Intro to menopause Flashcards
Average age of menopause in UK?
Around 51 years old
Menopause in ages 40-44 year old is regarded as what?
Early menopause (around 5% of female population)
What is premature ovarian insufficiency?
Experiencing menopause in younger than 40 years old. Occurs in around 1% of female population.
What is perimenopause?
Means “around menopause” and refers to the time during which your body makes the natural transition to menopause, marking the end of the reproductive years.
perimenopause is usually associated with regular periods. true/false?
False
Premenopause usually associated with regular periods.
Perimenopause usually associated with less or more frequent (overall irregular) periods.
How long do menopause symptoms usually last?
Around 7 years
3 most common symptoms of menopause?
Mood swings
Hot flushes
Night sweats
Other associated symptoms of menopause?
Memory loss
Anxiety
Brain fog
Dizziness
Dry skin + hair
Painful sex
Weight gain
Diagnosis of peri-menopause?
Many women develop menopausal symptoms years before their last period = perimenopause
Menopause symptoms charts can help to diagnose (peri-)menopause and to help monitor treatment.
For peri-menopause diagnosis in what cases and how often are FSH levels taken?
x2 (6 weeks apart)
In women > 45 with atypical symptoms (suspected premature menopause).
In women 40-45 with menopausal symptoms and/or iatrogenic amenorrhoea caused by factors such as hysterectomy, endometrial ablation etc.
What is menopause caused by?
Lack of ovarian follicular function
Sex hormone levels in menopause?
Oestrogen and progesterone levels are low
LH and FSH levels are high, in response to an absence of negative feedback from oestrogen
Process of oestrogen secretion during menstrual cycle?
Inside the ovaries, the process of primordial follicles maturing into primary and secondary follicles is always occurring, independent of the menstrual cycle.
At the start of the menstrual cycle, FSH stimulates further development of the secondary follicles.
As the follicles grow, the granulosa cells that surround them secrete increasing amounts of oestrogen.
How oestrogen affected during menopause?
process of the menopause begins with a decline in the development of the ovarian follicles.
Without the growth of follicles, there is reduced production of oestrogen.
As a result of low oestrogen secretion during menopause, FSH and LH levels are higher due to lack of negative feedback from oestrogen. true/false?
True
Oestrogen has a negative feedback effect on the pituitary gland, suppressing the quantity of LH and FSH produced.
Lack of oestrogen = more LH and FSH produced
How does lack of follicular development cause lack of menstruation?
The failing follicular development means ovulation does not occur (anovulation), resulting in irregular menstrual cycles.
Without oestrogen, the endometrium does not develop, leading to a lack of menstruation (amenorrhoea).
Lower levels of oestrogen also cause the perimenopausal symptoms. true/false?
True
Lack of oestrogen in perimenopausal period leads to what symptoms?
Hot flushes
Emotional lability or low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and atrophy
Reduced libido
What conditions can lack of oestrogen lead to?
Cardiovascular disease and stroke
Osteoporosis
Pelvic organ prolapse
Urinary incontinence
Pregnancy after 40 years of age comes with risks and complications. true/false?
True
UKMEC 1 (no restriction) contraception for women approaching menopause?
Barrier methods
Mirena or copper coil
Progesterone only pill
Progesterone implant
Progesterone depot injection (under 45 years)
Sterilisation
Why is progesterone depot injection not used over aged 45?
weight gain and reduced bone mineral density (osteoporosis). These side effects are unique to the depot and do not occur with other forms of contraception.
Reduced bone mineral density makes the depot unsuitable for women over 45 years.
Difference between menopause and perimenopause?
Perimenopause is when patient starts experiencing symptoms of menopause however periods have not stopped.
Menopause is classed when there is cessation of menstruation for >2 years. True/false?
False
Menopause = cessation of menstruation > 12 months (1 year)
Management of perimenopausal symptoms?
No treatment
Hormone replacement therapy (HRT)
Tibolone, a synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea)
Clonidine, which act as agonists of alpha-adrenergic and imidazoline receptors
Cognitive behavioural therapy (CBT)
SSRI antidepressants, such as fluoxetine or citalopram
Testosterone can be used to treat reduced libido (usually as a gel or cream)
Vaginal oestrogen cream or tablets, to help with vaginal dryness and atrophy (can be used alongside systemic HRT)
Vaginal moisturisers, such as Sylk, Replens and YES
