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Flashcards in Menopause & premature ovarian insufficiency Deck (17)
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1

What are the phases of the ovarian cycle

-Follicular phase
-Ovulation
-Luteal phase
'FOL'

2

What are the phases of the uterine cycle

-Menstuation
-Proliferative
-Secretory
'MPS'

3

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

4

What is menopause

-The last menstrual period
-retrospective diagnosis after one year of amenorrhea
-FSH high>30
-estradiol low <203
-most women expected to be post menopausal at age 54

5

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

6

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)

7

What happens in menopause?

-oocytes decrease, decreased estrogen (no ovulation)
-FSH increases (lack of inhibitory feedback from oestrogen on hypothalamus)

8

What consequences does menopause cause?

-Anovulatory cycles, menstrual irregularities, menorrhagia
-physical changes
-psychological changes

9

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
-alzheimers

10

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

11

What different non- hormonal treatment options are available for menopause?

-lifestyle measures
-replens
-Alpha 2 agonists: clonidine
-SSRI'S
-Gabapentin

12

What are the benefits of using HRT to treat menopause?

-Alleviate symptoms
-Protect bones
-Protect CVD
-reduces incidence of colorectal cancer
-improve QOL

13

What are the risks of using HRT to treat menopause?

-VTE
-breast and endometrial cancer

14

What different HRT preparations are available for menopause

-Oral
-Transdermal
-Implant
-Local

15

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

16

What different treatment options are available for POI

-Hormone replacement (HRT or COCP/patch)
-Fertility treatment
-Psychological support

17

What leads to POI

-Inadequate oogenesis
-follicle depletion
-Follicle dysfunction