22. Managing the menopause Flashcards
Lifestyle changes to manage menopause:
- 30 min 5x exercise
- Weight reduction
- Avoid hot drinks, alcohol, spicy food, caffeine, smoking
Non- Prescription management of menopause:
Black cohosh, Isoflavones
Non hormonal treatment for menopause:
Licensed: Clonidine (SE: insomnia, dry mouth, constipation, dizziness, drowsiness)
Unlicensed: SSRI/SNRI, Gabapentin (SE: dizziness, fatigue, tremor, weight gain)
HRT for menopause:
Bioidentical oestrogen to manage symptoms and progesterone to protect uterus
HRT contraindications:
- Abnormal vaginal bleeding
- Active arterial or venous thrombosis
- Liver disease and deranged LFTs
- Hormone dependent cancer
HRT systemic oestrogen types:
- Oral
- Transdermal (patch, gel, spray)
HRT types of progesterone:
- Oral (synthetic progestogens combined with E2 or micronized progesterone)
- Transdermal (synthetic progestogens combined with E2)
- Intravaginal (micronized progesterone)
- Intrauterine (Levonorgestrel)
Synthetic progestogens (combined with E2):
- Dydrogesterone
- Leconogestrel
- Medroxyprogesterone acetate
- Norethisterone
Benefits of HRT:
- Control of menopausal symptoms
- Bone mineral density control, and reduced risk of osteoporosis
- Reduced risk of T2DM, coronary heart disease
Risks of HRT:
- Endometrial cancer (reduced by addition of progesterone)
- Breast cancer (risk increase >5years)
No increase risk with transdermal oestrogen:
- DVT/PE
- CHD
- Stroke
Transdermal patch use indications:
- Angina
- Hypertension
- Smoking
- BMI >30
- Diabetes
- Migraine with aura
- Hypercholesterolaemia
If HRT not effective, how to improve low sexual desire?
Testosterone, in surgically menopausal women
Side effects of oestrogen in HRT:
- Fluid retention
- Breast tenderness
- Nausea
- Leg cramps
- Epigastric discomfort
- Headaches/visual disturbance
Side effects of progesterone in HRT:
- Fluid retention
- Breast tenderness
- Nausea
- Leg cramps
- Epigastric discomfort
- Headaches/visual disturbance
