Flashcards in Menopause & premature ovarian insufficiency Deck (17)
What are the phases of the ovarian cycle
What are the phases of the uterine cycle
What are the differences between men and women in age related decline in gonadal function?
-Men don't experience gametic exhaustion nor a sudden fall off in fertility, unlike women
-However they both experience senescent chanhges
What is menopause
-The last menstrual period
-retrospective diagnosis after one year of amenorrhea
-estradiol low <203
-most women expected to be post menopausal at age 54
What is the climateric?
-The period of time around the last menstrual period
-Also known as the perimenopause
-Based on symptoms
-vasomotor symptoms (night sweats, hot flushes) & irregular breathing
How and when do you diagnose menopause
-If the women is >45 yrs, you can diagnose it with no lab tests( e.g FSH& AMH)
-perimenopause: vasomotor symptoms& irregular bleeding
-menopause: amenorrhea for >12 months in women with a uterus
-menopause: based on symptoms on women without a uterus
-Can be more difficult to diagnose in women taking hormone medications to control heavy bleeding (e.g COCP & high doses of progesterone)
What happens in menopause?
-oocytes decrease, decreased estrogen (no ovulation)
-FSH increases (lack of inhibitory feedback from oestrogen on hypothalamus)
What consequences does menopause cause?
-Anovulatory cycles, menstrual irregularities, menorrhagia
What are the long term consequences of menopause?
-osteoporosis as oestrogens are needed for the maintenance of bone mass in both males and females ,acting to suppress bone resorption by osteoclasts and to promote bone formation by osteoblasts
-CVD( coronary artery disease, stroke, venous thromboembolism, pulmonary embolism)
-vaginal dryness and atrophy
What different hormonal treatment options are available for menopause?
-Oestrogen: reverse symptoms and effects of low oestrogen
-Progesterone: Necessary to protect the endometrium if uterus present
-Testosterone: increases overall energy level, enhances sexual desire and arousal
-Continuous vs sequential
What different non- hormonal treatment options are available for menopause?
-Alpha 2 agonists: clonidine
What are the benefits of using HRT to treat menopause?
-reduces incidence of colorectal cancer
What are the risks of using HRT to treat menopause?
-breast and endometrial cancer
What different HRT preparations are available for menopause
What is premature ovarian insufficiency?
-aka premature menopause or premature ovarian failure
-Diagnosis: amenorrhoea 4 months, FSH> 30U/L on two occasions 6 weeks apart, women less than 40yrs
-less common the younger you are
-In the case of idiopathic POI investigate via: cytogenetics, FMR1 premutation screening, anti-adrenal & anti-thyroid antibodies
What different treatment options are available for POI
-Hormone replacement (HRT or COCP/patch)