Menopause Flashcards
What is menopause and when does it happen?
- Permanent cessation of menstruation resulting from loss of ovarian follicular activity. Ends after 12 consecutive months of amenorrhoea.
- Median age of 51 in the UK.
What is perimenopause?
From the first features of menopause (vasomotor symptoms and menstrual irregularity), to 12 months after last menstrual period.
What is premature menopause?
Menopause occurring before the age of 40 (usually idiopathic)
What are the vasomotor symptoms of menopause and when do they occur?
- Hot flushes, night sweat
- Tiredness, irritability (due to sleep disturbance)
- Begin before periods stop and present for about 5 years
What are the urogenital symptoms of menopause?
- Vaginal atrophy - dyspareunia, itching, burning, dryness leading to cessation of sex
- Frequency, urgency, nocturia, incontinence
- Recurrent infection
What are the sexual symptoms of menopuse?
- Loss of sexual desire and arousal
2. Problems with orgasm and dyspareunia
What condition can develop in the bones during menopause?
Osteoporosis (fractures very common)
What are the cardiovascular symptoms of menopause?
- Increase in CAD and stroke occurrence
2. Leg cramps
What investigations are performed in suspected menopause and what do they show?
- FSH - increased levels suggest fewer oocytes
- AMH - low levels suggest ovarian insufficiency
- TFTs, PRL, 5-HIAA, urinary metanephrins
- Oestrogen (low)
- Mid-luteal progesterone for anovulation
- DEXA for those at risk of OP
How is HRT administered?
- Oral, transdermal, or vaginal
2. Lowest effective dose, encourage breast awareness and self-examination monthly
What is the difference between HRT with and without a uterus present?
- With - oestrogen and progesterone
2. Without - oestrogen only
What is the different between HRT in women with periods and post-menopausal women?
- Periods - oestrogen and cyclical progesterone (normal periods)
- Post-menopause - continuous combined HRT (amenorrhoea)
What does HRT importantly not provide?
Contraception
What contraception is provided for those on HRT?
- Full dose COCP for 1 or 2 years depending on LMP then wean to low doses in HRT
- HRT plus non-hormonal contraception (condoms)
- Mirena IUS and HRT dosing of oestrogen (most popular)
What can be given in high osteoporosis risk after HRT?
Bisphosphonates when HRT stopped.
What are the contraindications to HRT?
- Oestrogen dependent cancer
- History of VTE
- Undiagnosed vaginal bleeding
- Raised LFTs
- Pregnancy, breastfeeding
- Caution in those with family history of breast cancer
What are the side effects of HRT?
- Oestrogenic - nausea, vomiting, bloating, breast tenderness, headache, fluid retention
- Progestogenic - acne, hirsutism
What are the benefits of HRT?
- Reduction in vasomotor symptoms
- Improvement in urogenital symptoms
- OP fractures reduced whilst on treatment
- Reduced risk of colorectal cancer
What are the risks involved in HRT?
- Breast cancer in combined, falls on stopping therapy for 5 years.
- Endometrial cancer in unopposed oestrogen therapy
- VTE - highest risk in first year of use
- Increased risk of gallbladder disease
What is the purpose of androgen HRT?
Testosterone for low libido, especially in younger women.
What is tibolone and when is it used?
- Synthetic steroid converted in vivo to metabolites with oestrogenic, progestogenic, and androgenic actions.
- Used in post-menopausal state as HRT
What are the options for non-hormonal menopausal therapy?
- SSRI/SNRI - for hot flushes
- Alpha 2 antagonist - clonidine for vasomotor symptoms
- Herbal
- Adjuncts - vaginal lubricants
