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Reproduction Week 6 2018/19 > 3: Menopause > Flashcards

3: Menopause Flashcards

1
Q

What is the menopause?

A

A woman’s last menstrual period

Preceded / accompanied / followed by menstrual symptoms

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2
Q

Why can’t FSH and LH be measured to diagnose menopause?

A

Released in a pulsatile manner

Single raised measurement doesn’t mean much

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3
Q

Which women may be misdiagnosed as menopausal?

A

Pregnant women

Hysterectomy patients (ovaries haven’t been removed)

Women on contraception

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4
Q

What are the symptoms of the menopause?

A

HOT FLUSHES (‘vasomotor symptoms’)

NIGHT SWEATS

Palpitations

Insomnia

Arthralgia

Headaches

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5
Q

What are the knock on symptoms of hot flushes in the menopause?

A

Difficulty sleeping, concentrating

Irritability

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6
Q

What are the sexual symptoms of the menopause?

A

Vaginal dryness

Reduced libido

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7
Q

What causes

a) vaginal dryness
b) reduced libido

in the menopause?

A

a) Reduced collagen
b) Reduced testosterone

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8
Q

Which renal symptoms are seen in the menopause?

A

Increased frequency

Dysuria

Urinary incontinence

suggestive of UTI

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9
Q

What happens to ovulation during the climacteric and menopausal periods?

A

Becomes less frequent

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10
Q

Becomes ovulation occurs less often in the menopause, what symptom do women experience?

A

Irregular, menorrhagic periods

Menstruation still occurs two weeks post-ovulation but because ovulation is less frequent, oestrogen/prog. allow endometrium to proliferate - massive bleeding upon menstruation

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11
Q

What are some lifestyle adjustments women can make to reduce the severity of their menopausal symptoms?

A

Diet - eat more soy (contains phyto-oestrogens), achieve optimal Ca / Vit D intake to reduce chances of osteoporosis

Weight - losing weight makes sweats more bearable

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12
Q

Which therapy is used for the vasomotor symptoms of menopause?

A

Hormone replacement therapy

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13
Q

What HRT is given for the hot flushes in menopause?

A

Oestrogen AND Progesterone

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14
Q

Why isn’t oestrogen given alone for menopausal hot flushes?

A

Causes unmitigated profileration of endometrium - INCREASES ENDOMETRIAL CANCER RISK

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15
Q

Which diseases are HRT patients at increased risk of developing?

A

VTE

Breast cancer

Cervical cancer

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16
Q

Does HRT increase a woman’s risk of heart disease?

A

No

It has been proven not to

17
Q

What are the two routes of administration of HRT?

A

Topical

Oral

18
Q

Which cancer is associated with long term use of oestrogen and progesterone HRT?

A

Breast cancer

19
Q

After how long on HRT do the risks outweigh the benefits?

A

20+ years

20
Q

Which lifestyle factor has the greatest effect on breast cancer risk in menopausal women?

A

Raised BMI

far more than any HRT or contraceptive

21
Q

What is the average age for menopause?

A

50 years old

22
Q

What are the age thresholds for

a) early menopause
b) premature menopause
c) late menopause?

A

a) < 45

b) < 40

c) > 55

23
Q

Which term describes the decline in a woman’s sexual function which precedes the menopause?

A

Climacteric

24
Q

What are the effects of

a) oestrogen

b) progesterone

on the endometrium?

A

a) Proliferation

b) Maintenance

25
Q

Apart from proliferation of the endometrium, what are the effects of oestrogens on women?

A

LH surge causing ovulation

Secondary sexual characteristics (including hair, body shape and fat)

Oil and collagen distribution (vaginal dryness is a menopausal symptom)

26
Q

What should be asked about when taking a history from a woman complaining of menopausal symptoms?

A

Menstrual pattern

Are they having periods? When was it? Light/heavy?

27
Q

What type of bleeding is associated with endometrial cancer?

A

Post-menopausal bleeding

28
Q

What is mefanemic acid?

A

NSAID which reduces bleeding in menopausal women by inhibiting prostaglandin synthesis

29
Q

What is tranexamic acid?

A

Antifibrinolytic drug used to increase clotting in abnormal uterine bleeding

Useful for menopausal bleeding

30
Q

Which two drugs can be used in combination to reduce the heavy bleeding seen in menopause?

A

Mefanemic acid

Tranexamic acid

31
Q

Apart from drugs, what other device can be used to reduce heavy bleeding seen in the menopause?

A

Intrauterine system (IUS)

Secretes progesterone, maintaining the uterus

32
Q

Which surgical procedures can be performed to stop heavy bleeding in menopausal women?

A

Endometrial ablation

Hysterectomy

33
Q

Summarise the treatment options for menopausal women with heavy bleeding.

A

Medical - mefanemic acid + tranexamic acid; intra-uterine system

Surgical - endometrial ablation; hysterectomy

Reproduction Week 6 2018/19 (9 decks)

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