Menopause Flashcards
What is menopause?
It is defined as a permanent end to menstruation
What is the clinical definition of menopause?
It can be diagnosed once a woman has had no periods for 12 months
On average, when does menopause tend to occur?
51 years old
What is perimenopause?
It is defined as the time around menopause, where the woman may be experiencing menopausal symptoms and irregular periods
This includes the time leading up to the last menstrual period, and the 12 months afterwards
What is premature menopause?
Menopause < 40 Years Old
What is the cause of premature menopause?
Premature ovarian insufficiency
Describe the physiology of menopause
Menopause begins with a decline in the development of the ovarian follicles, which thus reduces the production of oestrogen
Oestrogen has a negative feedback effect on the pituitary gland, suppressing the quantity of LH and FSH produced
Due to reduced oestrogen levels in the perimenopausal period, there is an absence of negative feedback on the pituitary gland and increasing levels of FSH and LH
The failing follicular development means ovulation doesn’t occur, resulting in irregular menstrual cycles
In addition to this, the endometrium does not develop, leading to a lack of menstruation
What are the seven clinical features of perimenopause?
Irregular Periods
Hot Flushes
Night Sweats
Vaginal Dryness
Low Libido
Joint Pains
Mood Changes
What is the physiological cause of perimenopausal clinical features?
Decreased oestrogen levels
In most cases, how is menopause diagnosed?
Clinical history
What clinical history is sufficient for a diagnosis of menopause to be obtained?
It can be diagnosed in women over the age of 45 presenting with perimenopause symptoms and absence of a menstrual period for more than 12 months
What investigation can be used to diagnose menopause?
Blood Tests
When are blood tests used to diagnose menopause?
In women under the age of 45 with suspected menopause
What two blood test results indicate menopause?
Increased FSH & LH Levels
Decreased Oestrogen Levels
What are the four pharmacological management options of perimenopausal?
Hormone Repalcement Therapy (HRT)
Antidepressants
Vaginal Lubricants
Vaginal Oestrogen Cream
What is hormone replacement therapy (HRT)?
It is defined as medication which replaces female hormones, specifically oestrogen and progesterone
What are the five administration forms of hormone replacement therapy?
Vaginal Pessary
Vaginal Ring
Vaginal Cream
Oral
Transdermal Patch
Why is it recommended that individuals recieve combined hormone replacement therapy?
This is due to the fact that oestrogen alone increases the risk of endometrial hyperplasia and endometrial cancer
In which circumstance can oestrogen only hormone repalcement therapy be used to treat menopause? Explain
When individuals have undergone a hysterectomy
This is due to the fact that there is no endometrium present
What are the two hormone replacement therapy regimes?
Cyclical
Continous
When is the cyclical hormone replacement therapy regime used to manage menopause?
When individuals are premenopausal and have not yet reached menopause
What is the cyclical hormone replacement therapy reigme?
It involves administration of daily oestrogen, alongside progesterone
However, there is progesterone break - enabling a withdrawal bleed
When is the continous hormone replacement therapy regime used to manage menopause?
When individuals have reached menopause
What is the continous hormone replacement therapy reigme?
It invovles daily administration of oestrogen and progesterone
What are the five risks associated with systemic hormone replacement therapy?
Cardiovascular Disease
Stroke
Venous Thromboembolism
Breast Cancer
Ovarian Cancer
What are the four contraindications of systemic hormone replacement therapy?
Active/Previous Breast Cancer
Oestrogen Sensitive Cancer
Undiagnosed Vaginal Bleeding
Untreated Endometrial Hyperplasia
What should be administered when systemic hormone replacement therapy is contraindicated due to the risk of venous thromboembolism?
Transdermal hormone repalcement therapy
In women who take hormone repalcement therapy for premature menopause, how long should it be adminsitered for? Explain
Until > 50
This is due to the fact that it prevents osteoporosis development
When are antidepressants used to manage menopause?
When individuals experience vasomotor clincial features of perimenopause
Name three antidepressants used to manage menopause
Fluoxetine
Citalopram
Venlafaxine
When are vaginal lubricants used to manage menopause?
When individuals experience vaginal dryness clinical features of perimenopause
When is vaginal oestrogen cream used to manage menopause?
When individuals experience urogenital atrophy clinical features of perimenopause
How long should women > 50 years old use contraception after their last period?
12 months
How long should women < 50 years old use contraception after their last period?
24 months
Which contraception method is recommended in perimenopausal women?
Intrauterine System
In women who have the intrauterine system in situ, which is the msot appropriate additional treatment used to manage menopause?
Estradiol
What are the four complications of menopause?
Osteoporosis
Pelvic Organ Prolapse
Urinary Incontinence
Cardiovascular Disease
