E5 Menopause Flashcards
what does menopause cause and who does it affect?
- amenorrhea (no menstruation for continuous 12 months)
- natural process of ageing (ovaries stop ovulating, significant loss of oestrogen)
- irreversible loss of fertility
- affects women from 45-50 (perimenopause, early stage of menopause before oestrogen levels are significantly low)
signs and symptoms of menopause
- irregular periods that eventually stop
- hot flushes / night sweats
- mood swings
- vaginal dryness
- brain fog
- weight gain
- osteoporosis
- chills
- night sweats
- loss of hair / thinning
- stress
- insomnia / loss of sleep
- depression
- anxiety
- midlife crisis
- reduced sense of wellbeing
- sexual dysfunction
what can vaginal dryness cause?
increased risk of infections
how long can menopause last? what is the average?
can last 1-10 years
average is 4 years
what are some other types of menopause?
- induced menopause
- premature menopause
- post menopause
what is induced menopause caused by?
- surgical removal of ovaries
- chemotherapy
what is premature menopause classified as?
women who enter menopause before turning 40
what is post menopause?
when the process is complete and symptoms decline
how is oestrogen kept at the correct level in the body? how does this change in the menopause and what does this mean?
- when oestrogen is released from the ovaries, there is a feedback loop to switch this off
- this keeps oestrogen at the correct level
- no more ovulation in menopause so oestrogen or progesterone being produced (negative feedback loop has been switched off)
- there is no signal for LH and FSH to be produced and released
in women from the age of 35-75, why do FSH and LH have peaks in their level?
- they have a lack of negative feedback
- they haven’t been switched off so they are responding to less oestrogen by increasing their own concentrations
describe hormone changes in premenopause
- has cyclic release and decrease of hormones during continuous menstrual cycles
- this includes LH surges and oestrogen with peaks and troughs to initiate ovulation and menstruation
describe hormone changes in perimenopause
progesterone levels are irregular and random which causes random periods
when is someone considered to be in the menopause stage?
after 12 months of no periods
when is someone considered to be postmenopause?
when the hormone levels are consistently low and all symptoms of menopause are gone
what complications are linked with menopause if it is left untreated?
- heart problems
- osteoporosis
- muscle weakness
- weight gain
- urinary problems
non-clinical management methods of menopause
- do nothing (allow nature to take its course)
- diet
- strength building exercises
- herbal treatments
- behavioural therapy
explain how diet can be a non-clinical management method of the menopause
if rich in vitamin C and D it can reduce risk of fractures
explain how strength building exercises can be a non-clinical management method of the menopause
- recovers loss of muscle function
- improves mood swings
explain how behavioural therapy can be a non-clinical management method of the menopause
coaching women in how to manage their symptoms and what to do if they are found to experience certain emotions
what SSPs were applied by the NHS due to the global shortage of HRT medication for menopause?
SSP = Serious Shortage Protocols
limit dispensation to 3 months
- after 3 months the patient would have to go back to refill their prescription
describe the shortages of specific menopause medications
- oestrogel has improved but other HRT products are still in short supply
describe the actions and effects of hormone-based therapy
- replaces oestrogen and progesterone (return to normal physiological levels of premenopausal level)
- improves loss of bone density and beneficial effects on urogenital tract (reduced risk of fractures and infections)
what are the 2 main types of HRT?
- combined HRT (oestrogen and progestogen)
- oestrogen-only HRT
what kinds of women get the 2 different types of HRT?
- combined is for women who still have their womb intact
- oestrogen-only is for women who have had their womb removed in a hysterectomy
what are the different ways that oestrogen can be taken?
- tablets
- patch (convenient, don’t need to remember to take it)
- implant
- oestrogen gel
- oestrogen spray (applied to forearm)
3 common hormones for replacement therapy
- oestrogen
- preogesterone
- testosterone
describe oestrogen used in HRT
- most commonly prescribed hormone
- normally compounded with progesterone
describe progesterone used in HRT
- commonly prescribed hormone
- often prescribed alongside oestrogen
describe testosterone used in HRT
- rarely advised for women
- recommended to combine with oestrogen and / or progesterone
what types of women would HRT be recommended for?
- under 60
- menopause onset within 10 years
- low risk of breast cancer and cardiovascular disease
what types of women would HRT be considered with caution for?
- 60 or over
or
- menopause onset more than 10 years prior
or
- moderate risk of breast cancer or cardiovascular disease
what types of women would HRT be avoided for?
- high risk of breast cancer or cardiovascular disease
or
- over 60 or menopause onset more than 10 years prior AND moderate risk of breast cancer or cardiovascular disease
what dose do patients start on with HRT?
- when patients are started on HRT they are normally started on the lower doses
- this is to see if this relieves the symptoms and if this doesn’t work this can be increased
vasomotor symptoms of menopause
- menopausal symptoms such as hot flushes and night sweats caused by constriction and dilation of blood vessels in the skin that can lead to a sudden increase in blood flow to allow heat loss
- these symptoms can have a major impact on activities of daily life
urogenital atrophy in menopause
- caused by oestrogen deficiency
- this results in multiple symptoms such as vaginal dryness, vaginal irritation, a frequent need to urinate and urinary tract infections
low mood in menopause
- mild depressive symptoms that impair quality of life
- are usually intermittent and often associated with hormonal fluctuations in perimenopause
osteoporosis in menopause
- fractures that result from mechanical forces that would not ordinarily result in fracture (eg. a fall from standing height or less)
- reduced bone density is a major risk factor for fragility fractures which occur most commonly in the spine, hip and wrist
when are side effects most common with HRT?
- for women who have just started HRT
- they will often ease over time
common side effects of HRT
tender breasts
hair loss
weight gain
headaches
uncommon side effects of HRT
double vision
chest pains
jaundice
depression
if any of these occur, HRT is recommended to stop
in a 2002 study, what was proven to have an increased risk with HRT?
breast cancer
blood clots
endometrial cancer
hyperplasia
stroke
liver disease
vaginal bleeding
in a 18 year follow up to the 2002 study on HRT risks, what was found?
- main risk is with oral oestrogen in women at higher risk of breast cancer
- study included women over 60 when most menopausal women are lots younger
- little evidence when HRT is used for limited times
describe the risk of heart disease and stroke with HRT
- age dependent
- if you start HRT before 60, it does not increase your risk of cardiovascular disease
- HRT tablets (but not patches or gels) slightly raise the risk of stroke
describe the risk of breast cancer with HRT
combined HRT may increase breast cancer risk
describe the risk of blood clots (VTE) with HRT
- only HRT tablets increase the risk
- other products don’t carry this risk
describe the risk of dementia with HRT
- it is currently unknown whether HRT affects the risk of developing dementia
- NICE has recommended more research about this topic
