MENOPAUSE Flashcards
What is the strict diagnostic definition of the menopause?
Retrospective diagnosis after 1 year of absent cycles.
What age do women tend to go through the menopause?
45-55 years old
Average is 51
What do we call a premature menopause?
Less than 40 years old
Why can women experience symptoms of heavy bleeding and irregular periods in the perimenopausal phase?
Anovulatory (where no ovulation occurs) cycles become more common and oestrogen secretion can continue without progesterone opposition required to protect the endometrium. These patients are at risk of endometrial hyperplasia and rarely endometrial cancer.
What are the hormonal changes in the menopause?
FSH increases
LH increases
Oestrogen decreases
Progesterone decreases
What are the more immediate clinical features of the menopause?
Hot flushes and night sweats
Mood disturbances - mood swings, insomnia, anxiety, fatigue, loss of libido, loss of concentration
What are the intermediate and long term features and complications associated with the menopause?
Atrophy of vaginal tissue - dryness, dyspareunia and vaginal bleeding
Atrophy of urethra - dysuria, frequency and urge incontinence
Osteoporosis
Cardiovascular disease - gender equal likelihood by 70
It is still possible to get pregnant in the climacteric or perimenopausal phase?
Yes, therefore patients should continue to be offered contraception.
What blood test might you do to confirm the menopause?
Serum FSH levels will show markedly raised concentrations.
What are the conservative and medical options to help someone who has been through the menopause?
Regular aerobic exercise will help bone loss and improve muscle tone
Cessation of smoking and alcohol
Hormone replacement therapy
Non-hormonal pharmacological agents such as clonidine and SSRIs
What is the hormone given to postmenopausal women as part of HRT?
Oestrogen and progesterone
Oestrogen alone is given to patients who have had a hysterectomy, as progesterone is no longer required tpo protect the endometrium
Prior to the menopause, what is the main type of oestrogen circulating the body?
Oestradiol
Where is oestradiol produced?
In the granulosa cells of the developing follicle
Following the menopause, what is the main type of oestrogen circulating the body and where is it produced?
Oestrone produced in the peripheral tissues
What form of oestrogen is given as part of HRT?
Oestradiol
What are the different routes for administering HRT?
Oral
Transdermal (patch/gel)
Vaginal
Mirena IUS
Over what maximum period of time should cyclical preparations of HRT, which are therefore accompanied by monthly bleeding, be administered to a post-menopausal woman?
5 years
What are the advantages and disadvantages of oral HRT?
Advantages:
Cheap
Effective
Disadvantages:
First pass metabolism
Variable plasma levels
Higher doses required
What are the advantages and disadvantages of transdermal HRT?
Advantages:
Avoids first pass metabolism
Reduced risk of VTE
Continuous administration
Disadvantages:
Cost
Skin reactions
What are the advantages and disadvantages of vaginally administered HRT?
Advantages:
Good for urogenital symptoms
Minimal systemic absorption
Licensed for 3 months use without progesterone opposition
Disadvantages:
Unlikely to treat other symptoms
What are the advantages and disadvantages of Mirena coil HRT?
Advantages:
Licensed for 4 years to provide the progesterone arm of HRT
Contraceptive in perimenopausal phase
Disadvantages:
Only provides progesterones
What are the side effects of HRT?
Nausea Fluid retention Hirsutism Leg cramps Breast discomfort
What are the risks of taking HRT?
Cardiovascular disease
Breast cancer
Stroke
What are the contraindications to the use of HRT in the menopause?
Endometrial carcinoma Breast carcinoma Undiagnosed vaginal bleeding Undiagnosed breast lumps Severe active liver disease Pregnancy Personal history of VTE - transdermal may be used
If hormonal agents are not tolerated or contraindicated in someone needing medical management to control the symptoms of menopause, what medications can be given?
Clonidine - centrally active alpha-2 agonist
SSRIs
SNRIs
Who should be considered for HRT in the menopause?
HRT should only be considered for those with severe symptoms.
It is also recommended for those under the age of 50 undergoing menopause for bone protection. This should be reviewed at 51.
As well as HRT, what can be given for osteoporosis prevention?
Bisphosphonates
Selective oEstrogen Receptor Modulators (SERMs)
Calcium and vitamin D supplements
