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PR3152 > Menopause > Flashcards

Menopause Flashcards

1
Q

What is menopause

A

Permanent cessation of menses following the loss of ovarian follicular activity (no more menses for 12 months)

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2
Q

Etiology of menoapuse

A
  1. Natural: Perimenopause –> menopause –> postmenopause
  2. Induced: Menopause experienced before natural menopause with removal of both ovaries or iatrogenic ablation of ovarian function
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3
Q

How is the final menstrual period be determined?

A

Retrospectively (12 months later)

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4
Q

Signs of menopause transition

A
  1. Menstrual cycle starts getting longer and more infrequent (ovaries produce less and uneven hormones)
  2. Vasomotor symptoms experienced early
  3. Urogenital symptoms tend to occur later
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5
Q

What are some vasomotor symptoms (VMS)

A

Initiated due to estrogen withdrawal
1. Hot flushes
2. Night sweats
3. Intense feeling of heat on face
4. Rapid/ irregular HR
5. Flushing/ reddened face
6. Persipiration
7. Cold sweats
8. Sleep disturbances
9. Feeling of anxiety

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6
Q

What are the symptoms of genitourinary symptoms (GSM)?

A

Due to decreased estrogen
1. Genital dryness
2. Burning/ irritation/ pain
3. Sexual symptoms of lubrication difficulty
4. Impaired sexual function/ libido/ painful intercourse
5. Urinary urgency
6. Dysuria
7. Recurrent UTI

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7
Q

Psychological/ cognitive symptoms

A

Due to stress/ hormone fluctuations
1. Depression/ anxiety
2. Poor concentration/ memory
3. Mood swings

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8
Q

What are the clinical presentations/ symptoms associated with menopause? (4)

A
  1. Vasomotor symptoms (aka hot flushes/ night sweats)
  2. Genitourinary syndrome (GSM)
  3. Psychological symptoms
  4. Bone fragility
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9
Q

Non-pharmacological therapy for mild vasomotor symptoms

A
  1. Layered clothing
  2. Lower room temperature
  3. Less spicy food/ caffeine/ hot drinks
  4. More exercise
  5. Dietary supplements (isoflavones and Black Cohosh)
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10
Q

Non-pharmacological therapy for mild vulvovaginal symptoms

A
  1. Non-hormonal vaginal lubricants/ moisturizers
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11
Q

When is Hormone Replacement Therapy (HRT) considered

A
  1. Reserved for moderate/ severe symptoms
  2. Insufficient response to non-pharmacological
  3. Should not be used solely for the treatment of low libido/ CVD prevention/ psychiatric issues/ itchy skin and hair loss/ treatment of osteoporosis
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12
Q

When is progestin + estrogen hormone replacement therapy used?

A
  1. When patients have intact uterus (progestin used to protect the endometrium from overgrowth)
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13
Q

What are the dosage forms of estrogen available?

A
  1. Systemic oral tablets
  2. Systemic topicals (Patches or Gels)
  3. Local vaginal (pessary and creams)
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14
Q

What are the pros and cons of systemic oral

A

Pros
1: Inexpensive

Cons
1. Highest dose of estrogen required –> higher risk for side effects
2. Potential missed doses –> irregular bleeding

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15
Q

What are the pros and cons of systemic topicals?

A

Pros:
1. Convenient
2. Lower systemic dose of estrogen vs oral
3. Continuous estrogen release

Cons:
1. Expensive
2. Skin irritation
3. Gel has more variability in absorption

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16
Q

What are the pros and cons of local vaginal dosage forms?

A

Pros:
1. Lowest estrogen dose
2. Continuous estrogen release

Cons:
1. Inconvenient/ uncomfortable (with pessary)
2. Vaginal discharge
3. Only for localized urogenital atrophy

17
Q

Is there a pill-free interval for estrogen-only HRT?

A

No. Since the patient does not have an intact uterus anymore

18
Q

What are the two ways of administering estrogen + progestin Hormone Replacement Therapy?

A
  1. Continuous cyclic:
    Progestin is added on either the 1st or 15th of the month for 10-14 days while estrogen is continuous –> regulate menses in patients with intact uterus (withdrawal bleeding when progestin is stopped after 10-14 days)
  2. Continuous-combined:
    Estrogen and progestin given daily –> no withdrawal bleeding although high risk for breakthrough bleeding initially; amenorrhea may occur after several months
19
Q

Counseling points for patients on HRT

A

It may take up to 2-3 months of use before seeing a vast improvement of menopausal symptoms –> persevere and continue taking HRT

20
Q

What to monitor when initiated on HRT?

A
  1. Annual mammography –> for breast cancer development
  2. Endometrial surveillance (ie. any vaginal bleeding while on estrogen-only HRT, if bleeding occurs when progestins is on)
21
Q

What is the gold standard for treatment of vasomotor symptoms?

A

Hormone replacement therapy

22
Q

What other alternative treatments are there for treatment of VMS?

A
  1. Antidepressants (SNRI – venlafaxine, SSRI – paroxetine)
  2. Gabapentin (for night sweating and sleep disturbances)
  3. Tibolone (synthetic steroid with estrogenic, progestogenic and androgenic effects)

PR3152 (7 decks)

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