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A - MSRA Gynaecology [8] > [42] Menopause > Flashcards

[42] Menopause Flashcards

1
Q

What is the menopause?

A

The end of the female reproductive life

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2
Q

What is the average age of menopause in the UK?

A

51

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3
Q

What is the perimenopause also known as?

A

The climacteric

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4
Q

What is the perimenopause?

A

The transition period before the menopause, from the reproductive stage of life to the post-menopausal years

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5
Q

At what age can signs and effects of the perimenopause begin?

A

Can be as early as 35, but most women don’t become aware of them until about 10 years later

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6
Q

How can the duration and severity of perimenopause in an individual woman be predicted?

A

It can’t

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7
Q

What are the symptoms of perimenopause?

A
  • Weight gain
  • Menstrual irregularities
  • Reduced fertility
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8
Q

Where in particular is there weight gain in perimenopause?

A
  • Lower abdomen
  • Buttocks
  • Thighs
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9
Q

What % of women stop menstruating abruptly in the menopause?

A

10%

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10
Q

What happens to menstruation in the vast majority of women in the menopause?

A

They experience 4-5 years of varying cycle length due to progressive ovarian failure

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11
Q

What hormonal changes is the perimenopause initially characterised by?

A

Elevation of FSH and decreased inhibit levels, but normal levels of estradiol-17ß and LH

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12
Q

Are the hormonal changes in the perimenopause the same in every woman?

A

No, there is wide individual variation

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13
Q

What is the menopause defined as?

A

Cessation of menstrual cycles, where no more follicles develop

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14
Q

What is the result of the absence of follicular development in the menopause?

A

The ovary produces almost no oestrogen

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15
Q

What is the bodies primary source of oestrogen after the menopause?

A

Peripheral conversion of androgens

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16
Q

What is the importance of the lack of oestrogen following the menopause?

A

It is the lack of oestrogen that produces most of the symptoms of menopause

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17
Q

What other hormonal changes are there during the menopause?

A
  • 10-20x increase in FSH
  • 3x increase in LH
  • Increased androgens
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18
Q

When does the increase in LH caused by menopause peak?

A

1-3 years after menopause

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19
Q

Why is there increased androgens in the menopause

A

Because elevated gonadotrophin (LH and FSH) drive the ovarian stroma to produce androgens

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20
Q

How can the menopause be ‘induced’?

A
  • Surgical removal of ovaries

- Iatrogenic ablation of ovarian function by chemotherapy, radiotherapy, or treatment with GnRH analogues

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21
Q

How much does the experience of the menopause vary between women?

A

Widely. with some being debilitated and others unaffected by their symptoms

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22
Q

What % of women going through the menopause experience symptoms?

A

Around 80%

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23
Q

What proportion of women going through the menopause have severe symptoms?

A

1/4

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24
Q

What are the categories of symptoms of menopause?

A
  • Systemic
  • Psychological
  • Breast
  • Skin
  • Joint
  • Menstrual
  • Vaginal
  • Other
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25
Q

What are the systemic symptoms of menopause?

A
  • Weight gain

- Heavy night sweats

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26
Q

What are the psychological symptoms of menopause?

A
  • Dizziness
  • Sleep disturbance
  • Anxiety
  • Poor memory
  • Inability to concentrate
  • Depressive mood
  • Irritability
  • Mood swings
  • Less interest in sexual activity
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27
Q

What are the breast symptoms of menopause?

A
  • Enlargement

- Pain

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28
Q

What are the skin symptoms of menopause?

A
  • Hot flushes
  • Dryness
  • Itching
  • Thinning
  • Tingling
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29
Q

What are the joint symptoms of menopause?

A
  • Soreness

- Stiffness

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30
Q

What are the menstrual symptoms of menopause?

A
  • Shorter or longer between cycles

- Bleeding between periods

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31
Q

What are the urinary symptoms of menopause?

A
  • Incontinence

- Urgency

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32
Q

What are the vaginal symptoms of menopause?

A
  • Dryness

- Painful intercourse

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33
Q

What are the other symptoms of menopause?

A
  • Headache
  • Palpitations
  • Back pain
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34
Q

What % of women going through the menopause experience hot flushes?

A

75%

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35
Q

Describe a hot flush

A

They occur with a red flush starting on the face and spreading down to the neck and chest

36
Q

What are hot flushes associated with?

A

Peripheral vasodilation and a transient rise in body temperature

37
Q

What is the mechanism of hot flushes?

A

Exact mechanism is unknown, but thought to be due to pulsatile LH release influencing central temperature control

38
Q

Why are there urogenital changes in the menopause?

A

Because the uterus, vagina, bladder, and urethra are all affected by the reduction in oestrogen

39
Q

What happens to the uterus after menopause?

A

Thinning of myometrium

40
Q

What happens to vagina after menopause?

A

Marked atrophy of vagina, and thinning of vaginal walls with dryness

41
Q

What can the thinning of vaginal walls and dryness result in?

A

Dyspareunia

42
Q

What effect does the reduction in circulating oestrogen have on the bladder and urethra?

43
Q

What does atrophy of the bladder and urethra in the menopause cause?

A

Symptoms of urinary incontinence and increase in UTIs

44
Q

Why is oestrogen important for bones?

A

Protects bone mass and density

45
Q

How does oestrogen protect bone mass and density?

A

By reducing the activity of oestoclasts

46
Q

What is the effect of the drop in oestrogen in bones?

A

Tips the balance of oestoblast to osteoclast activity, and there is an increase in bone reabsorption resulting in an acceleration of age-related loss of bone density and increased frequency in fractures

47
Q

Where in particular is there an increased frequency of fractures after the menopause?

A
  • Wrist

- Hip

48
Q

What is the effect of oestrogen on heart disease?

A

Protective effect against heart disease

49
Q

How does oestrogen have a protective effect against heart disease?

A

Reduces levels of LDL cholesterol and raises HDL

50
Q

What happens to the risk of heart disease after menopause?

A

Women experience the same frequency of cardiovascular disease as men

51
Q

How is a diagnosis of menopause made?

A

Usually obvious from clinical picture

52
Q

When might it be harder to diagnose menopause?

A

In younger women in the early stages of menopause

53
Q

What needs to be considered in younger women presenting with suspected menopause?

A

Other causes of secondary amenorrhoea, e.g. pregnancy and hypogonadotrophic hypogonadism

54
Q

What other conditions can cause similar symptoms to menopause?

A
  • Diabetes

- Thyroid disease

55
Q

Are investigations recommended in the diagnosis of menopause?

A

Not usually

56
Q

What investigations may be undertaken in some women with suspected menopause?

A
  • FSH levels
  • TFT
  • Blood glucose
  • Blood cholesterol and triglycerides
57
Q

When should FSH levels be considered in suspected menopause?

A
  • To diagnose menopause in women 40-45 with menopausal symptoms
  • In women aged under 40 in whom POI is suspected
58
Q

When should blood cholesterol and triglycerides be considered to diagnose menopause?

A

If woman has cardiovascular risk factors

59
Q

What is involved in the management of menopause?

A
  • Healthy lifestyle

- Hormone replacement therapy

60
Q

What should a healthy lifestyle include in the management of menopause?

A
  • Stopping smoking
  • Losing weight
  • Limiting alcohol
  • Taking regular aerobic exercise
  • Ensure they have adequate calcium intake
61
Q

What is HRT an effective treatment for?

A

The typical menopausal symptoms

62
Q

What long-term problems associated with menopause can HRT have a positive influence on?

A
  • Risk of osteoporosis
  • Cardiovascular disease
  • Stroke
63
Q

What are the indications for the use of HRT?

A
  • Treatment of menopausal symptoms when risk:benefit ratio is favourable, in fully informed women
  • Women with early menopause, until age of natural menopause (around 51), even if asymptomatic
  • Women under 60 who are at risk of osteoporotic fractures, and in whom non-oestrogen treatments are not suitable
64
Q

What are the benefits of HRT?

A
  • Reduction in vasomotor symptoms
  • Improvement in quality of life
  • Improvement in mood changes
  • Improvement of urogenital symptoms
  • Reduction in osteoporosis risk
  • Reduction in cardiovascular disease
  • Lower risk of colorectal cancer
65
Q

What is the most effective treatment for vasomotor symptoms associated with menopause?

66
Q

How long does it take for benefit to be achieved in vasomotor symptoms using HRT?

A

Usually improved within 4 weeks of starting treatment, and maximal benefit gained by 3 months

67
Q

How can HRT improve quality of life?

A

Improve sleep, muscle aches and pains, and quality of life in symptomatic women

68
Q

What urogenital symptoms can be improved by HRT?

A
  • Vaginal dryness
  • Sexual function
  • Vaginal atrophy and related symptoms
  • Urinary frequency
69
Q

Describe the role of HRT in reducing osteoporosis risk?

A

It is the first line treatment for prevention and management of osteoporosis in women with menopausal symptoms under 50, significantly decreasing the incidence of fractures with long-term use

70
Q

What are the risks of HRT?

A
  • Thromboembolic disease (VTE and PE)
  • Stroke
  • Breast cancer
  • Endometrial cancer
71
Q

What kind of HRT increases the risk of thromboembolic disease the most?

72
Q

What else increases the risk of thromboembolic disease on HRT?

A
  • Age
  • Obesity
  • Previous thromboembolic disease
  • Smoking
73
Q

What kind of stroke is at increased risk with HRT?

74
Q

What kind of HRT increases the risk of stroke?

75
Q

What things are comparable to HRT in terms of increasing the risk of breast cancer?

A
  • Drinking 2-3 units alcohol/day

- Being overweight/obese

76
Q

What happens to the risk of breast cancer after stopping HRT?

A

It returns to that of a non-user

77
Q

Is there an increased risk of dying of breast cancer caused by HRT?

78
Q

Describe the link between HRT and endometrial cancer

A

Oestrogen-only HRT substantially increases the risk of endometrial cancer in a woman with a uterus

79
Q

How can the risk of endometrial cancer caused by HRT be reduced?

A

Use of cyclical progesterone for at least 10 days per 28 day cycle

80
Q

What are the modes of administration of HRT?

A
  • Continuous or cyclical oral therapy
  • Patches
  • Creams or gels
  • Nasal sprays
  • Local devices, e.g. progesterone releasing IUS
  • Oestrogen-releasing vaginal ring
81
Q

What side effects can oestrogen-containing HRT cause?

A
  • Breast tenderness
  • Leg cramps
  • Bloating
  • Nausea
  • Headaches
82
Q

What side effects can progesterone-containing HRT cause?

A
  • Premenstrual syndrome-like symptoms
  • Breast tenderness
  • Backache
  • Depression
  • Pelvic pain
83
Q

What side effects can oestrogen or progesterone containing HRT cause?

84
Q

How can low mood which arises as a result of the menopause be managed?

85
Q

Do antidepressants help in low mood caused by the menopause?

A

No evidence for this

A - MSRA Gynaecology [8] (52 decks)

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