Menopause Flashcards
How do you reach a diagnosis of menopause (sx and criteria and Ix)
Menopause= absence of menses for >12 months (retrospective usually)
average age 50- if under 45 consider Ix, and under 40 is premature ovarian failure
depletion of ooctyes- loss of progesterone oestradiol an testosterone
Sx–75% get sx for about 7years
Persistant ammenorhea-often initiation oligomenrrhoae
Vasomotor- hot flush, night sweats, palp, headaches
Urogenital -vaginal dryness, dyspareunia, frequency, dysuria
psych- poor conc, letharge, depression, reduce libido
Ix- pregnancy test
FSH LH should be HIGH, oestradiol LOW
prolactin, TFT, TVUSS - for ovarian cancer (bleeding- endometrial, no bleeding- ovarian)
What are the routes of delivery of Mx of menopause
Do they have an uterus -
no-systemic oestrogen
yes- combine with progesterone to protect vs carcinoma
Hrt can be systemic (oral, implant)
transdermal (if h of dvt)
Topical (if hx of DVT)
What is the 1st management of Menopause Mx
Lifestyles- exercise, alcohol, caffeinem weight loss, stress reduct Hot flush-exercise, WL, stress down sleep - hygene, Mood - sleep hygene, exercise Congitive, sleep exercise
What is the 2nd line Mx of menopause
Oestrogens alone - if NO UTERUS (elleste solo)
OD, oral oestrogen is standard
(transderman patch if BMI>30 cause of VTE
can use in combination with LNGIUS
Oestrogen with progesterone (elleste duo)
can be oral, topical, local (less clot), implant
Cyclical pattern– (often for perimenopausal)
monthly cycles- oestrogen every month + progesterone for last 14 days
for regular periods and menopause sx
3m cycles- oestrogen for 3 + progesterone for 14d
irregular peridods and sx
Continuous- if no period for 1y (post meno)
take oestrogen and progesterone everyday
What are the benefits, risk and SE of HRT
Benefits-
improve sx, and mx vaginal atrophy
Prevention of oesteoporisis and heart disease
Risk - cancer- oestrogen only - Breast, endo
combined- Breast
VTE risk 2-4x risk
SE- should pass in few weeks
Oestrogen- brest tender, nausea, headache
Prog- fluid retention, mood swing, depression
Unscheduules vaginal bleeding-1st 3m
Sequential > continous
Ix if last more than 6m
What are the absolute contraindications of HRT
Undiagnosed vaginal bleeding Breast cancer (not Fhx) Hx of VTE pregnancy severe liver disease current thrombophillia (FV leiden)
What are the alternatives of HRT for Mx of menopause
for vasomotor-
Fluoxetine
2ndline- citalopramm, venflafaxine
3rd line- gabapentin
vaginal dryness- lubricants
oestroporisi- bisphosphonates
