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Obstetrics & Gynaecology > Climacteric and Menopause > Flashcards

Climacteric and Menopause Flashcards

1
Q

Definition of menopause

A

Absence of period for 12 months

Permanent end to menstruation

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2
Q

Define “postmenopause”

A

The period from 12 months after the final menstrual period onwards

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3
Q

Define “perimenopause”

A

The time around the menopause, where the woman may be experiencing vasomotor symptoms and irregular periods

Includes the time leading up to the last menstrual period, and the 12 months afterwards

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4
Q

Define premature menopause

A

Menopause before the age of 40

A result of premature ovarian insufficiency

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5
Q

What causes menopause?

A

Lack of ovarian follicular function, resulting in changes in the sex hormones associated with the menstrual cycle:

Oestrogen and progesterone levels are low

LH and FSH levels are high, in response to an absence of negative feedback from oestrogen

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6
Q

Menopause symptoms

due to lack of oestrogen

A

Hot flushes

Emotional lability or low mood

Premenstrual syndrome

Irregular periods

Joint pains

Heavier or lighter periods

Vaginal dryness and atrophy

Reduced libido

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7
Q

Risks in menopause

A

Cardiovascular disease and stroke

Osteoporosis

Pelvic organ prolapse

Urinary incontinence

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8
Q

How long do women need to use contraception for after menopause?

A

Two years after the last menstrual period in women under 50

One year after the last menstrual period in women over 50

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9
Q

Management of perimenopausal symptoms

A

No treatment

Hormone replacement therapy (HRT)

Tibolone, a synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea)

Clonidine, which act as agonists of alpha-adrenergic and imidazoline receptors

Cognitive behavioural therapy (CBT)

SSRI antidepressants, such as fluoxetine or citalopram

Testosterone can be used to treat reduced libido (usually as a gel or cream)

Vaginal oestrogen cream or tablets, to help with vaginal dryness and atrophy (can be used alongside systemic HRT)

Vaginal moisturisers, such as Sylk, Replens and YES

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10
Q

What is HRT?

A

Exogenous oestrogen

Used in perimenopausal and postmenopausal women wot alleviate symptoms associated with menopause

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11
Q

Why does progesterone need to be given in addition to oestrogen in women with a uterus?

A

To prevent endometrial hyperplasia and endometrial cancer secondary to unopposed oestrogen

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12
Q

Which type of HRT should be given to a woman still having periods?

A

Cyclical progesterone

Regular breakthrough bleeds

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13
Q

What type of HRT should be given to postmenopausal women with a uterus and more than 12 months without periods?

A

Continuous combined HRT

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14
Q

Outline the non-hormonal management for menopausal symptoms

A

Lifestyle changes such as improving the diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine and reducing stress

CBT

Clonidine, which is an agonist of alpha-adrenergic and imidazoline receptors

SSRI antidepressants (e.g. fluoxetine)

Venlafaxine, which is a selective serotonin-norepinephrine reuptake inhibitor (SNRI)

Gabapentin

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15
Q

What is clonidine?

How does it work?

A

Agonist of alpha-2 adrenergic receptors and imidazoline receptors in the brain

Alternative to HRT

Lowers BP and HR

Can be helpful for vasomotor symptoms and hot flushes

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16
Q

Side effects of clonidine

A

Dry mouth, headaches, dizziness and fatigue

Sudden withdrawal can result in rapid increases in BP and agitation

17
Q

Indications for HRT

A

Replacing hormones in premature ovarian insufficiency, even without symptoms

Reducing vasomotor symptoms such as hot flushes and night sweats

Improving symptoms such as low mood, decreased libido, poor sleep and joint pain

Reducing risk of osteoporosis in women under 60 years

18
Q

Benefits of HRT

A

Improved vasomotor and other symptoms of menopause (including mood, urogenital and joint symptoms)

Improved quality of life

Reduced risk of osteoporosis and fractures

19
Q

Risks of HRT

A

Generally more significant in women >60

Increased risk of breast cancer (particularly combined HRT - oestrogen-only HRT has a lower risk)

Increased risk of endometrial cancer

Increased risk of VTE (2-3 times the background risk)

Increased risk of stroke and coronary artery disease with long term use in older women

20
Q

How can we reduce the risks associated with HRT?

A

Risk of endometrial cancer greatly reduced by adding progesterone in women with a uterus

Risk of VTE reduced by using patches rather than pills

21
Q

Contraindications to HRT

A

Undiagnosed abnormal bleeding

Endometrial hyperplasia or cancer

Breast cancer

Uncontrolled hypertension

Venous thromboembolism

Liver disease

Active angina or myocardial infarction

Pregnancy

22
Q

Steps to choosing the correct HRT formula

A

Step 1: Do they have local or systemic symptoms?

Local: topical treatments such as topical oestrogen cream or tablets
Systemic: use systemic treatment - go to step 2

Step 2: Does the woman have a uterus?

No uterus: use continuous oestrogen-only HRT
Has uterus: add progesterone (combined HRT) - go to step 3

Step 3: Have they had a period in the past 12 months?

Perimenopausal: cyclical combined HRT
Postmenopausal (more than 12 months since last period): continuous combined HRT

23
Q

What are the options for delivering oestrogen?

A

Oral (tablets)

Transdermal (patches or gels)

24
Q

Which is the preferred method for delivering oestrogen?

A

Patches due to reduced risk of VTE, cardiovascular disease and headaches

25
Q

What are the options for delivering progesterone?

A

Oral (tablets)

Transdermal (patches)

Intrauterine system (e.g. Mirena coil)

26
Q

What are the regimes for delivering progesterone?

A

Cyclical (10-14 days per month) - women that have had a period within the past 12 months, allows for monthly breakthrough bleed

Continuous - woman has not had a period in the past 24 months if under 50 or 12 months if over 50

27
Q

What are the different types of progesterone?

A

Progestogens - any chemicals that target and stimulate progesterone receptors

Progesterone - hormone produced naturally in the body

Progestins - synthetic progestogens

28
Q

What is the preferred method for delivering progesterone?

A

IUS

Added benefit of contraception and treating menorrhagia

No progestognenic side effects

29
Q

Oestrogen side effects

A

Nausea and bloating

Breast swelling

Breast tenderness

Headaches

Leg cramps

30
Q

Progestogenic side effects

A

Mood swings

Bloating

Fluid retention

Weight gain

Acne and greasy skin

31
Q

Stopping HRT

A

No specific regime

Can be stopped gradually or abruptly

Gradually may be preferable to reduce risk of symptoms recurring suddenly

Obstetrics & Gynaecology (13 decks)

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