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endo y3s1 > IC18 Menopause > Flashcards

IC18 Menopause Flashcards

1
Q

definition

A

permanent cessation of menses, following loss of ovarian follicular activity

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2
Q

natural etiology

stages & their production of hormones

A

perimenopause
Will have reduced production of progesterone & oestrogen; have suppression of FSH production (can be tested)
Difficult to predict menses

menopause, postmenopause
No longer produces progesterone & oestrogen

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3
Q

clinical presentation

A
  1. vasomotor symptoms
  2. genitourinary syndrome
  3. psychological
  4. bone fragility
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4
Q

clinical presentation: vasomotor symptoms

A

Hot flushes → intense feeling of heat on face + reddened face
* Possibly due to thermoregulatory dysfunction initiated at hypothalamus by oestrogen withdrawal

Perspiration → cold sweats, night sweats

Rapid/irregular HR
Sleep disturbances
Feeling of anxiety

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5
Q

clinical presentation: genitourinary syndrome
changes in structures

A

Changes to labia, clitoris, vestibule, vagina, urethra & bladder
Due to decreased oestrogen

Vulva & endometrium undergo atrophy → thinner layers will be easily irritated

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6
Q

clinical presentation: genitourinary syndrome
symptoms

A
  • Genital dryness, burning/ irritation/ pain
  • Sexual symptoms of lubrication difficulty, Impaired sexual function/ libido/ painful intercourse
  • Urinary urgency, Dysuria, Recurrent UTI
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7
Q

clinical presentation: psychological symptoms

A
  • Multifactorial
  • Depression, anxiety (may be new onset/ relapse if previously diagnosed)
  • Poor concentration/ memory
  • Mood swings
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8
Q

clinical presentation: bone fragility

purpose of estrogen + problems in menopause

A

Oestrogen receptors present on bone → stimulates bone growth

Decreased oestrogen ⇒ no stimulation; more bone loss

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9
Q

clinical presentation: bone fragility
symptoms

A
  • Risks of osteoporosis & fractures (esp early onset menopause)
  • Joint pain
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10
Q

non-pharmacological indications

A

mild symptoms ONLY ⇒ first line before pharmacological therapy

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11
Q

non-pharmacological managements

A
  1. vasomotor symptoms
  2. genitourinary syndrome
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12
Q

non-pharmacological: vasomotor symptoms

A
  • Layered clothing that can be removed/ added as necessary
  • Lower room temperature
  • Less spicy food/ caffeine/ hot drinks
  • More exercise
  • Dietary supplements
    Isoflavones: soy beans, legumes (lentils, chickpea)
    Black Cohosh: possible serotonergic activity at hypothalamus
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13
Q

non-pharmacological: genitourinary syndrome

A

Non Hormonal vaginal lubricants/ moisturisers
If have issues with intercours

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14
Q

pharmacological managements

A
  1. menopausal hormone therapy (MHT) -> first line, gold standard
  2. antidepressants
  3. gabapentin
  4. tibolone
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15
Q

pharmacological indication

A

moderate/ severe symptoms OR insufficient response to non-pharmacological

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16
Q

pharmacological: MHT types

A
  1. estrogen-only
  2. estrogen + progesterone
17
Q

pharmacological: MHT
oestrogen-only

indication

A

NO intact uterus OR if patient is on levonorgestrel IUD

18
Q

pharmacological: MHT
oestrogen-only

types

A
  1. systemic oral contraceptives
  2. systemic topical (gels & patch)
  3. local vaginal (cream & pessary)
19
Q

pharmacological: MHT
oestrogen-only

administration

A

Systemic oral tablets
Take same time everyday
(once finish pack, start new one immediately)
Gel
Use the ruler provided to measure the dose.
Apply over arms/ thighs daily & let dry.
Rotate sites
Patch
Replaced twice a week on lower back, abdomen, thighs or butt → rotate sites
Cream
Squeeze cream from tube into applicator.
Lie down with knees drawn towards you.
Insert applicator into vagina & press applicator downward.
Wash the applicator with mild soap & warm water.
Pessary
Inserted 2x a week before bedtime (minimise movement)

20
Q

pharmacological: MHT
oestrogen-only

advantages

A

Systemic oral tablets
Inexpensive
systemic topical
Lower systemic dose than oral
Convenient (external application)
Continuous oestrogen release
local vaginal
Lowest oestrogen dose → no need for concomitant progestin
Continuous oestrogen release

21
Q

pharmacological: MHT
oestrogen-only

disadvantages

A

systemic oral tablets
Highest dose required → higher risks of SE
Potential for missed dose → irregular bleeding
systemic topical
Expensive
Skin irritation; Good to rotate sites
Gel → more variability in absorption
local vaginal
inconvenient/ uncomfortable
Vaginal discharge
Only for localised urogenital atrophy

22
Q

pharmacological: MHT
combined

indication

A

INTACT uterus OR if patient does not have levonorgestrel IUD

23
Q

pharmacological: MHT
combined

role of estrogen & progesterone

A

Oestrogen → causes growth in lining of endometrium

Progestin → To protect endometrium from overgrowth (increased risk of endometrial cancer associated with unopposed oestrogen
* If oestrogen not kept in check, endometrium will keep growing

24
Q

pharmacological: MHT
combined

types

A
  1. combined cyclic
  2. combined continuous
25
Q

pharmacological: MHT
combined (cyclic)

A
  • Progestin added on either 1st or 15th of month, for 10-14 days
  • Withdrawal bleeding when progestin stopped → menses occurs
  • Regulate menses → predictable bleeding
26
Q

pharmacological: MHT
combined (continouous)

A
  • Oestrogen & Progestin daily
  • No withdrawal bleeding although chance of breakthrough bleeding initially
    spotting might occur until body is adjusted
  • After several months, amenorrhea likely to occur
27
Q

pharmacological: MHT
combined

when will improve, tests upon initiation, problem of discontinuation

A
  • Might require 2-3 months of use before improvements of menopausal symptoms
    Should continue MHT if there is need

Tests Upon initiation
* Annual mammography
* Endometrial surveillance
Unopposed oestrogen: any vaginal bleeding
Continuous-cyclic: if bleeding occurs when progestin is still on
Continuous-combined: if bleeding is prolonged, heavier than normal, frequent, persists after >10 months after treatment started

Discontinuation of treatment ⇒ ~50% chance of symptoms returning

28
Q

pharmacological: antidepressants

drugs & importance of evaluation

A
  • Serotonin & norepinephrine reuptake inhibitors (SNRIs) → venlafaxine
  • Selective serotonin reuptake inhibitors (SSRIs) → paroxetine
  • Important to evaluate & differentiate mood changes from menopause & depression
29
Q

pharmacological: gabapentin
purpose

A

Night sweating, sleep disturbances

30
Q

pharmacological: tibolone

drug composition

A

Synthetic steroid with estrogenic, progestogenic & androgenic effects
* May have hirsutism & acne

31
Q

pharmacological: tibolone

indication

A

postmenopausal women ≥ 12 months since last natural period
* Cannot be <12 months → will cause bleeding

32
Q

pharmacological: tibolone

advantage

A
  • Improves mood, libido, menopause symptoms, vaginal atrophy (less than oestrogen)
    Affects ALL symptoms of menopause
  • Protects against bone loss
33
Q

pharmacological: tibolone

disadvantage

A

Risk of stroke, breast CA recurrence, endometrial cancer
* Due to estrogenic component

endo y3s1 (16 decks)

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