Menopause Flashcards
How is premature ovarian insufficiency diagnosed
Aged under 40 not on HRT/COCP
Symptoms of menopause including oligo/amenorrhoea
2 FSH readings above 30 4 weeks apart
What symptoms can precede menopause
Reduction in length of periods
Change in bleeding most often increases
Symptoms of menopause
Hot flushes/night sweats
Cognitive impairment and mood disorders
Vaginal dryness affecting libido
Urogenital symptoms
Sleep disturbances
When use FSH to diagnose menopause
Under 45
Over 45 with atypical symptoms
Over 50 on progestogen contraception
In general when can women stop taking contraception
After 55
After menopause when can women stop using contraception knowing they cant get pregnant
Under 50- 2 years after last period
Over 50- 1 year after last period
Management of vasomotor symptoms in menopause
Offer lifestyle- regular exercise and weight loss, smoking, spicy foods
If wants to use HRT
- with uterus use oral or transdermal oestradiol and progestogen
- without a uterus offer oral or transdermal oestogen only
If not consider SSRI, SNRI, clonidine, gabapentine
Management of mood disorders in menopause
If wants HRT
- Choice of oral or transdermal HRT preparations
If not
- CBT
- SSRI if diagnosis of depression
Management of genitourinary symptoms of menopause
Can always use vaginal moisturisers and lubricants esp when do not want HRT
Low dose vaginal oestrogen 1st line
Increase dose 2nd line
If contraindicated or not tolerated use opsemifene
MOA of ospemifene
Selective oestrogen receptor modulator
How often should people on HRT be followed up
3 months after initiation or dose change
1 year thereafter
What does HRT increase the risk of
VTE- oral greater risk
Stroke- oral oestrogen negligible risk
CHD- combined has slight risk
What is management of premature ovarian failure
HRT until 51 but note this is not contraception in case ovary spontaneously returns to functioning
Contraindications to HRT
Breast cancer currently or in past
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Active liver disease
Thrombophilic
Previous VTE
Oestrogen dependant cancer history
Who do you use HRT with caution in
Porphyria cutanea tarda.
Diabetes mellitus (increased risk of heart disease).
Factors predisposing to venous thromboembolism.
History of endometrial hyperplasia.
Migraine and migraine-like headaches.
Causes of post menopausal bleeding
Vaginal atrophy most common
HRT
Endometrial cancer/hyperplasia
Cervical cancer
Vaginal/vulval cancer
Bleeding disorders
How is PMB due to vaginal atrophy treated
Topical oestrogens- increases thickness of uterus
Lubricants
How is PMB due to HRT use treated
Change preparation
Which HRT combination gives lowest VTE risk
Transdermal
What do if someone with LNG-IUS needs HRT
Just give oestradiol
Mirena counts as progesterone part for 4 years
What are recognised causes of premature menopause
Addisons
Infections- TB, mumps, malaria
Chemo and radiation
What diseases are HRT patients at increased risk of
Breast cancer
Endometrial cancer
Gallbladder disease
What are options for combined and oestrogen only HRT
Oral or transdermal for both
How long after HRT commencement should abnormal bleeding be investigated for endometrial cancer
6 months
Which oestrogens are used in HRT
Natural conjugated oestrone etc
Avoid synthetic unless POI
Which progestogens are used in HRT
Synthetic
- dydrogesterone
- medroxyprogesterone
- norethisterone
- levonorgestrel
What are regime options for combined HRT
Cyclical
Monthly- take oestrogen every day, progesterone for last 14 days of cycle
3 monthly- oestrogen every day, progesterone for 14 days every months
Continuous
Both every day
What regime is used for oestrogen only HRT
Daily forever
What regime is used for perimenopausal women without regular periods
3 monthly cyclical regime
What regime is used for perimenopausal women with regular periods still
Monthly
Who is continuous combined HRT regime used in
Woman whos last period was over a year ago
Why is cyclical HRT used in perimenopausal women
To identify when periods end
Can you have HRT with prior VTE
Only if being actively anti-coagulated
Can you have HRT with prior VTE
Only if being actively anti-coagulated
What do if woman has irregular bleeding over age of 45
TVUSS
