2200798
Description
Flashcards by Hannah Tribe, updated more than 1 year ago
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Created by Hannah Tribe
over 9 years ago
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| Question | Answer |
| What is the official definition of the menopause? | Permanent cessation of menstruation due to loss of ovarian follicular function, with amenorrhoea for 12 consecutive months. |
| What is the perimenopause? | A period of changing ovarian function which precedes the menopause by 2-8 years |
| What is premature ovarian failure? | Women experiencing the menopause younger than 40 |
| What are some symptoms of the menopause? (6) | 1. initially reduced length of cycle 2. Irregularity of cycles with intermittent amenorhhoea approx. 4 years before menopause 3. hot flushes causing disturbed sleep in the last stages of menopause 4. Dry vagina, causing painful sex 5. Decreased fertility, becoming infertile 6. Irritability, depression and joint pains, although these are not proven to be directly caused by the menopause |
| What are some pathophysiological observations seen in menopause? (4) | 1. reduced number of follicles, eventually becoming none 2. Reduced number of granulosa cells 3. reduced function of the granulosa cells 4. Increased chromosomal abnormalities of existing oocytes |
| What factors contribute to the depletion of follicles? (3) | 1. Increased apoptosis 2. Decline in levels of AMH, which normally inhibits release of follicle (limits release to 1 a month), so more follicles released (and lost) 3. FSH levels increase so more follicles are recruited (and lost) |
| What factors contribute to the decrease in granulosa cell number and function? (4) | 1. Decreased levels of inhibin B allow FSH levels to rise 2. Decreased levels of inhibin A normally produced during the luteal phase, but anovulatory cycles mean there is no luteal phase. This decrease allows rise in FSH 3. Decreased FSH receptors and decreased sensitivity impairs recruitment of dominant follicle 4. Impaired secretions of growth factors and hormones |
| Why does the cycle initially shorten? | The decline in inhibin B causing rise in FSH causes earlier rise in oestrogen and therefore earlier LH surge |
| What causes the later delayed or absent ovulation? | Granulosa cell function has deteriorated so despite the rise in FSH and therefore oestrogen, the threshold for negative feedback to switch to positive may not be reached and therefore there is no surge of GnRH and LH. decrease in sensitivity of FSH receptors may also suppress LH surge. |
| Why might women experience heavier periods during the menopausal transition? | High levels of FSH allow rising levels of oestrogen, but due to lack of ovulation there is constant levels of oestrogen for prolonged periods of time, which continues to stimulate the endometrium, so eventually there comes a point where the endometrium is so thick it must shed away, causing heavier bleeding. |
| What causes the hot flushes? | low oestrogen levels in the later stages of the menopause cause disturbances in serotonin levels which reset thermoregulatory nucleus and cause increased heat loss through the skin |
| Production of which hormone totally stops after the menopause and why? | Progesterone, due to the lack of ovulation causing no formation of a corpus luteum at all after menopause. |
| What causes the decline in oocyte function and development? | Decline in granulosa cells causes lack of production of adequate growth factors for oocytes and so there is increased chance of aneuploidy and miscarriage or anovulatory cycles. |
| What is it important to remember to give women >40 years old, even if they think they are going through the menopause? | Contraception, because if pregnancy does occur, there is increased chance of chromosomal abnormalities and miscarriage |
| What modifiable risk factor is known to bring on earlier menopause and why? | Smoking, possibly due to altering the ovarian environment |
| Which hormone decreases first during a woman's reproductive life? | AMH |
| What is the most common treatment for hot flushes? | Hormone replacement therapy |
| What should also be given to women who still have a uterus and why? | Progesterone for 13 days each month, to reduce the risk of endometrial carcinoma |
| If oestrogen in HRT is unopposed by progesterone, what can be the consequences? | Endometrial hyperplasia, or possibly carcinoma. |
| What can happen if continuous oestrogen and progesterone are given? | May get break through bleeding, which is not good for women who have not yet stopped having periods. |
| In what ways can HRT be delivered? | Tablets (combined or with cyclical progesterone), patches, oestrogen implants, progesterone IUDs, gels (although this is hard to dose), vaginal oestrogen creams to combat dryness |
| What are 2 significant contraindications for giving HRT? | 1. If the woman is high risk for thromboembolic events (DVT etc.) 2. Oestrogen-receptive breast cancer |
| What can be given instead of HRT to relieve hot flushes? | Anti-depressants such as Sertraline (SSRI) |
| What other health problems can be reduced by HRT? | 1. Reduced osteroporosis 2. Reduced rates of colon cancer |
| What is a suggested benefit of HRT? | May have a protective effect from Alzheimer's Disease, but there are no randomised controlled trials proving this |
| What is the downside to the protective effect of HRT on osteoporosis? | The protective effect only lasts while the woman is taking the HRT |
| What other non-medical solutions are there to improving menopause symptoms? | 1. Quit smoking 2. Increase exercise 3. Improve nutrition to reduce BMI 4. Manage cardiovascular risks |
| If a woman bleeds again after 13 months of amenorrhoea, is this normal? | No, this is post-menopausal bleeding, which is regarded as cancer until proven otherwise, the woman should be referred under the 2 week rule |
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