HRT and the Menopause Flashcards
Why would you expect during menopause for there to be an increase in the number of UTIs?
There are two possible reasons for an increase in UTIs:
1) The vaginal tissue thins, making it more prone to infection (reduce in the natural barrier defence)
2) Women may experience difficulty emptying their bladder, which again increases risk of infection
Aside from recurrent UTIs, what are some of the other urinary symptoms associated with menopause?
Dysuria
Increase in the frequency and urgency of passing urine
Urinary incontience
What is the mean age of menopause occuring in the UK?
51
When can menopause actually be determined?
Following 12 months of spontaneous amenorrhea (absence of menstrual periods for a year) as a result of loss of follicle activity.
Describe the hormone changes that occur during the menopause.
By the age of menopause the number of eggs within the ovaries has significantly decreased meaning that the overall follicular activity begins to decline, stimulating a decrease in estrogen level. Due to the drop in estrogen there is then no negative feedback cycle acting on the pituitary to regulate FSH and LH levels and therefore they continue to rise.
The decline in which hormone is responsible for the symptoms associated with the menopause?
Decline in estrogen
How can some women still conceive during the menopause?
Despite levels of estrogen dropping during the menopause meaning that the negative feedback cycle is no longer established and FSH and LH are able to rise, often the LH level can remain relatively stabilised for some time and meaning that conception is possible.
What are the three stages of the menopause and what is the average associated with each stage?
Perimenopausal - usually lasts about 4 years starting at the age of around 47.5 years
Menopause - mean age is 51 years
Postmenopausal - 80% of women by the age of 54
What is the defining symptom that determines whether a women is in the perimenopause or menopause?
The symptoms associated with the perimenopause and menopause are generally the same (due to the drop in estrogen) however during perimenopause the women usually first has menstrual abnormalities such as periods being more irregular (longer or shorter cycles), and usually heavier cycles. Menopause is the time in which periods cease and then postmenopausal is the time period after which a women has not had a period for 12 months.
What is the percentage of women that do not undergo a perimenopausal transition?
About 10% of women their periods, instead of becoming more irregular, just stop abruptly
What age is classed as a premature menopause?
If a women’s periods stop before the age of 40
What types of risks are associated when a women undergoes a premature menopause?
Increased risk of osteoporosis
Increased risk of cardiovascular disease (heart attack, stroke etc).
What percentage of post-menopausal women seek help for their symptoms?
50%
What are some of the short term symptoms associated with the menopause, aside from changes in the menstrual cycle?
Sexual dysfunction (dyspareunia, vaginal dryness, reduced libido)
Depression
Sleep disturbances
Mood changes
Irritability
Joint and muscle pain
Vasomotor symptoms (night sweats, hot flushes, palpitations)
Recurrent UTIs
Urinary incontinence
What percentage of women during menopause experience vasomotor symptoms?
80%
What can urinary incontience during the menopause lead to?
Utheral syndrome which is defined by the symptoms:
Dysuria (pain on passing urine)
Increase in the frequency and urgency of passing urine
What are some of the positive effects of associated with estrogen?
Estrogen has positive effects on:
Increasing and protecting bone density
Positive effect on blood lipid profile
Positive effect of coagulation and fibrinolytic pathway
Briefly describe the role of estrogen in bone metabolism?
Estrogen increases bone density by promoting the activity of osteoblasts (bone forming cells) and reduces the number and activity of osteoclasts (bone degrading cells).
What age does peak bone mass occur?
Between the ages of 30 and 35
What age in women does the rapid deterioration of bone density occur?
In the five years after menopause as the protective effects of estrogen is no longer present (due to the decline in menopause) in maintaining/ increasing bone density.
What is meant by the blood lipid profile?
A blood lipid profile simple means the level of lipids in your blood. There are two types of lipids cholesterol and triglycerides.
What are some of the exerted cardio protective effects of estrogen in pre-menopausal women?
Estrogen specifically E2 mediates a range of cardioprotective effects such as reducing reactive oxygen species (ROS), oxidative stress and fibrosis whilst increasing angiogenesis and vasodilation all of which reduces the cardiovascular risk in premenopause.
What is estrogen’s role in the coagulation and fibrinolytic pathway?
Estrogen increases fibrinogen and the activity of coagulation factors whilst decreasing the concentration and activity of anti-coagulant proteins.
Which demographics often experience the complications associated with estrogen and why?
Those taking combined hormonal contraceptives.
Estrogen promotes coagulation and this can result in the clinical complication and side effect of the combined hormonal contraceptive, venous thromboembolism.