18. Menopause Flashcards
How is the menopause defined medically?
How has the average age of menopause changed over time?
What is early and premature menopause?
What is the climacteric (perimenopause)?
No period for at least 1 year.
1900: 48, life expectancy = 48. 2013: 51.4, life expectancy = 82.
Early = 20% of women aged 40-45. Premature = 1% of women aged <40.
Transitional phase during which reproductive function declines and ceases.
What are some climacteric symtoms?
What are the short-term symptoms and long-term sequelae of the menopause?
Changes in menstural cycle length, hot flushes/night sweats.
All are symptoms of OVARIAN FAILURE i.e. oestrogen deficiency.
Short-term symptoms: vasomotor (hot flushes, night sweats, palpitations, headaches), psychological (depression, mood swings, insomnia, memory loss, panic), urogenital (urinary frequency, dysuria, stress and urge incontinence, vaginal dryness, dyspareunia), collagen (dry inelastic skin, brittle nails, hair loss, joint/muscle pains)
Long-term sequelae: CVS (hyperlipidemia, IHD), skeletal (osteopenia, osteoporosis), skin (inelastic thin flaky skin, easy bruising), genito-urinary (atrophic changes, prolapse, incontinence, depressed libido and dyspareunia), psychological (AD - lose density in cerebral cortex)
What is osteoporosis?
How does rates of osteoporosis differ with race?
What is a dowager’s hump?
Why are prolapses more common after menopause?
Resorption of bone mass and decrease in bone density (after menopause). Fracture more easily esp. NOF and scaphoid.
Common in white women, lowest risk in Afro-Carribeans (have more collagen).
Loss of bone density in vertebrae - fractures and curvatures of the spine caused by osteoporosis.
Oestrogen promotes collagen which keeps the uterus and vagina etc. suspended by series of ligaments - become more lax after menopause.
What symptoms might utero-vaginal prolapse cause?
What is (uteral) procidentia?
What is the triad of disgnostic features for the menopause?
What other diagnostic tests/investigations could you do?
Urinary incontinence, uncomfortable dragging sensation.
Uterus comes down vagina and presents at vaginal introitus. Can get ulcerated and sore. If young = hysterectomy. If old = pessaries.
Typical symptoms, 12 months’ amenorrhoea, FSH > 15iu/ml (increases after menopause)
Serum oestradiol levels (only useful if <45yo), bone mineral density (osteoporosis diagnosis)
What are the 2 different types of HRT?
What are the routes of HRT administration?
What are some common side effects of HRT?
If uterus present: oestrogen + progesterone. If uterus absent: oestrogen. Menopause symptoms due to lack of oestrogen but need progesterone too or high oestrogen will hyperstimulate endometrium -> endometrial cancer.
Oral, patches and gels, implants and injections (not used much now), intravaginal creams, pessaries, rings, nasal sprays.
Heavy cyclical/unscheduled irregular bleeding, bloating and weight gain, mastalgia, headaches, muscle cramps, abdominal pain, depression.
HRT may improve life/prolong life/cause cancer/TED…
What are 2 serious complications of HRT?
When must HRT not be given?
1) Breast cancer: risk increases >5yrs of use, by 2-6/1000 women.Thus try and give lowest dose of HRT possible for a short time to get through bad symptoms. Obesity = biggest risk for breast cancer.
2) Thrombo-embolic events: DVT/PE affect approximately 5/10,000 women on HRT, and most commonly occur in year 1 of use. Need doppler ultrasound if suspected. Treat DVT with LMW heparin to disperse clot.
Do not give HRT if: breast/endometrial cancer, endometriosis, fibroids, IHD, obese, smoker, history of clotting/thromolytic events, lack mobility.
What are some non-hormonal altunatives to HRT?
Bisphosphonates and calcitonin: decrease osteoclast activity.
Selective oestrogen receptor modulators (SERM): change way oestrogen receptors work to promote higher levels of oestrogen.
Clonidine and venlaflaxine: antidepressants can reduce vasomotor symptoms.
Lifestyle issues: vitamins, herbs, phyto-oestrogens, exercise, no smoking
