Menopause Flashcards
Definition of menopause
No periods for 12 months due to absolute oocyte deficiency.
Perimenopause
Symptoms before absolute menopause due to decreased oestrogen
Perimenopausal symptoms
Hot flushes Night sweats Mood disturbance Vaginal dryness Anxiety Decline in libido Hair thinning Irregular periods
Average age for menopause
51
Early menopause/ primary ovarian insufficiency
Menopause before 40 yo
Investigations
Bloods - FSH x 2 at least 4 - 6 weeks apart
HRT types
Continuous
Sequential
Types of sequential HRT
Regular periods - Oestrogen + Progesterone for 14 days every month
Irregular periods - Oestrogen + progesterone for 14 days every 3 months
When can oestrogen-only HRT be given
If hysterectomy
Side effects of HRT
Increases the risk of breast cancer
Headaches Breast tenderness Bloating Muscle cramps Irregular bleeding VTE - oral HRT not gel or patch
Benefits of HRT
Alleviates menopausal symptoms
Better CVD outcomes
Decreases risk of osteoporosis
Reduces risk of UTI
When are investigations done
If menopausal symptoms in women less than 45 yo
Advice for menopause
Exercise at least 2.5hrs per week
Smoking cessation
Reduce alcohol and coffee intake
Mediterranean diet
Open window, wear thinner clothes
Vaginal lubricant
Impact of menopause on hormones
Oestrogen and progesterone - low
LH and FSH levels - high
Impact of low oestrogen
Increased risk of:
- CVD
- Stroke
- Osteoporosis
- Pelvic organ prolapse
- Urinary incontinence
When can perimenopause and menopause be diagnosed
45+ yo
When should women use contraception in relation to menopause?
For 2 years after the last menstrual period in women under 50
For 1 year after the last menstrual period in women over 50
Side effects of the progesterone only depot injection
Weight gain
Osteoporosis
Non-Hormonal Treatments for Menopausal Symptoms
Lifestyle changes - improving the diet, exercise, weight loss, smoking cessation, reducing alcohol, reducing caffeine and reducing stress
CBT
Clonidine - agonist of alpha-adrenergic and imidazoline receptors
SSRI antidepressants (e.g. fluoxetine)
Venlafaxine, which is a selective serotonin-norepinephrine reuptake inhibitor (SNRI)
Gabapentin
Clonidine
Lowers blood pressure and reduces the heart rate
Helpful for vasomotor symptoms and hot flushes
Side effects of clonidine
Dry mouth
Headaches
Dizziness and fatigue
Sudden withdrawal can result in rapid increases in blood pressure and agitation
