Menopause Flashcards
Predominant postmenopausal oestrogen?
Estrone
From androgens produced by ovarian stroma which are aromatised
Define menopause
Period following final menstrual period, diagnosis made retrospectively
Normal range 45 - 55; mean 51
Define climacterium
Aka perimenopause.
Transitional period leading up to fmp characterised by variation in menses and fluctuating FSH
Define premature menopause
Before age 40
(Average 48 - 52 years)
Define early menopause
Before age 45
Describe the reproductive stages of life according to STRAW (stages of reproductive aging workshop) (4)
- -5: early reproductive phase after menarche. Variable duration. Menstruation variable - regular.
- -4: peak reproductive phase. Regular menstrual cycle.
- -3: late reproductive phase.
→ - 3a: regular menstrual cycle. Low FSH, Amh (anti mullerian hormone) and central follicle count.
→ - 3b: subtle changes in flow/length. Variable FSH (blood draw on cycle days 1-5 = elevated); low AMH, inhibin ß and antral follicle count
Describe the menopausal transition stages of life according to STRAW (stages of reproductive aging workshop) (2)
All considered premenopause.
- -2: early menopausal transition. Variable duration. Menstrual cycle variable length but persistent 7 or more day difference in length of consecutive cycles. Increased variability of FSH (blood draw on cycle days 1 -5 = elevated); low AMH, inhibin b, antral follicle count.
- -1: late menopausal transition. Duration 1-3 years. Menstrual cycle interval of amenorrhea 60 days or less. FSH > 25 iu/l; low AMH, inhibin b, antral follicle count. Vasomotor symptoms likely.
Describe the postmenopause stages of life according to STRAW (stages of reproductive aging workshop) (4)
- +1: early postmenopause.
→ +1a: premenopausal phase without periods, 1 year. Fsh variable (blood draw cycle days 1-5 = elevated); low AMH and inhibin b, very low antral follicle count. Vasomotor symptoms most likely
→ + 1 b: 1 year.
→ + 1c: 3-6 years. Fsh stabilises; very low AMH and inhibin b, very low antral follicle count. Increasing symptoms of urogenital atrophy. - 2: late postmenopause. Remaining lifespan
Name negative effects of menopause (9)
- 75% hot flushes and night sweats
- Insomnia → lethargy, chronic tired, irritable, OSA
- deterioration mental health, libido, sad, loss interest, poor concentration, guilt…
- cognitive changes: reduced cognitive function, slower learning, reduced verbal recall
- vaginal atrophy (from dryness)
- weight gain + redistribution body fat to abdomen → insulin resistance, CVD
- bone loss: initially only trabecular bone, later cortical. → fractures, osteoarthritis
- muscle mass deteriorate→ falls, fractures
- skin thickness, elasticity, hydration, collagen reduced → wrinkling. Hair reduced
Management bone health menopausal women? (10)
Lifestyle
- Exercise 150 minutes moderate per week. Esp weight bearing
- weight loss of 10.%. Improves insulin resistance but low BMI = poor BMD (less oestrogens)
- limit alcohol to 20g per day
- reduce fall risk: good lighting, handrails, non-slip bath mats, avoid loose carpets, spectacles, less aggressive management bp.
Pharmacological
- MHT: drug of choice in women 50 - 60 with increased # risk
- tibolone: synthetic, binds to oestrogen, progesterone, androgen molecules
- calcium: only supplement if clear deficiency of <1200 mg / day - excessive intake increase risk CVD, renal calculus, constipation
- vitamin D: 800 iu daily intake
- bisphosphonates: inhibit bone resorption and effective but risk atypical femur #, osteonecrosis jaw and esophagitis. Breaks in prescription recommended
- other: SERMS, parathyroid hormone, strontium ranelate, denosumab (monoclonal antibody)
Which hormones are used for menopausal management (3)
- Oestrogen only if no uterus and no breast cancer: conjugated oestrogens, estradiol
- add progestogen if uterus to protect endometrium from hyperplasia, malignancy
- tibolone: synthetic drug with oestrogenic, progestogenic, androgen action. Ideal drug
Management hot flushes menopausal women? (6)
Lifestyle
- weight control, regular exercise
- slow diaphragmatic breathing
- correct clothing, cold drinks
- avoid triggers eg alcohol, spicy foods
Pharmacological
- oestrogens oral/transdermal very effective
- other: ssri, snri, gabapentin (anti-epileptic)
Define osteoporosis
T score < - 2,5 standard deviations
Management cardiovascular disease menopausal women? (4)
Lifestyle
- weight loss, exercise, lipid control
- smoking cessation
- bp control
Pharmacological
- Mht: most benefit to women age 50 - 60 or < 10 years since FMP, advantages diminish later due to atherosclerosis and hypercoagulability of oestrogen so actually dangerous.
Biochemical diagnosis menopause? (4)
- Estradiol: low
- FSH: high
- inhibin b: low
- AMH: low (not routinely done)
