Hormone Replacement Therapy (HRT) Flashcards
What is the definition of Menopause?
Menopause is the permanent cessation (stop) of menstruation resulting from loss of activity of the ovarian follicles
When can Menopause be determined?
After 12 months of spontaneous amenorrhoea (absence of menstrual period)
What is the mean age for menopause
51
What happens during menopause?
- Number of eggs decreases until none are left
- Follicular activity fails
- Oestrogen levels fall -> leading to symptoms
- Negative feedback loop on pituitary starts to fail
- Levels of FSH and LH rise
- Low oestrogen - High FSH - High LH
What is perimenopause?
Perimenopause is when you have symptoms before your periods have stopped.
What happens during perimenopause?
Gradual onset of endocrine changes as ovaries start to fail
How long does perimenopause last?
Last approximately 4 years starting on average at 47.5 years
What percentage of women will not experience perimenopause and will cease menstruation abruptly?
10%
What is premature menopause ?
- Menopause occurs before the age of 40 years
- Lead to increased risk of developing osteoporosis and cardiovascular disease
What is postmenopause?
- The time after the menopause
- Occurs after 12 months of spontaneous amenorrhoea
- Difficulty to identify, especially in women who have started HRT
By what age are 80% of women postmenopausal?
54 years
What are the short term symptoms of menopause?
- Menstrual cycle shortens or lengthens
- Menstrual blood loss alters
- Vasomotor symptoms (Hot flushes/Night sweats/Palpitations)
- Psychological problems (Mood changes/Irritability/Sleep disturbance/ Depression/ Decreased libido)
- Musculoskeletal symptoms (Joint & muscle pain)
- Vaginal symptoms (Vaginal dryness/Dyspareunia (pain during sex))
- Urinary symptoms (UTIs/Urinary incontinence/Urethral syndrome)
What are the long term symptoms of menopause?
- Significant loss of calcium fro bones giving an increased risk of fractured due to osteoporosis
- Change in blood lipid profile giving an increased risk of cardiovascular disease
First signs of problems:
- Fractured neck of femur (broken hip)
- Myocardial infarction
- Stroke
What protective functions does oestrogen have in a pre-menopausal woman?
- Positive effect of bone mass
- Positive effect of blood lipid profile
- Positive effect on coagulation (formation of blood clots) and fibrinolytic activity (prevention of blood clots)
What is hormone replacement therapy (HRT)?
Hormone Replacement Therapy (HRT) is a treatment used to relieve symptoms of the menopause.
What kind of HRT is given to a woman with an intact uterus and why?
- Oestrogen + Progestogen
- Because to stop over-stimulation of the endometrium (layer of tissue lining the uterus) by unopposed oestrogen
What kind of HRT is given to a women without an intact uterus?
- Oestrogen alone
- Because if the uterus has been removed there is no endometrium to stimulate
What is the aim of oestrogen therapy?
- Aims to restore and maintain near normal plasma oestrogen levels
- Reinstates the negative feedback loop on LH and FSH so levels fall
What are the 3 nature;;y occurring oestrogens?
- Estradiol
- Estrone
- Conjugated oestrogens (equine)
Why are natural oestrogens used in HRT over synthetic oestrogen?
In HRT the risk of using synthetic oestrogen outweighs the benefits because of potentially serious side effects:
- Adverse lipid profile
- Raised BP
- Increased risk of abnormal blood clotting
Synthetic oestrogen used in oral contraceptives are up to 200 time more potent (powerful) than natural oestrogens. True or False
True
HRT is not as effective as contraceptive. True or False
True
- HRT is less potent therefore not as effective
For how long are women considered potentially fertile if they are under 50 years and menopause?
For 2 years after last period
For how long are women considered potentially fertile if they are over 50 years and menopause?
For 1 year after last period
