Zero to finals gynae Flashcards
1
Q
What is the hypothalamic-pituitary gonadal axis?
A
Hypothalamus releases gonadotrophin releasing hormones. These stimulate anterior pituitary to produce lutenising hormone and follicle stimulating homrone. Stimulate the development of follices in the ovaries. The theca granulosa cells aroudn the ovary secrete oestrogen. Oestrogen has a negative feedback on hypothalamus and anterior pituitary
2
Q
What is oestrogen
A
A steroid sex homrone produce by ovaries in response to LH and FSH
3
Q
Where does oestrogen act?
A
Acts on tissues witb oestrogen receptors
4
Q
What does oestrogen stimulatre?
A
Breast tissue development
Growth and development of female sex organs
Blood vessel development in the uterus
Development of the endometrium
5
Q
What is progestrone?
A
Steroid sex hormone
6
Q
What is progestrone produced by? When?
A
Corpus luteum
After ovulation
7
Q
What happens to progestrone if pregnancy occurs?
A
Mainly produced by placenta from 10 weekjs gestation onwards
8
Q
Where does progestrone act?
A
On tissues that have been previously stimulated by oestrogen
9
Q
What does progestrone act to do?
A
Thicken and maintain the endometrium
Thicken cervical mucus
Increase the body temperature
10
Q
When does puberty start in girls?
A
8-14
11
Q
When does puberty start in boys?
A
9-15
12
Q
What is aromatase?
A
Enzyme found in adipose tissue
Important in creation of oestrogen
Therefore more adipose the higher the quantity of enszy,e responsible for oestrogen creation
13
Q
What is the first episode of menstration called?
A
Menarche
14
Q
What can the satge of pubertal deveopment be determined by?
A
Tanner sc ale
15
Q
What are the hormonal changes during puberty?
A
Growth hormone increases initally causing a hrowth during the initial phase of puberty
Hypothalamus starts to secrete GnRH initially during sleep then throughout the day in later stages of puberty. GnRH stimulates the release of FSH and LH from the pituitary gland. FSH and LH make ovaries produce oestrogen and progesterone. FSH levels plateau about a year before menarche. LH levels continue to rise and spike just before they induce menarche
16
Q
What does oestrogen do?
A
Suppress growth hormone causing rowth to slow down as oestrogen levels increase/ This suppression is the reason growth spurt finishes sooner in girls leaving them short in adult hood
17
Q
What is the follicular phase?
A
From the start of menstruation to the moment of ovulation
18
Q
What is the luteal phase?
A
From the moment of ovulation to the start of menstration
19
Q
What surrounds oocytes and what does this create?
A
Granulosa cells surroudn the oocytes forming structures called follicles
20
Q
What are the 4 key stages of development of the ovaries?
A
Primordial follicles
Primary follicles
Secondary follicles
Antral (graffian) follicles
21
Q
What happens once the follciles reach the secondary follicle stage?
A
They have receptors for follicle stimualting hormones
Further deelopemtn requires stimulation of FSH
22
Q
What happens when FSH stimulates the secondary follicle?
A
The follicle grows and the granulosa cells that surround them secrete increasing amounts of oestrogen. This has a negative feedback on pituitary so LH and FSH decreased. Also cervical mucus becomes more permeable allowing sperm to penetrate cervix around time of ovulation.
23
Q
What is the dominant follicle
A
One follicle will dveelop further than the others and become the dominant follicle. LH spikes just before ovulation and dominant follicle is released to the ovum
24
Q
What happens to the follicle after ovulation
A
The follicle that released the ovum collapses and becomes the corpus luteum. This secretes high levels of progesterone which maintains the endometrial lining. This progesterone also causes the cervical mucus to become thick and no longer permeable.. Corpus luteum also secretes a small amount of oestrogen
25
What happens to the corpus luteum if ovulation occurs
The syncytiotrophoblast of the embryo secretes HCG. This maintains corpus luteum. Withput HCG corpus luteum degenerates
26
What happens to corpus luteum if no fertilisation
Degenerates and stops producing oestrogen and progestrone. This fall causes the endometrium to break down and menstration to occur
27
What do prostagalndins cells do and what releases them?
The stromal cells of the endometrium release prostaglandins.These encourage the endometrium to break down and the uterus to contract.
28
What does menstration involve?
Involves the superficial and middle layers of the endometrium separating from the basal layer. The tissue is broken down inside the uterus and released via the cervix and vagina. The release of fluid containing blood from vagina lasts 1-8 days
29
What does the primordial follicle contain?
A primary oocyte
Oocyte are the germ cells that eventually undergo meiosis to become the mature ovum ready for fertilisation
Contain full 46 chromosomes
These spend the majority of their lives waiting in the ovary
30
Where is the primary oocyte contained?
Within the pregranulosa cells surrounded by the outer basal lamina layer
31
What do the primordial follicles grow and become
Grow and become primary follciles. 3 layers- Primary ooyte in centre, zona pellucida and the cuboidal shaped granulosa cells
32
What do the granulosa cells secerete
Material that becomes the zona pellucida. They also secrete oestrogen
33
What happens as follicles grow larger?
Develop a further layer called the theca follucli
Inner layer of this is the theca internal
34
What does the theca interna secrete?
Androgen hormones
35
What is the outer layer of the theca external made up of?
Connective tissue cells containing smooth muscle and collagen
36
What happens as primary follicles become secondary follicles
They become larger and develop small fluid filled gaps between the granulosa cells
Once the follicles reach the secondary follicle stage, they have receptors for follicle stimulating hormone
Further development after the secondary follicle stage requires stimulation from FSH
At the start of the menstrual cycle, FSH stimulates further development of the secondary follicles
37
What happens with further development of the secondary follicles
Develops a single large fluid filled area with graulosa cells called the antrum
38
What is the antrium
Refers to naturral chamber within a structure
39
What happens to the antrum of the follicle?
This antrum fills with increasing amount of fluids, making the follicle expanded rapidly
40
What is the corona radiata
Made up of granulosa cells and surrounds the zona pellucida and oocyte
At this point one of the follicles become the dominant follicle
The other follicles start to degenerate, while the dominant follicle grows to become a mature follicle
This follicle bulges through the walls of the ovary
41
What happens when there is a surge of lutenising hormone from the pituitary?
Causes the smooth mucles of the theca external to squeeze and the follicle to burst
42
Where is the oocyte released into?
Released into the area surrounding the ovary
At this point it is floating in the perioteal cavity but is quickly swept up by the fimbriae of the fallopian tube
43
Where does the corpus luteum come fropm?
The leftover part of the follicle colapses and turn yellow. The collapsed follicle becomes the corpus luteum
44
The cells of the granulosa and theca internal become what?
Luteal cells
45
What do luteal cells secrete?
Steroid hormones most notably progestrone
46
When does the corpus luteum persist?
In response to human chornic gonadotrophin from a fertilised blastocyst when pregnancy occurs
47
How long does corpus luteum take to degenerate?
Degenerates after 10-14 days
48
Where does the sperm enter the ovum
Attempt to penetrate the corona radiata and zona pellucidum
Only one sperm will get through usually
49
What happens to the chromosomes once the sperm enters the egg
23 chromones of the egg multiply into 2 sets
One set combine with 23 of sperm
The second makes a second polar body
50
23 chromomsones from the egg and 23 from sperm make what?
A fertilised zygote
Divides rapidly to make the morula
51
What does the blastocyst contain?
The main group of cells in the middle called the embryoblast and a fluid filled cavity celled the bastocele
The outer layer is the trophoblast
52
What happens when the blastocyst enters the uters?
Contains 100-150 cells
53
What is the outer layer of the trophoblast cells?
Syncytioreophoblast
54
What happens to cells of the stroma?
Convert into a tissue called decicdua that is specialised in providing nutrients to the trophoblast
55
Why is HCG importnat for the corpus luteum?
Allowing the ovary to continue producing progestrone and oestorgen
56
Where does the fetus get oxugen?
Placenta
57
What has a higher affinity for oxygen fetal or adult haemoglobin?
Fetal
58
What does the syncytiotraphoblast produce?
HCG
59
What symptoms does HCG cause
Nausea and vomiting in early pregnancy
60
Whatdoes the placenta producing oestrogen do?
Soften tissues and make them more flexible
Allows the muscles and ligaments of the uterus and pelvis to exam and the cervix to become soft and ready for birth
Enlarges and prepares the breasts and nipples for breastfeeding
61
What is the role of progestrone?
Maintain the pregnancy
Relaxation of the uterine muscles and maintains the endometrium
Relaxes LOS, the bowel and blood vessels
Raises body temperature between 0.5 and 1 degree celcius
62
How do embryos develop immunity
The mother's antibodies can transfer across the placenta to the fetus during pregnancy
Antibodies allow the fetus to benefit from the long term immunity of the mother during pregnancy and shortly after birth
63
What are changes in the anterior pituitary during pregnancy?
Produce more ACTH, Prolactin and melanocyte stimulating hormone in pregnancy
64
What thyroid levels rise in pregnancy?
T3 and T4 rise
65
What changes occur to the uterus during pregnancy?
Size of the uterus increases from 100g to 1.2 kg
66
What does oestrogen in pregnancy do to uterus?
Cervical ectropion and increased cervical discharge
Oestrogen also causes hypertrophy of the vaginal muscles and increases vaginal discharge
These changes in the vagina prepare it for delivery, however they make bacterial nd candidial infection more common
67
What do prostaglandins do to the uterus during pregnancy?
Prostaglandins break down collagen in the cervix allowing it to dilate and efface during childbirth
68
What are some cardiovascular changes during pregnancy?
Increased blood volume
increased plasma volume
Increased CO with increased SV and HR
Decreased peripheral vascualr resistance
Decreased blood pressure in early and middle pregnancy, returning to normal by term
Varicous veins can occur due to peripheral vasodialtion and obstruction of the IVC by the uterus
Peripheral vasodilation also causes flushing and hot sweats
69
What are the respiratory changes in pregnancy?
Tidal volume and respiratory rate icnreases in later pregnancy to meet the increase oxygen demands
70
What are the renal changes in pregnancy?
Increased blood flow to the kindyes
Increased GFR
Increased aldosterone leads to increased salt and water reabsorptuon and retention
Increased protein excretion from the kidneys
Dilation of the ureters and collecting system, leading to a physiological hydronephrosis
71
WHat happens to RBC producgtion im pregnancy?
Leads to higher iron, folate and B12
72
What happens to plasma volume during pregnancy?
Increases more than RBC volume leading to a lower concentration of RBC
High plasma volume means the haemoglobin concentration and red cell concentration falls in pregnancy resulting in anaemia
73
What happens to clotting factors during pregnnsayc?
Fibrinogen and factor VII, VIII, and X increase in pregnancy making women more hypercoaguable
This increases the risk of venous thromboembolism
Prengnat women are more likely to develop DVT and PE
74
What are some skin chages durin gpregancy
Increased skin pigmentation due to increased melanocyte stimulating hormone, wth linea nigra and melasma
Striae graviadarum
General itchiness
Spider naevi
Palmer erythma
75
WHat is the first stage of labour?
From the onset of labour until 10cm cervical dialtion
76
What si the second stage of lbaour?
Is from 10cm cervical dilation to delivery of the baby
77
What si the third stage of labour?
Delibery of the baby to delivery of the placenta
78
What do prostaglandins do?
Act like hormones, triggering specific effects in local tissue
Tissues throughout the entire body contain and respond to prostaglandins
Play a crucial role in menstration and labour by stimulating contraction of the uterine muscles
Ripen the cervix before delivery
79
What is a key prostaglandin?
Pessiary containing prostaglandin E2 (Dinoprostone) can be used to induce labour
80
What are braxton-hicks contractions?
Occasional irregular contractions of the uterus
Felt during the second and third trimester
Temporary and irregu;ar tightening or mild cramping in the abdmen
81
What is the show?
Mucus plug in the cervix that prevents bacteria from entering the uterus during pregnancy falling out and creating space for the baby to pass through
82
Stages of labour in the first stage?
Latent phase: 0-3 cm dilation of the cervix. This progresses at around0 0.5 cm per hour. There are irregular contractions
Active phase: 3-7 cm dilation of the cervox. Progesses at around 1cm per hour and there are regular contractions
Transition phase: From 7cm-10m dilatio of the. cervix. This progresses at around 1cm per hour and there are strong and regular contractions
83
When does the second stage of lbaour last from?
10cm dilation of the cervix to delivery of the baby
84
What does the success of the second stage depend on?
Power- Strngth of uterine contractions
Passanger- Size, lie, attitude, presentation
Passage- Size and shape of passegway mainly the pelvis
85
What are the cardinal movements of labour?
Engamgement
Descent
Flexion
Internal rotation
Extension
Restitution and external rotation
Expulsion
86
Descent is measured in centimeters from?
Ischial spines
- 5: when the baby is high up at around the pelvic inlet
0: when the head is at the ischial; spines
+5 when the fetal head has descended further out
87
What is phsyiological manageent of the placenta?
Where the placenta is delivered by maternal effort without medications or cord traction
88
What is the active manage,ent of the third stage?
Where the midwife or doctor assist in delivery of the placenta. Active management shortens the third stage and reduces risk of bleeding
Haemorrhage or more than 60 minute delay of the placenta should promote active mangement
Active management can be associated with nausea and vomiting
89
What medication is given for actie management of labour?
Intramusuclar oxytocin to help the uterus contract and expel the placenta
Careful traction is applied to the umbilical cord to guide the placenta out of the uterus and vagina
90
What is amenorrhea?
Lack of menstral period
91
What is primary amenorrhea?
When the patient has never to develop periods
92
What can primary amenorrhea be due to?
Abnormal functioning of the hypothalamus or pituitary gland
Abnormal functioning of the gonads
Imperforated hymen or other structural pathology
93
What is secondary amenorrhea?
Patient previosuly had periods that subsequently stopped
94
What is secondary amenorrhea due to?
Prenancy
Menopause
POS
Meds
Premature ovarian insufficiaency
Thyroud hromone
Cushing's sryndrome
95
What does irregular menstal bleeding indicate?
Anovulation or irregular ovulation
96
What is irregular menstration due to?
Extremes of reproductive age
POCS
hormonal imbalances
97
What is intermenstral bleeding?
Refes to any bleeding that occurs between menstral periods
98
What are the key causes of intermenstral bleeding?
Hormonal contractiption
STI
Endometrial polyps
99
What is dysmeorrhea?
Painful periods
100
What are the causes of dysenorrea?
Endometrisis
Fibroids
Copper coil
101
What is menorrhagia?
Heavy menstral bleeding
102
What is heavy menstral periods?
Fibroids
PCOS
Connective tissue disorder
103
What is postcoital bleeding?
Refers to bleeding after sexual intercourse
Red flag
104
Causes of postcoital bleeding?
Cervical cancer
Trauma
Atrophic vaginitis
Vaginal cancer
105
What are some causes of pelvic pain?
uti
Dysmenorrhea
IBS
Ovarian cancer
Pelvic adhesions
106
What does abnormal vaginal discharge indicate?
BV
Candidaisis
Chalymdia
Gonorrhoea
107
What is pruritus vulvae
Itching of the vulva and vagina
108
WHat are the causes of pruitus vulvae
Irritants
Atrophic vaginitis
Infections
Vuvae malignancy
109
When does primary amenorrhea defined as not starting menstraiton by when?
By 13 years when there is no other evidence of pubertal dveelopment
By 15 years where there are other signs of puberty such as breast bud and development
110
What does hypogonadism refer to?
Lack of the sex hormones, oestrogen and testosterone
111
What is hypogonadotrophic hypogonadism?
Deficiency of LH and FSH
112
What is hypergonadotrophic hypogonadism?
A lack of response to LH and FAH by the gonads
113
What is Kallman syndrome?
Genetic condition causing hypogonadotrophic hypogonadism with faikure to start puberty
Associated with a reduced or absent sense of smell (ansomia)
114
What is hypergonadotrophgic hypogonadism?
Where the gonads fail to respond to stimulation from the gonadotrophins
Withot negative feedback from the sex hormones the anterior pituitary produces increasing amounts of LH and fsh
Consequently you get high gonadotrophins and low sex hormones
115
What is hypergonadotrophic hypogonadism can be due to?
Previosuly damage to the gonads
Congenital absence of ovaries
Turner's syndrome
116
What is congenital adrenal hyperplasia caused by?
Congenital deficincey of the 21 hyroxylase enzyme
Genetic condition inherited in an autosomal recessive pattern
117
WHat does congenital adrenal hyperplasa cause?
Underproduction of cortsiol and aldosterona dn overproduction of androgens from birth
118
What happens in severe cases of congenital adrenal hyperplasia?
Unwell shortly after birth with electrolyte disturbances and hypoglycaemia
119
What happens in mild female cases of congenital adrenal hyperplasia?
Tall
Facial hair
Absent period
Deep voice
Ealry puberty
120
What is androgen insensitive syndrome?
Condition occur in males where the tissue are unable to respond to androgen hormones meaning typical male sexual characteristics do not develop
It results in a feaml phenotype other than the internal pelvic organs
Normal female external genitalia and breast tissue
Internally there are testes in the abdomen or inguinal canal and an absent uterus, upper vagina, fallopian tubes and ovaries
121
What is secondary amenorrhea?
Defiened as no menstration for more than 3 months after previous regular periods
122
What do high prolactin levels do?
High prolactin levels act on the hypothalamus to prevent the release of GnRH
Without GnRh there is no release of LH and FSH this hypogonadotrophic hypogonadism
123
What is the most common cause of hyperprolactinaemia?
Pituitary adenoma secreting prolactin
124
What can reduce prolactin productio?
Dopamine agonsists such as bromocriptine or cabergoline
125
WHat does the assessment of secondary amenorrhea involve?
Detailed history and examination to assess for potential causes
Hormoonal blood tests
US of the pelvis to dianose PCOS
126
What does patients with amenorrhea associated with low oestrogen levels are at increased risk of what?
Osteoporosis
127
What is PMS?
Physiological, emotional and psychological symptoms that occr during the luteal phase of the menstral cyctle
Resolve once menstration begins
128
Symtoims of PMS
Low mood
Anxiety
Mood swings
Irritability
Bloating
129
Premenstral dysphoric disorder
Whe PMS has a significant effect on QOL
130
Management of PMS
General healthy lifestyle changes
Combined contraceptive pill
SSRI antidepressant
CBT
131
What is heavy menstral bleeding also called?
Menorrhagia
132
What volume of blood loss is menorrhagia?
80ml lost
133
What are some symtpoms of menorrhagia?
Changing pads every 1-2 hours
Bleeding more than 7 days
Large clots
134
What are causes of Heavy menstral bleeding?
Dysfunctional uterine bleeding
Extremes of reproductive age
Fibroids
Endometriosis and adenomyosis
Endocrine disorders
135
What are important hisotry questions in heavy menstral bleeeidng?
Age at menarch
Cycle length
Contraceptive hisotry
Sexual history
Intermenstral and post coital bleeding
Possibolity of pregnancy
Plans for future pregnancy
Cervical screening history
Migranes with or without aura
PMH and DH
Smoking and alcohol hisotry
FH
136
What are investigations for heavy menstral bleeding?
Pelvic exam
FBC
Outpatient hysteroscopy
Pelvic and transvaginal US
Swabs
Coagulation screen
Ferritin
TFTs
Coagulation screen
137
What is transexamic acid?
Antifibrinolytic- reduces bleeding
138
What is Mefenamic acid
NSAID
Reduces bleeding and pain
139
Management of heavy menstral bleeding if contracpetion is acceptable?
Mirena coil
COCP
Cyclical oral progestrone such as norethisterone 5mg 3X a day from day 5-26
140
What can be done when medical management of heavy menstral bleeding fails?
Endometrial abalation
Hysterectomy
141
What is endometrial abalation?
Involves destroying the endometrium
142
What are fibroids?
Benign tumours of the smooth muscles of the uterus
143
What are the types of fibroids?
Intramural means within the myometrium
Subserosal means just below the outer layer of uterus
Submucosal means just below the lining of the uterus
Pedunculated mans on a stalk
144
What are the presentations of fibroids?
Asymptomatic
Heavy menstral bleeding
Prologned menstration lasting more than 7 days
Abdominal pain worse during menstration
Bloating or feeling full in the badomen
Urinary or bowel symptoms due to pelvic pressure or fullness
Deep dyspaneuria (pain during intercourse)
Reduced fertility
145
What are investigations for fibroids?
Hysteroscopy
Pelvic US
MRI
146
What are the fibroids management if less than 3cm
Mirena coil
Symtpomatic management with NSAIDs and tranexemic acid
Combined oral contraceptive
Cyclical oral progestrone
147
What are some surgical options for management of fibroids?
Endometrial abalation
Resection
Hysterectomy
148
What can be done with fibroids more than 3cm?
Refer to gynae
Medical options- NSAIDS for symtpoms
Mirena coil
Combined oral contraceptive
Cyclical oral progestogens
149
WHat are the surgial options for large fibroids?
Uterine artery embolisation
Myomectomy
Hysterectomy
150
What do GnRh agonists do in the treatment of fibroids?
Reduce the size of fibroids before surgery
Inducing a menopause like state
Reduce amount of oestrogen
151
What is a myomectomy?
Involves surgicalluy removing the fibroid via laproscopic surgery or lapraotomy
Only treatment known to potentially improve fertility in patients with fibroids
152
What is a hysterectomy?
Involves removing the uterus and fibroids
May be laparoscopy, lapraotomy or vaginal approach
153
What are complications of fibroids?
HMB
Reduced fertility
Pregnancy complication
Constipation
Urinary outflow obstruction
Red degeneration of fibroids
Torsion of the fibroid
154
What is red degeneration of fibroids?
Refers to ischemia, infarction and necrosis of the fibroid due to disrupted blood supply
May occur as the fibroid rapidly enlarges during pregnancy, outgrowing its blood supply and becoming ischaemic
Severe abdominal pain, low grade fever, tachycardia and vomiting
155
What is endometriosis?
Condition where there is ectopic endometrial tissue outside the uterus
156
What is an endometrioma?
Lump of endometrial tissue outdside the uterus
157
What are chocolate cycsts?
Endometriomas in the ovaries
158
What is adenomyosis?
Endometrial tissue within the myometrium of the uterus
159
What is the main symptom of endometriosis?
Pelvic pain
160
What is the presentation of endometrisosi?
Asymptomatic
Cyclical abdominal or pelvic [ain
Deep dyspaneuria
Dysmenorrhea
Infertility
Cyclical bleeding from other sites, such as haematuria
161
What is the pathophysiology of the endometrisosi?
The cells of the endometrial tissue outside the uterus respond to hormones in the same way as endometrial tissue in the uterus
During menstration the shedding happens in the endometrial tissue elsewhere in the body
Causes irritation and inflammation for he tissues
Localised bleeding and inflammation can lead to adhesions
162
What may an exmaintion in endometriosis lead to?
Endometrial tissue visible in the vagina on specilum exam partciualrly in the posterior fornix
A fixed cervix on bimanual exmaintion
Tenderness in the vagina, cervix and adnexa
163
Waht is the gold standard way to diagnose abdominal and pelvic endometrisosi
Laprascopic surgery
164
What is the inital management of endometriosis?
Estabilishing a diagnosis
Providing a clear explanation
Listening to the patient
Analgesia as required for pain
165
What are the surgical manegement options for endometriosis?
Laproscopic surgery to excise or ablate the endometrial tissue and remove adhesions
Hysterectomy
166
What can cyclical pain be treated with?
Hormonal medications that stop ovulation and reduce endometriual thickening
This can be achieved using the combined oral contracpetive pill, oral progesterone only pill, the progestogen depot injectm the progestrone implant or the mirena coil
167
WHat induces a menopause like state?
GnRH agonisits
Exmaples are goserlin (Zoladex) or leuproreline (Prostap)
Shut down the ovaries temporarily and can be useful in treating pain in many women
Risk of osteoporosis
168
Whart does laprascopic surgery do in endometriosis?
Used to excise or abalate the ectopic endometrial tissue
169
What is adenomyosis?
Endometrial tissue inside the myometrium
170
What does adenomyosis present with?
Painful periods- dysmenorrhea
Heavy periods- menorrhagia
Pain during intercouse- dyspanuria
171
What does examination of adenomyosis show?
Enlarged and tender uterus
It will feel more soft than a uterus containing fibroids
172
What is the imaging that can be done to diagnose adenomyosis?
Travaginal US is first line
MRI
Transabdominal US
173
What is adenomyosis associated with?
Infertility
Miscarriage
Preterm birth
Small for gestational age
Malpresentaiton
174
What is menopause?
Retrospective diagnosis after a women has had no periods for 12 months
Permenant end to menstration
175
What is perimenopause?
Refers to the time around the menopasue where the women may experiencing vasomotor symptoms and irregular periods
176
What is premature menopause?
Menopaise before the age of 40
Result of premature ovarian insufficiency
177
WHat are the physiological changes in menopause?
Caused by a lack of ovarian follicular function, resulting in changes in the sex hormones associated with the mesntral cycyle:
Oestroegne and progesterone are low
LH and FSH are high in response to an absence of negative feedback from oestrogen
178
What do perimenopausal period leads to symptoms of what?
Hot flushes
Emotional libaility or low mood
Joint pains
Irregular epriods
Heavier or lighter periods
179
What conditions does menopause put people at higher risk of?
CVD
Stroke
Osteoporosis
POP
Urinary incontinence
180
When do women need to use effective contraceptive till?
Two years after the last menstral period in women under 50
Women aged 40-45 years with menopausal symptoms or a change in the menstral cycle
181
How long does it take vasomotor symtpoms to resolve in menopause?
2-5 years
182
What is the management of perimenopausal symptoms
HRT
Tribolone- A synthetic steroid hormone that acts as a continuous combined HRT
Clonidine- Acts as an agonist of alpha-adrengeric and imidazoline receptors
CBT
SSRO
Tesosterone
Vaginal oestroge
Vaginal moisturister
183
What is premature ovarian insufficiency?
Defined as menopause before the age of 40
Decline in the normal activity of the ovaries at an early age
Presents with early onset of the typical symptoms of the menopause
184
How is premature ovarian insufficiency characterised by?
Hypergonadotropic hypogonadism
Under activity of the gonads means there is a lack of negative feedback on the pituitary gland resulting in an excess of the gonadotrophics
185
What are the causes of premature ovarian insufficiency?
Idio[atjoc
Iatrogenic
Autoimmunne- Associated with coielic,. adrenal insufficiency, type 1 diabetes or thyroid disease
Genetic- Positive FH or conditions such as Turner's syndrome
Infections- Mumps, TB, CMV
186
What is the presenation of premature ovarian insufficiency?
Presents woth irregular menstral periods, lack of menstral periods and symptoms of low oestrogen levels, such as hot flushes, night sweats and vaginal dryness
187
What is premature ovarian insufficiency associated with?
CVD
Stroke
Osteoporosis
Cognitive impairment
Dementia
Parinsonism
188
What us the management of premature ovarian insufficiency?
HRT
2 types: Traditional hormonal replacement therapy and combined oral contraceptive pill
189
What is HRT?
Used in perimenopasual and psot menopausal women to alleviate symtpoms associated with menopause
Symptoms are associated with a decline in the level of oestrogen
Exogenous oestrogen is given to alleviate the symtpoms
Progestrone needs to be given to women that have a uterus
190
What are some non hormonal treatments for menopausal syptoms
Lifestyle changes
CBT
Clonidine
SSRI andidepressants
Venlafaxine
Gabapentien
191
What is clonidine?
Acts as an agonist of alpha-2 adrenergic receptors and imidazoline receptors
Lowers BP and reuces HR
Antihypertensive medication
Helpful for vasomotor symptoms and hot fluses
192
What are side efects of clonidine?
Dry mouth
Headache
Dizzines
Fatigue
