Menopause Flashcards

1
Q

When does menopause usually occur?

A

Average is 51

Premature menopause is considered <40

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2
Q

Is menopause instant?

A

No it takes ~5yrs prior to the actual date of menopause for the body to change. This is known as perimenopause and is when you get the symptoms of menopause

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3
Q

What is happening during menopause?

A

Ovarian insufficiency. Oestradiol starts to fall and FSH rises

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4
Q

What are the symptoms of menopause?

A
Vasomotor (Hot flushes)
Vaginal dryness & soreness
Low Libido
Muscle & joint aches
Mood change & forgetfulness
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5
Q

Menoapuse also causes osteoporosis due to the lack of oestrogen, what are the risk factors for this?

A
  • Thin women
  • Caucasians
  • Smokers
  • Alcohol
  • FH
  • Amenorrhoea
  • Malabsorption
  • Steroids
  • Hyperthyroid
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6
Q

How can we prevent and treat osteoporosis in menopausal women?

A
  • Exercise
  • Ca2+ & Vit D
  • HRT
  • Bisphosphonates
  • Denosumab
  • Teriparatide
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7
Q

What is denosumab?

A

A monoclonal antibody to osteoclasts

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8
Q

What is the normal 1st line treatment for osteoporosis?

A

Bisphosphonates (if its not due to menopause)

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9
Q

HRT is common treatment for peri-menopausal symptoms, how long is it used for?

A

For roughly 5 yrs, only used to treat peri-menopausal symptoms not forever

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10
Q

How can we deliver HRT?

A

Local - Vaginal oestrogen pessary, ring or cream

Systemic - Transdermal patch or oral

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11
Q

Why would you choose transdermal vs oral HRT?

A

Transdermal carries less risk of VTE

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12
Q

HRT also comes in various formulations and regimens, what are these?

A

1) Oestrogen only
2) Oestrogen/Progestogen (aka combined)
- (2a) Cyclical - 14 days E –> 14 days of E&P
- (2b) Continuous - 28 days E & P

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13
Q

When would we use Oestrogen only HRT?

A

If the women had no uterus, e.g. her menopause was after a TAH & BSO

Ergo if a woman still has a uterus you use combined HRT

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14
Q

When would we use Cyclical combined HRT vs continuous?

A

Cyclical is used if theres still some ovarian function i.e. still perimenopausal

Continuous is used if there’s no ovarian function i.e. its >1yr since menopause or they’re >54

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15
Q

There is another option for HRT delivery that can be used at any age, whats that?

A

Mirena Levonorgestrel Intra-uterine system (LNG IUS)

Along with daily E either oral or transdermal

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16
Q

What are the contraindications to HRT?

A
  • Current hormone dependant breast/endometrial cancer
  • Current liver disease
  • Uninvestigated abnormal bleed

You should also seek advice you’ve had previous:

  • VTE
  • Thrombophilia & Fh/o
  • Breast Ca
  • Or carry BRCA genes
17
Q

How do different types of HRT affect bleeding?

A

Cyclical combined has a withdrawal bleed

Continuous combined HRT is bleed free after 3 months

18
Q

What are the pros & cons of HRT?

A

Pros = Works for vasomotor, local genital & osteoporosis symptoms

Cons = Increases risk of breast/ovarian cancer as well as VTE & stroke if taken orally

19
Q

Heres some common misconceptions about HRT which patients may believe or ask about?

A
  • It helps alzheimers
  • It increases risk of CVD (doesn’t if started <60)
  • High risk of breast cancer (goes from 1/100000 to 2/100000, actually less than if you were obese or drank a lot)
20
Q

Whne should we give HRT?

A
  • If they have severe vasomotor symptoms, and it should be reviewed annually
  • For premature ovarian insufficiency (up to age 50)
  • Vaginal oestrogen if they have vaginal symptoms

Don’t give it for someone just cos they have osteoporosis, treat that with bisphosphonates

21
Q

Name some other non-HRT treatments for menopause?

A
  • Selective Oestrogen Receptor Modulators (SERMS)
  • SSRI & SNRI antidepressants e.g. venlafaxine
  • Natural methods e.g. red clover & hypnotherapy
  • Non-hormonal lubricants e.g. Sylk
22
Q

How effective are antidepressants for menopause?

A

Pretty crap and they have lots of side effects

23
Q

How effective are natural methods of treating menopause?

A

They have a high placebo effect and can be very costly. Some work some don’t its not really worth it.

24
Q

Men have their own form of menopause called “andropause” how does this work?

A

Testosterone falls by about 1%/yr after 30, DHEAS also falls.

Unlike menopause fertility remains and the changes are more gradual