Menopause Flashcards
What are the definitions of premenopause, perimenopause and postmenopause?
Premenopause: regular periods, perimenopause: irregular periods (last period was within the last year), postmenopause: no periods >12 months
What is the average age of menopause in UK?
Around 51
Approximately 1% of women enter menopause prematurely and have premature ovarian insufficiency. Under what age is it considered POI?
<40
Approximately 5% of women experience early menopause. What age group is it considered early?
40-44
What percent of women have symptoms that can be severe and on average how long do they last?
85% of women and 7.4 years
When are menopause symptoms most severe?
Late peri- and early postmenopause
What are the main 3 symptoms of menopause?
Mood swings, night sweats and hot flushes
List some more unknown signs of menopause.
Anxiety, depression, painful sex, loss of libido, lack of energy, pins and needles, insomnia, palpitations, weight gain, dry skin and hair, brain fog
In women >45 years, no routine FSH test is necessary. When is the exception to this?
Women aged >50 on hormonal contraception who do not want to continue until the age of 55
FSH levels are measured confirm a diagnosis of peri-menopause in two groups of women, what tests are carried out and what two groups?
FSH levels x2 (6 weeks apart) in women >45 with atypical symptoms and in women between 40-45 with menopausal symptoms and/or iatrogenic amenorrhoea
FSH, E2, TFT, glucose, prolactin and FAI should be checked in women with symptoms of what age?
In women <40
Chromosomes should be checked to exclude autoimmune disorders in women with menopausal symptoms under what age?
<35
When should you consider therapeutic trial of HRT?
In symptomatic patients, consider it independent from blood results and/or amenorrhoea
What are non-hormonal treatments available for menopause? Few trials done
Herbal medicine: St. John’s Wort, Black Kohosh, Sage etc
Medical: antidepressants SSRIs/SNRIs, gabapentin
Complementary: acupuncture, homeopathy, aromatherapy
Benefits of HRT?
Symptom relief particularly vasomotor, improvement of low mood associated with perimenopause, improvement of sexual function, decreased risk of osteoporosis & CVD if <60, prevention and treatment of urogenital/vulvovaginal atrophy
Risks of HRT?
Increased risk of breast cancer, VTE and CVD if >60
What is antoher name for urogenital/vulvovaginal atrophy?
Genitourinary syndrome of the menopause
List 5 contraindications to HRT
Hx of breast cancer, coronary heart disease, TIA or previous stroke, unexplained vaginal bleeding, active liver disease
If hysterectomy or mirena in situ, estrogen only can be given. This can be oral or transdermal. What are the 2 oral meds and what are the 3 transdermal?
Oral: estradiol or conjugated equine estrogens + Transdermal: estradiol gel, patch or spray
If no hysterectomy or mirena in situ, estrogen and progesterone must be given together for HRT. If perimenopausal what kind of therapy is given and if postmenopausal what kind of therapy is given?
Perimenopausal: cyclical therapy (progesterone cyclical) + postmenopausal: continuous combined
What is treatment for those with POI or early menopause?
HRT until the average age of menopause (51) + continue with contraception!
HRT can be gradually reduced or immediately stopped and depends on what patient wants. True/false
True
WHat are the benefits of transdermal over oral HRT?
Carries low/no increased VTE risk, is better for symptom control and associated with less CVD risks
When would transdermal HRT be indicated?
Individual preference, poor symptom control with oral HRT, GI disorder affecting oral absorption, increased VTE risk, variable blood pressure control
What are some side effects of HRT? (Estrogenic)
Bloating, breast enlargement, breast tenderness, fluid retention, headaches/migraine, leg cramps, mood swings, nausea
What are some side effects of HRT? (Progestogenic)
Acne, anxiety, bloating, breast tenderness, depression, headaches/migraine, hirsutism, lower abdo/pelvic/back pain, mood swings
When can contraception be stopped in perimenopausal women aged 40-49?
2 years after last natural menstrual period or 2 years after 2 results of FSH > 30IU/I taken at least 4-6 weeks apart
When can contraception be stopped in perimenopausal women >50 yrs?
1 year after last natural menstrual period or 1 year after 1 result of FSH of >30IU/I
When can contraception be stopped in perimenopausal women aged >55?
Contraception can be stopped even if still having periods cos oocytes quality poor
