35) Menopause and Premenopause; Hormone Replacement Therapy (HRT)

Question 1

What is the Definition of “Climacteric Period”?

Answer 1

INCLUDES

• Peri-menopausal
• Menopause
• Post-menopausal

Period from OPTIMAL MENSTRUATION — MENOPAUSE

Question 2

What is Perimenopause?

Answer 2

• The Years leading upto Menopause
• Presented with very few oocytess left, hence infrequent ovulation
• HIGHER FSH –> HIGHER Estradiol Levels
• CFs = AUB, Endometrial Hyperplasia, Hot Flushes, Headaches
• Tx = Oral Progesterone for Days 14 - 28, Hormonal Therapy

Question 3

What is the Definition of “Menopause”?

Answer 3

• Cessation of Menstruation
• Signifies the depletion of Oocytes
• The Absence of Menstruation for 12 Months

Question 4

What are the Types of Menopause?

Answer 4

1) Premature Menopause - Permanent Cessation of Menses BEFORE AGED 40 due to loss of ovarian fx

• DUE to = Cigarettes, Pelvic Radiation, Hysterectomy, Chromosomal Abnormality

2) Spontaneous

3) Induced - Surgery, Chemo / Radio

Question 5

What are the Physiological Changes in Menopause?

Answer 5

• Urogenital Atrophy
• Uterine, Breast, Skin + Hair Changes

Question 6

What is Urogenital Atrophy?

Answer 6

• Atrophy of Vagina, Urethra, Bladder + Pelvic Floor - where there’s REDUCED Thickness of Vaginal Epithelium + Vascular Flow
• Due to DECREASED Oestrogen Levels

CFs
- Infection, Trauma
- Dyspareunia (painful sex)

• UTI Symptoms (Dysuira, Frequency, Urgency, Incontinence)

Question 7

Describe the Changes of Breast, Skin + Hair

Answer 7

BREAST = FATTY REPLACEMENT of Breast Tissue with atrophy of ACTIVE GLANDULAR UNITS

SKIN = Collagen Content + Thickness decrease with time

HAIR = INCREASED Androgens causing INCREASED Facial Hair - due to DECREASED Oestrogen levels

Question 8

What are the Clinical Features of Menopause?

Answer 8

• Hot flushes, sweating, heat intolerance
• Headaches, insomnia, Mood Swings
• Vulvovaginal Atrophy (Dry Vagina, Thin Endometrium)
• Urogenital Atrophy
• Osteoporosis - INCREASED RISK of Fractures, due to DECREASED Bone Mineral Density

Question 9

Describe Premenopause and Post-Menopause?

Answer 9

PREMENOPAUSE = Period FROM Menarche — ONSET of PERIMENOPAUSE

POST-MENOPAUSE = ALWAYS ABNORMAL!

• DUE TO = Vaginal Atrophy, Endometrial Hyperplasia

Question 10

How’s Menopause Diagnosed?

Answer 10

• INCREASED Levels of FSH

DECREASED LEVELS

• Estradiol
• Progesterone
• Inhibin-B
• Assessment of Clinical Signs

Question 11

What is Hormone Replacement Therapy (HRT)?

Answer 11

1) Hormone Therapy = Combined Use of Oestrogen + Progesterone

2) Oestrogen Therapy = Use of Oestrogen - Usually given to women UNDERGONE Hysterectomy

• REDUCES Symptoms of DECREASED Oestrogen - Hot Flushes, Insomnia + Mood Disorders
• TREATS Vaginal Atrophy / Dryness
• Improves BONE HEALTH

ADMINISTERED VIA Transdermal Patches, Vaginal Ring, Orally, Topically

THERAPEUTIC GOAL = LOWEST DOSE of Oestrogen + APPROPRIATE Progesterone, for women with uterus

Question 12

What are the the CONTRAINDICATIONS and RISKS for HRT?

Answer 12

CONTRAINDICATED IN

• Abnormal Genital Bleeding
• Suspected Breast Cancer
• History of Thrombosis, Stroke, MI
• Allergic
• Suspected Pregnancy

RISKS

• Endometrial Cancer
• Abnormal Bleeding
• Venous Thromboembolism