lecture 24 - women's health Flashcards
what is premature menopause POI?
menopause occurring before the age of 40
why is early menopause?
menopause occurring before the age of 45
what is natural menopause?
menopause occurring around the age of 51
how is menopause diagnosed in people aged 45 or over?
diagnosis is based on symptoms without the need for lab tests
name 3 common vasomotor symptoms of menopause
hot flushes, night sweats and temperature fluctuations
what are common genitourinary symptoms of menopause?
vaginal dryness ((Sylk, YES, Replens, Hyalofemme), urinary urgency, frequency and incontinence
how can menopause affect mental health ?
it causes mood changes, depression and anxiety
what are mucoskeletal symptoms of menopause
joint and muscle pain
what is the first-lime treatment for moderate-to-sever menopause symptoms?
HRT
what is the difference between sequential and continuous combined HRT?
the choice between sequential and continuous combined HRT depends whether the patient is still having their periods and time since menopause
sequential HRT is used for perimenopausal women <12m of last period
with oestrogen then daily and progesterone added in cycles. Progestogen for 12–14 days each month (for those with regular periods).
Progestogen for 12–14 days every 3 months (for those with infrequent periods).
continuous combined HRT is used for postmenopausal women ager over 54 with oestrogen and progesterone taken daily. it prevents unpredictable bleeding and is preferred or long term use
why is transdermal HRT preferred over oral HRT in some cases?
it bypasses liver metabolism, reducing the risk of VTE
what is the best HRT option for patients with a high risk of VTE?
transdermal oestrogen (patch or gel) and separate progestogen (if uterus intact)
give examples of transdermal oestrogen and separate progesterone
oestrogen (transdermal patch) options are
- EVOREL 50/75/100 PATCH
- sandrena (gel, 0.5 = 1mg daily)
- Estrogel (1-4 pumps daily, flexible dosing)
progesterone (if uterus is intact)
- mirena (levonorgesterol IUS) - best option for endometrial protection
- utrogestan
Micronised progesterone (Utrogestan) has lower VTE risk than synthetic progestogens
Mirena coil provides local endometrial protection without systemic progestogen effects
what are preferred menopause treatments for women with a history of breast cancer?
non-hormonal treatments such as SSRIs, SNRIs, gabapentin (for night sweats), clonidine or vaginal moisturisers
why should oral HRT be avoided in women with migraines with aura ?
oral HRT increases the risk of stroke in these patients - prefer tx with transdermal oestrogen and separate progesterone
HRT and Interactions
Drugs that induce CYP3A4 increase oestrogen and progestogen metabolism, reducing HRT effectiveness
Carbamazepine, Phenytoin, Phenobarbital, Primidone, Topiramate
Rifampicin, Rifabutin
Efavirenz, Nevirapine
St John’s Wort
Use transdermal HRT instead of oral(patches, gels are not affected by enzyme induction).
Consider higher doses of HRT if needed, but monitor symptoms.
how does menopause impact cardiovascular risk ?
oestrogen deficiency increases the risk of CVD in postmenopausal women
why are post menopausal women at a higher risk of osteoporosis
oestrogen deficiency leads o decreased bone density
name three non-hormonal treatments for menopause symptoms
SSRIs/SNRIs, cognitive behavioral therapy (CBT), and lifestyle modifications.
What are some herbal alternatives to HRT?
Black cohosh, red clover, soy, and St John’s Wort (not endorsed by BMS/IMS).
how do we diagnose menopause?
Diagnosis based on symptoms in peopleaged 45 or overwithout lab tests
Menopause is confirmed if periods have been absent for12+ months(if not on hormonal contraception).
Laboratory tests (e.g., FSH) arenot recommendedfor diagnosis in those over 45.
Consider serum FSH tests for thoseaged 40-45with symptoms and menstrual changes
