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Repro > 23 - 2y Amenorrhoea & Menopause > Flashcards

23 - 2y Amenorrhoea & Menopause Flashcards

1
Q

define menopause?

A

woman’s last ever period

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2
Q

average age of menopause?

A

51 years

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3
Q

when does perimenopause occur?

A

~ 5 years before

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4
Q

define premature menopause?

A

40 years or less

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5
Q

describe 2 things which happen in menopause?

A

ovarian insufficiency - oestradiol falls

FSH rises

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6
Q

what happens to FSH levels in perimenopause?

A

they fluctuate

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7
Q

describe 3 scenarios when menopausal transition may be sudden?

A

following -

oophorectomy

chemotherapy

radiotherapy

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8
Q

describe 2 vasomotor symptoms of menopause and how long they last?

A

hot flushes & night sweats

usually last 2-5 yrs- but may be 10 years+

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9
Q

describe 5 other symptoms of menopause?

A

Vaginal dryness / soreness

Low libido

Muscle and joint aches

Mood changes

poor memory

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10
Q

what is a severe and hard to detect change which can occur with menopause?

A

osteoporosis

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11
Q

what is osteoporosis?

A

reduced bone mass -

DEXA scan shows bone density described as T score

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12
Q

what is a possible result of osteoporosis?

A

fractured hip / vertebra

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13
Q

give 4 RFs for developing osteoporosis?

A

thin

caucasian

smoking

high EtOH

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14
Q

give 4 ways to prevent and treat osteoporosis?

A

wt bearing exercise

adequate calcium & Vit D

HRT

calcitonin

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15
Q

give 3 examples of local vaginal HRT?

A

oestrogen pessary/ring/cream

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16
Q

how long does local HRT need to be used to be effective?

A

longterm

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17
Q

what is a benefit of systemic oestrogen transdermal/ oral HRT?

A

less risk of Venous thromboembolism

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18
Q

when should combined oestorgen and progesterone HRT be used?

A

if there may still be some ovary function to avoid irregular bleeding

19
Q

3 contraindications for systemic HRT?

A

Current Hormone dependent cancer breast/endometrium

Current active liver disease

Un-investigated abnormal bleeding

20
Q

which lubricants should be used for vaginal dryness?

A

Non hormonal lubricants -

Replens or Pre sex ‘Sylk’

21
Q

in terms of treating depression for those with menopause, which medications should NOT be used?

A

clonidine

SSRI SNRI

22
Q

give 3 benefits for using HRT?

A

control vasomotor symptoms

local genital symptoms controlled

reduces risk of osteoporosis

23
Q

3 risks with using HRT?

A

breast Ca if combined HRT

ovarian Ca

venous thrombosis if oral route

24
Q

association with HRT and risks of CVS?

A

no increase of CVS risks if HRT is started before 60 years

25
Q

if HRT is being used to control night-sweats and hot flushes, how often should it be reviewed?

A

annually

26
Q

what is the first line for osteoporosis prevention?

A

bisphosphonates

27
Q

what is first line for vaginal symptoms?

A

vaginal oestrogen

28
Q

what is andropause?

A

condition characterised by Testosterone falling by 1% a year after 30 yrs

29
Q

what, other than testosterone, falls with andropause?

A

DHEAS

30
Q

andropause’s effect on fertility?

A

fertility remains

31
Q

define 1y amenorrhoea?

A

never had a period

32
Q

define 2y amenorrhoea?

A

has had periods in past but none for 6 months

33
Q

give 5 causes of 2y amenorrhoea?

A

Pregnancy / Breast feeding

Premature ovarian insufficiency

PCOS

contraception-related

Asherman’s syndrome

34
Q

give 7 endocrine causes for 2y amenorrhoea?

A

Thyroid disease

Cushing’s syndrome

raised Prolactin (prolactinoma)

hypothalamic causes (stress)

androgen secreting tumour

Sheehan’s Syndrome (pituitary failure)

congenital adrenal hyperplasia

35
Q

7 components of examination for 2y amenorrhoea?

A

BP

BMI

enlarged clitoris

deep voice

acne

hisutism

Cushingoid

36
Q

4 tests for 2y amenorrhoea?

A

urine pregnancy test

dipstick for GLC

bloods

pelvic ultrasound

37
Q

name 7 things the FBC will be measuring?

A

FSH

oestadiol (to rule out menopause)

prolactin

thryroid function

testosterone

17 hydroxy progesterone

38
Q

3 treatments for 2y amenorrhoea?

A

treat specific cause

aim for BMI >20 and <30 for ovulation

emotional support

39
Q

what should be offered as treatment if found to have premature ovarian insufficiency?

A

HRT until turn 50 years old

40
Q

how to diagnose PCOS?

A

need 2/3 of the following -

oligo/amenorrhoea

androgenic symptoms: excess hair/acne

Polycystic ovarian morphology on scan

41
Q

risks associated with PCOS?

A

diabetes and cardiovascular disease regardless of BMI and body shape

42
Q

Does PCOS cause weight gain/ pain?

A

No - but weight gain can worsen PCOS

43
Q

treatment for PCOS?

A

weight loss & exercise - BMI of 20-25

antiandrogen combined hormonal contrception - spironolactone

alfornithine cream to reduce facial hair

support and information - e.g. support group

44
Q

role of metformin for PCOS patients?

A

encourages ovulation but no consistent evidence of benefit for androgenic symptoms or helping weight loss

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