Menopause & premature ovarian insufficiency Flashcards

1
Q

What are the phases of the ovarian cycle

A

-Follicular phase
-Ovulation
-Luteal phase
‘FOL’

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2
Q

What are the phases of the uterine cycle

A

-Menstuation
-Proliferative
-Secretory
‘MPS’

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3
Q

What are the differences between men and women in age related decline in gonadal function?

A
  • Men don’t experience gametic exhaustion nor a sudden fall off in fertility, unlike women
  • However they both experience senescent chanhges
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4
Q

What is menopause

A
  • 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
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5
Q

What is the climateric?

A
  • 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
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6
Q

How and when do you diagnose menopause

A
  • 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)

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7
Q

What happens in menopause?

A
  • oocytes decrease, decreased estrogen (no ovulation)

- FSH increases (lack of inhibitory feedback from oestrogen on hypothalamus)

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8
Q

What consequences does menopause cause?

A
  • Anovulatory cycles, menstrual irregularities, menorrhagia
  • physical changes
  • psychological changes
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9
Q

What are the long term consequences of menopause?

A
  • 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
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10
Q

What different hormonal treatment options are available for menopause?

A
  • 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
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11
Q

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

A
  • lifestyle measures
  • replens
  • Alpha 2 agonists: clonidine
  • SSRI’S
  • Gabapentin
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12
Q

What are the benefits of using HRT to treat menopause?

A
  • Alleviate symptoms
  • Protect bones
  • Protect CVD
  • reduces incidence of colorectal cancer
  • improve QOL
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13
Q

What are the risks of using HRT to treat menopause?

A
  • VTE

- breast and endometrial cancer

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14
Q

What different HRT preparations are available for menopause

A
  • Oral
  • Transdermal
  • Implant
  • Local
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15
Q

What is premature ovarian insufficiency?

A
  • 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
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16
Q

What different treatment options are available for POI

A
  • Hormone replacement (HRT or COCP/patch)
  • Fertility treatment
  • Psychological support
17
Q

What leads to POI

A
  • Inadequate oogenesis
  • follicle depletion
  • Follicle dysfunction