Menopause Flashcards
When is the diagnosis of menopause made
Retrospective diagnosis made after woman has not had any periods for 12 months. Permanent end to menstruation around 51 years of age
What is the perimenopausal stage
Time around the manopause where the woman may experience vasomotor symptoms and irregular bleeding
What is classed as premature menopause
Before age of 40
Cause of menopause
Lack of ovarian follcular function, resulting in changes in the sex hormones associated with menstrual cycle. Oestrogen and progesterone are low, LH and FSH are high in response to absence of negative feedback
Process of menopause
Begins with a decline in development of ovarian follicles -> reduced production of oestrogen -> negative feedback on pituitary gland, but there is absence of feedback -> increasing levels of FSH and LH -> ovulation does not occur -> endometrium does not develop without oestrogen -> perimenopausal symptoms
What are perimenopausal symptoms
Hot flushes
Emotional lability or low mood
Premenstrual syndrome
Irregular periods
Joint pains
Heavier or lighter periods
Vaginal dryness and strophy
Reduced libido
Risk of menopause
CVD and stroke, osteoporosis, pelvic organ prolapse, urinary incontinence - from lack of oestrogen
Management of perimenopausal symptoms
HRT
Tibolone
Clonidine
CBT
SSRI
Testosterone
Vaginal oestrogen
Vaginal moisturisers
What is HRT used for
Alleviate symptoms associated with perimenopause and menopause.
Oestrogen and progesterone given - progesterone is to prevent endometrial hyperplasia and endometrial cancer secondary to unopposed oestrogen
Indications for HRT
Replacing hormones in premature ovarian insufficiency
Reducing vasomotor symptoms
Improving symptoms such as low mood, poor sleep, joint pain and decreased libido
Reducing risk of osteoporosis in women under 60
Different regimes for HRT
Cyclical HRT
Continuous combined
Oestrogen only for those with no uterus
Risk of HRT
Breast cancer, endometrial cancer, VTE risk, stroke and coronar artery disease risk
Contraindications of HRT
Undiagnosed abnormal bleeding
Endometrial hyperplasia or cancer
Breast cancer
Uncontrolled HTN
VTE
Liver failure
Active angina or MI
Pregnancy
Three criteria to chose formulation of HRT
Local or systemic symptoms
Does the woman have a uterus
Have they has a period in the last 12 months
Side effects of oestrogen
Nausea, bloating, breast swelling, breast tenderness, headaches, leg cramps
Side effects of progesterone
Mood swings, bloating, fluid retentoin, weight gain, acne, greasy skin
What is atrophic vaginitis
Refers to dryness and atrophy of the vaginal mucosa related to lack of oestrogen
Presentation of atrophic vaginitis
Thin mucosa, less elastic and dry, tissue is prone to inflammation, changes in vaginal pH and microbial flora contributing to localised infections, itching, dryness, dysparenuria, bleeding from localised inflammation,
What will you find in examination of atrophic vaginitis
Pale mucosa, thin skin, reduced skin folds, erythema and inflammation, dryness, sparse pubic hair
Management of atrophic vaginitis
Vaginal lubricants - Sylk, replens, and YES
Topical oestrogen - estriol cream, pessaries, tablets and ring
What is lichen sclerosis
Chronic inflammatory skin condition affecting the labia, perineum, and perianal skin of women, but can also infect other areas such as axilla, thighs, foreskin and glans of penis
Presentation of lichen sclerosis
45-60 years old, vuvlal itching, skin changes in the vulva, asymptomatic, soreness and pain possibly worse at night, dysparenuria, skin tightness, erosions, fissures
How is lichen sclerosis diagnosed
Clinical examination but if there is dount a vulval biopsy can be taken
What is Koebner phenomenon
Signs and symptoms are made worse by friction to the skin, occurs with lichen sclerosis and can be made worse by wearing tight underwear, clothes, urinary incontinence and scratching
