2.9 Menopause Flashcards
Why is menopause a retrospective diagnosis?
Menopause is the point at which menstruation stops.
Diagnosis is made after 12 months of no periods
What is the average age of menopause?
51 years
When is perimenopause and postmenopause?
peri is the lead up (eg 45yrs) to last period and then 12 months after the last period.
post starts 12 months after the last period.
At what age is premature menopause?
<40 years, caused by premature ovarian insufficiency
What hormones are high and what ones are low in menopause?
low oestrogen and progesterone
high LH and FSH (no negative feedback)
What is happening physiologically in the menopause?
Decrease in the development of follicles meaning fewer granulosa cells produce oestrogen.
What are 8 perimenopausal symptoms?
- hot flushes
- joint pains
- emotional lability / low mood
- premenstrual syndrome
- reduced libido
- vaginal dryness
- irregular periods
- heavier or lighter periods
What conditions are at increased risk due to a lack of oestrogen?
- CVD and stroke
- osteoporosis
- pelvic organ prolapse
- urinary incontinence
How can you diagnose the menopause?
Clinical Dx:
- over 45 and typical Sx
Do FSH blood test in:
- women <40 with suspected premature ovarian failure
- women 40-45 with symptoms or change in cycle
When can women stop using contraception?
two years after LMP in women <50
one year after LMP in women >50
What contraceptives are UKMEC 1 for perimenopausal women?
- barrier
- mirena or copper
- POP
- implant
- depot
- sterilisation
What is COCP UKMEC after age 40? Advice?
UKMEC 2 after 40, can be used until 50yrs
Advised to use one with norethisterone or levonorgestrel due to lower VTE risk
What important side effects does the depot injection have? Implication in perimenopause?
reduced bone mineral density
weight gain
–> only use until age 45
How long will vasomotor symptoms last in the menopause?
2-5 years
What management is there for perimenopausal symptoms?
- no treatment
- HRT
- tibolone
- clonidine
- CBT
- SSRIs
- testosterone
- vaginal oestrogen
- vaginal moisturisers
