Menopause Flashcards
What is the definition of menopause
The age at the last menstrual period
What is the climacteric
The time period from when the ovaries start to fail until 12 months after the last menstrual period
What is postmenopause?
The time after complete cessation of menstruation. Can only be determined after 12 mnths of amenorrhoea
Primary ovarian insufficiency definition
Menopause that occurs before age 40
What is the average age of menopause ?
51
What factors can result in early menopause? (3)
1- Genetic predisposition (30-70%)
2- type 1 diabetes
3- smoking
Hallmark endocrine changes of menopause
1- decreased inhibin B
2- increased FSH
What is the source of estrogen postmenopause
Aromatisation of androstenedione in peripheral tissues
What is the percentage fall of testosterone by the time of menopause
50%
What effect does decreased estrogen have in the body (4)
- decreases production of neurotransmitters
- decreased collage
- endothelial function
- atrophy of estrogen sensitive epithelial surfaces
What are the acute manifestations of menopause ? (4)
- cessation of menses
- vasomotor symptoms
- psychological: mood swings, panic attacks, depression, memory loss
- headaches
What percentage of women are affected by vasomotor symptoms?
70-80%
What is the median duration of vasomotor symptoms
7 years
What are the medium term symptoms of menopause? (5)
- vaginal dryness and dyspareunia
- reduced libido
- increased vaginal pH: >4.5 with recurrent UTIs
- atrophy GU tract : increased urge incontinence
- thinning skin, hair loss
What are the long-term health implications (2)
- increased fragility fractures
- increased Cardiovascular disease
What are the indications for HRT?
Significant vasomotor symptoms
What are the types of HRT (5)
- estrogen only
- sequential combined cyclic
- sequential combined long cycle
- continuous combined
- continuous progestogen
What are the different estrogen preparations? (4)
- transdermal estradiol
- oral conjugated equine estrogen
- subcutaneous estradiol pellets
- transvaginal: ring, tablets, cream
What are the routes of progesterone for hrt? (5)
- oral
- patch
- pessary
- cream
- IUS
What is a consequence of LNGIUS when used with estrogen
Doubles the risk of breast cancer
What is a consequence of tibolone
Doubles the risk of stroke
What is a benefit of the estrogen patch
Decreases the risk of venous thromboembolism
How does the patch decrease the risk of VTE
It by passes the gut and liver first pass metabolism hence preventing hepatic globin and coagulation factor synthesis
Benefits of oral estrogen (2)
- more affordable
- improves HDL LDL and cholesterol
What is the percentage reduction in osteoporosis with HRT
30%
What HRT method carries the highest risk of breast cancer
Continuous combined therapy
Baseline risk of VTE in women age 50-70
100-200:100,000 women/years
Contraindications to HRT (7)
- hormone dependent malignancy
- history of active or recent arterial thrombosis (MI/stroke)
- venous thromboembolism
- pregnant
- active severe liver disease
- univestigated AUB
- acute intermittent porphyria
Recommended followup on HRT
Three months
Six months
Yearly
A)What test can confirm cessation of ovarian function with the absence of vasomotor symptoms?
B) what is the value
A) FSH 2 separate occasions
B) >30IU/L
Recommended duration of HRT use
5 years
Non hormonal agents for menopause (2)
- clonidine( alpha 2 agonist)
- SSRI and SNRI (only with vasomotor plus depression)
Agents that do not benefit menopausal symptoms
DHEA
Complementary therapies (further studies needed)
Phytoestrogens
- Soy
- flaxseed
- red clover
(Highest levels)
Herbal preparations(5)
- black cohosh (not effective for hotflushes)
- evening primrose oil (not effective for hotflushes)
- kava (anxiolytic)
- ginko biloba (improves memory)
- st John’s wort (drug interactions
What is the pathophysiology of bone resorption in menopause
Estrogen deficiency results in cytokine inhibition of osteoblastogenesis , stimulates the activity and prolongs the life span of osteoclast .
What percentage of patients with surgical menopause have hot flushes
90%
How is primary ovarian insufficiency diagnosed
Two FSH levels >20iu/l 1 month apart
What is the most common chromosomal cause of POI
Turner syndrome 45 XO
What autoimmune diseases are associated with POF
- hypothyroidism
- hypoparathyroidism
- hypoadrenalism
- Addison disease
- type 1 diabetes
Can cyclic HRT function as a contraceptive
-No
HRT only inhibits ovulation in 40% of women
What is the incidence of POI
1%
What are the overall causes of poi
90% idiopathic
10% chromosomal, autoimmune, infective , iatrogenic
