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Gynaecology > Menopause > Flashcards

Menopause Flashcards

1
Q

When can menopause be diagnosed?

A

Retrospective diagnosis - made after a women has had no periods for 12 months.

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2
Q

What is menopause?

A

The point at which menstruation stops.

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3
Q

What is the average age women undergo menopause?

A

~51

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4
Q

What is postmenopause?

A

The period from 12 months after the final menstrual period onwards.

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5
Q

What is perimenopause and when is it?

A

Refers to the time around the menopause, where the woman may be experiencing vasomotor symptoms and irregular periods.

Perimenopause includes the time leading up to the last menstrual period, and the 12 months afterwards. This is typically in women older than 45 years.

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6
Q

What is premature menopause?

A

Menopause before the age of 40.

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7
Q

What is premature menopause the result of?

A

Premature ovarian insufficiency.

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8
Q

What are the sex hormone levels at menopause?

A

Oestrogen and progesterone are low.

LH and FSH levels are high in response to absence of negative feedback from oestrogen.

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9
Q

How does the process of menopause begin?

A

Decline in development of ovarian follicles. With reduction in follicles, there is reduced oestrogen production.

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10
Q

What are permenopausal symptoms caused by?

A

Lack of oestrogen.

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11
Q

List perimenopausal symptoms.

A
  1. Hot flushes
  2. Emotional lability or low mood
  3. Premenstrual syndrome
  4. Irregular periods
  5. Joint pains
  6. Heavier or lighter periods
  7. Vaginal dryness and atrophy
  8. Reduced libido
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12
Q

What does a lack of oestrogen increase a person’s risk of (4)?

A
  1. Cardiovascular disease and stroke
  2. Osteoporosis
  3. Pelvic organ prolapse
  4. Urinary incontinence
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13
Q

How is a diagnosis of perimenopause and menopause made?

A

Can be made in women over 45 with typical symptoms, without performing any investigations.

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14
Q

When do NICE guidelines recommend considering an FSH blood test to help with diagnosis of menopause?

A
  1. Women under 40 years with suspected premature menopause

2. Women aged 40-45 with menopausal symptoms or a change in the menstrual cycle

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15
Q

How long do women need to take contraception for after the menopause?

A
  1. Two years after last menstrual periods in women under 50

2. One year after last menstrual period in women over 50

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16
Q

How do hormonal contraceptives affect the menopause?

A

Do not affect the menopause, when it occurs or how long it lasts, although they may suppress and mask the symptoms. This can make diagnosing menopause in women on hormonal contraception more difficult.

17
Q

What are good contraceptive options (UKMEC 1) for women approaching the menopause?

A
  1. Barrier methods
  2. Mirena or copper coil
  3. Progesterone only pill
  4. Progesterone implant
  5. Progesterone depot injection (under 45 years)
  6. Sterilisation
18
Q

What is the advice on the combined oral contraceptive pill in women approaching the menopause?

A

The combined oral contraceptive pill is UKMEC 2 (the advantages generally outweigh the risks) after aged 40, and can be used up to age 50 years if there are no other contraindications. Consider combined oral contraceptive pills containing norethisterone or levonorgestrel in women over 40, due to the relatively lower risk of venous thromboembolism compared with other options.

19
Q

What are two key side effects of the progesterone depot injection (e.g. Depo-Provera?

A
  1. Weight gain

2. Reduced bone mineral density (osteoporosis)

20
Q

What group is the progesterone depot injection unsuitable for?

A

Women >45 years due to osteoporosis risk.

21
Q

Without treatment, how long are vasomotor symptoms likely to last for?

A

Tend to resolve after 2-5 years.

22
Q

What are treatment options for the management of perimenopausal symptoms?

A
  1. No treatment
  2. Hormonal replacement therapy (HRT)
  3. Tibolone
  4. Clonidine
  5. Cognitive behavioural therapy
  6. SSRI antidepressants
  7. Testosterone
  8. Vaginal oestrogen cream or tablets
  9. Vaginal moisturisers
23
Q

What is tibolone?

A

Synthetic steroid hormone that acts as continuous combined HRT (only after 12 months of amenorrhoea).

24
Q

What is clonidine?

A

Agonist of alpha-adrenergic and imidazoline receptors.

25
Q

Name two SSRIs used in the management of perimenopausal symptoms.

A
  1. Fluoxetine

2. Citalopram

26
Q

What is testosterone used for in the management of perimenopausal symptoms?

A

Used to treat reduced libido (usually as a gel or cream).

27
Q

What is vaginal oestrogen cream or tablets used for in the management of perimenopausal symptoms?

A

To help with vaginal dryness and atrophy (can be used alongside systemic HRT).

Gynaecology (25 decks)

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