menopause Flashcards
when is a diagnosis of menopause made?
- no periods for 12 months- usually happens at 51
- no periods for >2years if <50
what is perimenopause?
- time around menopause when the woman is experiencing vasomotor symptoms and irregular periods- happens from 45 onwards
when does premature menopause occur?
menopause occurring <40 due to ovarian failure
what are the hormone levels like in menopause?
- oestrogen and progesterone are low
- FSH and LH are high
what are perimenopausal 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 are risks of menopause?
- CVD and stroke
- osteoporosis
- pelvic organ prolapse
- urinary incontence
at that age can diagnosis of menopause/perimenopasue be made?
> 45
in those < 40 consider premature menopause
how long do women need to keep using contraception for?
- 2 years after LMP in women <50
- 1 year over LMP in women >50
what are UKMEC1 options for contraception after menopause?
Barrier methods Mirena or copper coil Progesterone only pill Progesterone implant Progesterone depot injection (under 45 years) Sterilisation
what are side effects of the progesterone depot injection?
- weight gain
- reduced bone mineral density (osteoporosis)- that’s why its not suitable for women >45
why is COCP UKMEC2?
- The advantages outweigh the risks- in over 40
- the risk is VTE
- can be used to 50 with no other contraindications
how long does it take for menopausal symptoms to subside?
2-5 years without any treatment
which medication can be given to reduce hot flushes?
- clonidine
- a non hormonal medication
- lowers blood pressure and reduced headache migraine and hot flushes
it acts as an agonist of alpha adrenergic receptors
what can be used to treat vaginal dryness and atrophy?
- vaginal oestrogen tablets or creams. can also use vaginal moisturisers like silk and repels
what can be used to treat low libido?
- testosterone gel or cream
what are the 3 methods of treating menopause?
Lifestyle modifications
Hormone replacement therapy (HRT)
Non-hormone replacement therapy
what are some lifestyle managements for menopause?
Hot flushes
regular exercise, weight loss and reduce stress
Sleep disturbance
avoiding late evening exercise and maintaining good sleep hygiene
Mood
sleep, regular exercise and relaxation
Cognitive symptoms
regular exercise and good sleep hygiene
what are contraindications to starting HRT?
- current or past breast cancer
- any oestrogen sensitive cancer
- undiagnosed vaginal bleeding
- untreated endometrial hyperplasia
what type of HRT should be given to women with a uterus?- why
- combines orally or by transdermal patch- as you should avoid unopposed oestrogen because it can increase endometrial hyperplasia
when diagnosing premature ovarian insufficiency how many times do you check the FSH?
2 blood samples are taken 4-6 weeks apart
which type of HRT should be given to women without uterus?
oestrogen only
which HRT increases the risk of VTE?
increased risk with all oral but not transdermal
Which HRT increases the risk of stroke?
Taking HRT tablets is associated with a small increase in the risk of stroke, but the risk of stroke for women under age 60 is generally very low, so the overall risk is still small.
which HRT increases the risk of coronary artery disease?
HRT does not significantly increase the risk of cardiovascular disease (including heart disease and strokes) when started before 60 years of age, and may reduce your risk.
which HRT increases the risk of breast cancer?
There is little or no change in the risk of breast cancer if you take oestrogen-only HRT.
Combined HRT can be associated with a small increase in the risk of breast cancer.
Risk is related to how long you take HRT and falls after you stop taking it
which HRT increases the risk of ovarian cancer?
all
which HRT increases the risk of endometrial cancer?
oestrogen only
can you give hot to women with undiagnosed vaginal bleeding?
no its contraindicated
can you use a continuous regimen one of HRT if you haven’t yet completed menopause?
Menopause is defined as amenorrhea for >1 year, where a continuous regime can be used (oestrogen and progesterone daily).
This patient has not yet achieved her menopause, so a cyclical regime should be used (oestrogen daily, but progesterone used for a few weeks in the cycle).
what type of HRT should someone with a Mirena coil in situ be given?
- oestrogen only- the coil will act as the protective progesterone component
which patients need to have cyclical HRT?
If they are still having periods you go bleed (cyclical) HRT ie. Last period within 1y.
For this regime if their periods are regular take continuous oestrogen and 2w of progesterone every month to induce a bleed monthly. Or with irregular periods, continuous oestrogen every day and 2w of progesterone every 3m to induce a bleed every 3m.
which patients are given continuous HRT?
If they have stopped having periods you can go non-bleed (continuous) HRT ie. Where they have not had a period for a year and are classed as menopausal
For this regime take oestrogen and progesterone every day as there is no need to allow a bleed.
what ways can progesterone be given to a patient?
Progesterone can be given orally, as a combined patch, or as part of the IUS
what does progestogens in HRT increase the risk of?
breast cancer
