss of desire, arousal, orgasm problems, dyspareunia

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12
Q

Why does menopause=osteoporosis

A

Oestrogen protects bone resorption

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13
Q

What to ask in a menopause history about osteoporosis?

A

Parental history of fractures hip, early menopause, chronic use of corticosteroids, prolonged immobilization and prior fracture.

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14
Q

How do you investigate for menopause management

A
  • -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-
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15
Q

What test indicates anovulation?

A

Low progesterone, usually PCOS

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16
Q

Bone density tests are best performed on the

A

hip or lumbar spine

17
Q

HRT treatment doesnt include progesterone when

A

patient has had a hysterectomy

18
Q

Methods of HRT admin

A

Oestrogens-Oral, transdermal (patch/gel), subcut implant.

Progesterone- Oral, transdermal, IUS

19
Q

Tibolone is

A

Synthetic steroid compound that is inert but converts to natural oestrogen/prog/androgen action.

20
Q

Women after hysterectomy are given what HRT?

A

Oestrogen alone

21
Q

Women with a uterus are given what HRT?

A

Combined oestrogen/progesterone

22
Q

Perimenopausal women are given what HRT?

A

Sequential/cyclical therapy

23
Q

Post menopausal women are given what HRT?

A

Continuous combined therpay

24
Q

Sequential therapies cause the risk of

A

endometrial cancer. continous causes endometrial atrophy

25
Q

Topical oestrogens are used to treat

A

“Urogenital symptoms”?
Vaginal
-oestriol by cream or pessary
-oestrodiol by tablet or ring

26
Q

Risks of HRT (4)

A

Breast cancer
Endometrial cancer
Venous thromboembolism
Gallbladder disease

27
Q

Possible risks of HRT that theyre not sure about (4)

A

Cardiovascular disease
Dementia and cognition
Ovarian cancer
Qalys

28
Q

HRT helps with what 3 factors

A

Menopausal symptoms
Osteoporosis
Colorectal cancer

29
Q

What do you give women for menopausal symptoms that refuse HRT

A

Progestagens
Clonidine
SSRIs
Gabapentin

30
Q

Prevention and treatment of osteoporosis

A 
Bisphosphonates
Strontium ranelate- reduces vertebral and hip fracture risk
Raloxifene- oestrogen receptor modulator
Parathyroid hormone peptides
Denosumab- mab against rankl
calcium and vitD supplements

Gynaecology (11 decks)

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