3: Menopause Flashcards
What is the menopause?
A woman’s last menstrual period
Preceded / accompanied / followed by menstrual symptoms
Why can’t FSH and LH be measured to diagnose menopause?
Released in a pulsatile manner
Single raised measurement doesn’t mean much
Which women may be misdiagnosed as menopausal?
Pregnant women
Hysterectomy patients (ovaries haven’t been removed)
Women on contraception
What are the symptoms of the menopause?
HOT FLUSHES (‘vasomotor symptoms’)
NIGHT SWEATS
Palpitations
Insomnia
Arthralgia
Headaches
What are the knock on symptoms of hot flushes in the menopause?
Difficulty sleeping, concentrating
Irritability
What are the sexual symptoms of the menopause?
Vaginal dryness
Reduced libido
What causes
a) vaginal dryness
b) reduced libido
in the menopause?
a) Reduced collagen
b) Reduced testosterone
Which renal symptoms are seen in the menopause?
Increased frequency
Dysuria
Urinary incontinence
suggestive of UTI
What happens to ovulation during the climacteric and menopausal periods?
Becomes less frequent
Becomes ovulation occurs less often in the menopause, what symptom do women experience?
Irregular, menorrhagic periods
Menstruation still occurs two weeks post-ovulation but because ovulation is less frequent, oestrogen/prog. allow endometrium to proliferate - massive bleeding upon menstruation
What are some lifestyle adjustments women can make to reduce the severity of their menopausal symptoms?
Diet - eat more soy (contains phyto-oestrogens), achieve optimal Ca / Vit D intake to reduce chances of osteoporosis
Weight - losing weight makes sweats more bearable
Which therapy is used for the vasomotor symptoms of menopause?
Hormone replacement therapy
What HRT is given for the hot flushes in menopause?
Oestrogen AND Progesterone
Why isn’t oestrogen given alone for menopausal hot flushes?
Causes unmitigated profileration of endometrium - INCREASES ENDOMETRIAL CANCER RISK
Which diseases are HRT patients at increased risk of developing?
VTE
Breast cancer
Cervical cancer
Does HRT increase a woman’s risk of heart disease?
No
It has been proven not to
What are the two routes of administration of HRT?
Topical
Oral
Which cancer is associated with long term use of oestrogen and progesterone HRT?
Breast cancer
After how long on HRT do the risks outweigh the benefits?
20+ years
Which lifestyle factor has the greatest effect on breast cancer risk in menopausal women?
Raised BMI
far more than any HRT or contraceptive
What is the average age for menopause?
50 years old
What are the age thresholds for
a) early menopause
b) premature menopause
c) late menopause?
a) < 45
b) < 40
c) > 55
Which term describes the decline in a woman’s sexual function which precedes the menopause?
Climacteric
What are the effects of
a) oestrogen
b) progesterone
on the endometrium?
a) Proliferation
b) Maintenance
Apart from proliferation of the endometrium, what are the effects of oestrogens on women?
LH surge causing ovulation
Secondary sexual characteristics (including hair, body shape and fat)
Oil and collagen distribution (vaginal dryness is a menopausal symptom)
What should be asked about when taking a history from a woman complaining of menopausal symptoms?
Menstrual pattern
Are they having periods? When was it? Light/heavy?
What type of bleeding is associated with endometrial cancer?
Post-menopausal bleeding
What is mefanemic acid?
NSAID which reduces bleeding in menopausal women by inhibiting prostaglandin synthesis
What is tranexamic acid?
Antifibrinolytic drug used to increase clotting in abnormal uterine bleeding
Useful for menopausal bleeding
Which two drugs can be used in combination to reduce the heavy bleeding seen in menopause?
Mefanemic acid
Tranexamic acid
Apart from drugs, what other device can be used to reduce heavy bleeding seen in the menopause?
Intrauterine system (IUS)
Secretes progesterone, maintaining the uterus
Which surgical procedures can be performed to stop heavy bleeding in menopausal women?
Endometrial ablation
Hysterectomy
Summarise the treatment options for menopausal women with heavy bleeding.
Medical - mefanemic acid + tranexamic acid; intra-uterine system
Surgical - endometrial ablation; hysterectomy
