Menopause Flashcards
Average age of menopause in the UK?
51
clinial diagnosis of menopause?
Retrospective; can be made after 12 months amenorrhoea (or based on symptoms in women without a uterus)
At what age should menopause be investigated biochemically and how is this done?
<45
FSH greater than 30 on two separate occasions at least one month apart
If menstruating, when should FSH levels be checked?
Day 2-5 of cycle
1st line for vasomotor symptoms?
HRT- effective for 80-90%
Non-licensed treatments for vasomotor symptoms? (3)
SSRIs, gabapentin, clonidine
Options for urogenital symptoms? (2)
Vaginal moisturisers Topical oestrogen (can be used in addition to systemic HRT)
In what circumstance only is HRT contraceptive?
If IUS if used for endometrial protection
When should non-hormonal contraception be continued until?
2 years after LMP if <50
1 year after LMP if >55
When should patients on hormonal contraception/HRT, in whom timing of menopause is not clear, continue contraception until?
55 years old- loss of fertility can be assumed at this point
Premature menopause is defined as..?
Cessation of menstruation before age 40
How should HRT be commenced?
If patient has uterus, requires progesterone
Commence at low dose and provide 3 month supply
Indications for cyclical vs continous progesterone?
Cyclical- use for patients who continue to have periods.
Continuous should only be used >12 months after LMP
Risks of HRT: VTE
Increased with oral preparations but not transdermal
Risks of HRT: CVD
Oral oestrogen- slight increase in risk of stroke.
Tibolone increases stroke risk
