Hrt Menopause W3 Flashcards
Definition of menopause
Is the permanent sensation of menstruation resulting from loss of activity of the ovarian follicles?
It can only be determined after
12 months of spontaneous amenorrhoea
amenorrhoea
Absence of menstrual period
Mean age of menopause
51
What happens at menopause (steps)?
Number of eggs decrease until none are left
Follicular activity fails
Oestrogen levels fall – causes the symptoms
Negative feedback loop of pituitary starts to fail
Levels of FSH and LH rise
Menopausal pattern established
Phases of menopause
Perimenopause
Premature menopause
Post menopause
Perimenopause
Gradual onset of endocrine changes as ovaries start to fail
Last approximately four years
10% of women will not experience this transition
Premature menopause
Occurs before 40
Leads to increased risk of developing osteoporosis and CVD
Post menopause
Time after menopause
Because after 12 months of spontaneous amenorrhoea
Difficult to identify, especially in women who have started HRT
Estimate estimated by the age of 54, 80% of women are postmenopausal
Symptoms of menopause: short term
Menstrual cycle, shorten or lengthens
Menstrual blood loss alters
Up to 80% of women experience hot flushes, night sweats, palpitation
Physiological problems – mood changes
Musculoskeletal symptoms,
Vaginal symptoms
Urinary symptoms – recurrent UTI
Symptoms of menopause: long-term
Effect on bone mass
Affect on blood lipid profile giving increased risk of CBD
Affect on coagulation and fibrinolytic activity
Significant loss of calcium
Increased risk of fractures due to osteoporosis
HRT for a woman with an intact uterus
Oestrogen plus progesterone
To stop the overstimulation of the endometrium by unopposed hydrogen
HRT for a Woman without an intact uterus
Oestrogen alone
If the uterus has been removed, there is no endometrium to stimulate
Oestrogen therapy
Aim to restore and maintain near normal plasma oestrogen levels
Reinstate the negative feedback loop on LH and FSH levels fall
Usually naturally occurring oestrogen such as estradiol
These natural oestrogens are better than synthetic oestrogen that are used in contraceptive pills as the risk of synthetic outweighs the benefit because of serious side-effects such as:
Adverse lipid profile
Raised BP
Increased risk of abnormal blood clotting
Because of the greater risks of synthetic oestrogen is blazing to using natural oestrogen in HRT it means that:
HRT is less potent and is not as effective as contraception
A woman is considered potentially fertile:
For two years after their last period, if aged less than 50 years
For one year after their last period if aged over 50 years
A woman under the age of 50 can have a low dose of what for contraception and relief of menopausal symptoms
Low-dose COC
Women over 50 should use what for contraception and menopausal symptoms
Non-hormonal contraception and HRT
Progesterone therapy
Progesterone is added to HRT for women with an intact uterus to protect from overgrowth and potential cancer
Progesterone is needed for a minimum of 10 days per 28 day cycle to protect against overgrowth
Less androgenic progesterone
Dydrogesterone
More androgenic progesterone
Norethisterone
Levonorgestrel
What kind of HRT are there?
Combined HRT and oestrogen only HRT
Routes of HRT
Oral, transdermal, vaginal, implant
Transdermal versus oral
Transdermal gives less day-to-day variation in blood level and produces are more natural physiological estradiol to oestrone ratio
It bypasses the first pause metabolism and has less effect on the clotting factors produced by the liver
It is also a small dose
Gives a lower rate of Venus thromboembolism
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OTC vaginal oestrogen: Gina
Estradiol 10 MCG vaginal tablets
For vaginal atrophy due to hydrogen deficiency in a post menopausal woman who have not had a period for at least one year
One tablet daily for two weeks and then twice weekly
Systemic HRT
Tablets, patches, gel, spray, implants
For Veo motor symptoms and other symptoms control as well as prevention and treatment of osteoporosis
