Menopause Flashcards
define menopause
last menstural period 12 months ago
-retrospective diagnosis
average age of menopause in uk
52
what is defined as premature menopause
under 40yo
-result of prematre ovarian insufficiency
define perimenopause
time arounnd the menopause, where women may be experiencing vasomotor symptoms and irregular periods
what causes menopause
lack of ovarian follicular function
-resulting in changes in the sex hormones associated with the menstrual cycle
-oestrogen and progesterone levels are low
-LH and FSH are high in response to absence of negative feedback from oestrogen
failing follicular development means ovulation does not occur and without osteogen the endometirum does not develop leading to lack of menstruation
describe some perimenopausal symptoms 8
hot flushes
emotional labilty or low mood
premenstrual syndrome
irregular periods
joint pains
heavier or lighter periods
vaginal dryness and atrophy
reduced labido
what conditions are menopausal women at an increased risk of due to lack of oestrogen 4
CVD and stroke
oestoporosis
pevlic organ prolapse
urinary inctoninence
how can diagnosis for menopasue be made
-when would further testing be recommended for menopausal women and state that test
without any investigatiosn in women over 45yo w typical syx
-conisder FSH blood test if:
-wopmen under 40 suspected of premature menopause
-women aged 40-45 w menopausal syx or a change in menstural cycle
other causes of menopause 6
surgical removal of ovaries
radio/chemo
hysterecomty w conservation of ovaries
smoking
deletion of X chromone 45XO
fragile X pre-mutation
vasomotor syx of menopause 2
hot flushes
night sweats
what affects do menopause have on the vagina and what are their consequences 4,5
affects
- epithelium thinner
-intermediate cells replaced w superficial
-secretions diminish
-pH decreases
consequences
-vaginal drynes
-dysparenuia and sex dysfunction
-relationship breakdown
-gneral discomft
-trauma and bleeding
what affects do menopause have on the urinary tract and what are their consequences 1,4
effects- urethral mucosa atrophic
consequneces
-frequnecy
-dysuria
-incontinence
-recurrent UTI
what affects do menopause have on the pelvic floor and what are their consequences 3,1
effects
-decreased blood supply
-decreased tone
-increased relaxation
consequence
-uterovaginal prolapse
effects of menopause on mood 6
depresion
irritabilitu
anxiety
memory
sleep distrubance
alzheimers
state the natrual oestroegns native to humans 4
17b-oestradiol (E2)
oestrone (E1)
oestriol (E3)
estetrol (E4)
how are oestrogen replacement therapies commonly given 3
oral
transdermal patch
pessaries
why is oestreogn alone unsafe as a hormone replacement therapy
-what is given in combination
-how frequently is HRT prescribed
not given alone as reports of incresaed endometrial carcinomas
given with progesterone
cyclical
-oestradiol E and progesterone for 2 weeks then only oestradiol for 2 weeks - then repeat
treatment of urinary incontinence in menopausal women
no evidenec of local oestrogen
-instead recommend weight reduction, supervised pevlic floor muscle training and bladder training and antimuscarinics
what factors affect a menopasuals womens chance of getting oestoporosis 2
the amount of bone they have when they reach menopause
how fast they lose bone after they reach menopause
how are menopausal women assessed for oestoporosis risk 1
FRAX- WHO facture risk assessment tool
how does HRT affect CVD and stroke risk
decreased risk of CVD
possible incresed risk of stroke
regarding the use of HRT and weighing the risks versus benefits - what is the consensus
benefits are more likely to outweigh risks for symptomatic women before the afe of 60 or within 10 years after menopause
alternatives of HRT for vasomotor symptom in menopause
prescribed- clonidine( has lots of side effects) , SSRI, gabapentin
alternative- acupuncture, lifetsyle, stellate ganglion blockade
CBT- shown to be VERY effective
when do women stil need contraception if approaching menopause age
two years after last menstural periond in women under 50
one year after last menstrual period in women over 50
*-hormonal contracetives don’t affect menopause but may suppress/mask syx making it difficult to dx menopause
what type of contraception is not recommneded in women approaching menopause and why
COCP can be used up until the age of 50 but not after
due to increase risk of gynae cancers, CVD risk and increased VTE risk
what unique side effects doe sthe progesteone depot injection have and why is this important
causes wiehgt gain adn reduced bone minral denisty (oestoporosis)
-unique to depot
-oestooporosis risk makes it unsuitable for women over 45
benefits of E+P HRT
reduced flush frequency
reduced flush severity
improves vagainal syx and sexual dysfunction
non-hormonal Mx of vaginal menopausal syx
-who might use
vaginal moisturriesres
-women w hormone sensitive cancers or who do not wish to use oestradiol
how is the endometrium affected by unilateral oestorgen HRT
-how is this managed
assoc w significant risk of endometrial hyperplasia
-addition of progesterone
