Menopause Flashcards
Menopause is defined as
the cessation of menses due to loss of ovarian activity, average age 51 in the US
Postmenopausal =
12+ months after final menses
Perimenopausal/ transition =
4-6 years of cycle changes and other sx before total cessation of menses
Premature menopause =
ovarian failure before the age of 40
Early menopause age =
40-45
Surgical menopause =
cessation of menses due to BSO
Menopause is a part of the normal …
aging process, is NOT a disease process
Menopause can be early in
smokers and in setting of malnutrition
Perimenopause:
Onset age =
Average length =
When does this begin?
What leads to pt’s having sx?
47
4-8 years
begins when the menstrual cycles begin to be irregular
erratic fluctuations of hormones lead to sx
Perimenopausal sx =
Vasomotor - hot flashes, night sweats, insomnia
Psych - depression, irritability, mood swings
Cognitive - concentration/ memory issues
Sexual - vaginal dryness/ dysparenia
Menstrual changes - longer/shorter cycles, irregular bleeding
other - urinary incontinence, dry itchy skin, wt gain
Physiology of Perimenopausal =
decrease synthesis of estrogens and progesterone
GnRH released at max - increasing androgens
testosterone production may continue for several more years after menopause
Types of estrogen:
Estrone (E1) = made after menopause
Estradiol (E2) = most common type of estrogen, most potent/ abundant during reproductive years
Estriol (E3) = main type of estrogen in a pregnant person’s bloodstream, prepares for childbirth
Consequences of estrogen loss
sx (early) - hot flashes, insomnia, irritability
Physical changes (intermediate) - vaginal atrophy, skin atrophy
Diseases (later) - osteoporosis, Coronary heart disease
Menopausal Menstrual changes
Luteal insufficiency - follicles become less responsive to FSH
fewer oocytes available in early follicular phase - FSH levels increase further
Corpus Luteum doesn’t function as well and progesterone secretion is diminished - result heavier menses
Changes in menstrual cycle during menopause
shortened cycles - luteal phase stays the same at 14 days but the follicular phase shortens because there are higher rates of follicular maturity
anovulation - accelerated decline in responsive follicles, bleeding episodes eventually spread out and then stop
What causes the follicular phase to shorten during menopause
Higher FSH levels cause follicles to mature faster - ovulation occurs earlier (hence the overall cycle is shortened)
Vasomotor symptoms that occur with menopause
hot flashes and night sweats
present in 75% of women
Hot flashes and night sweats are when
there is a sudden sensation of heat centered in face and chest that rapidly becomes generalized
can last 2-4 min - can have one or more per day
average duration is approx 5 years (but can continue for up to 10 after LMP)
can arouse from sleep leading to sleep disturbance
What is the most common reason women seek medical attention during menopause?
vasomotor sx - can significantly impair quality of life
VMS etiology
not fully understood
skin temps rise because of peripheral vasodilation followed by drop in core temp
How to treat VMS
Exogenous estrogen widens thermo-regulatory zone so fewer sx
Atrophic Vulvovaginitis is when
there is a gradual thinning of the genital mucosa
loss of vaginal rugae (folds)
decreased pliancy of the tissue, less flexible
Drier
pH becomes alkaline, change in microbiome
Sexual changes with Atrophic Vulvovaginitis
dyspareunia
decreased lubrication with arousal
increased frequency of UTI/ candidal infection
lack of desire, longer arousal cycle
Treatment of Atrophic Vulvovaginitis
personal lubricants and moisturizers, vaginal estradiol
encourage communication with partners, provide education
Recurrent UTI - Genitourinary syndrome of menopause –> is dx when
> 2 culture confirmed UTI’s in 6 months or
3 in 12 months
Women are at an increased risk when reached menopause
cardiovascular health - MI
bone health - osteoporosis
cognitive changes - depression, anxiety, sleep disturbance, brain fog
hair and skin changes - thinning of skin and hair, hirsutism
Early and premature menopause is due to
ovarian dysfunction
ages 40-45 = early menopause
before age 40 = premature menopause
treatment of early and premature menopause
unless contraindicated may want to use HRT until natural menopause age (51)
Positive menopausal changes include
decreased issues with fibroids and endometriosis
end of menstrual migraines and PMS
no more need for contraceptives, no more menses and monthly hormonal cycles
Treatment for menopausal sx
reassurance - this is a normal aging process
comfort measures - vaginal lubricants, natural products
VMS- estrogen/ progesterone - if contraindicated you can use SSRIs SNRIs clonidine
Prolonged, heavy or frequent vaginal bleeding (peri-menopausal care) you should
transvaginal US +/- endometrial sampling to exclude hyperplasia/ neoplasia
Why do you always have to give estrogen with progesterone
to prevent endometrial carcinoma
if the pt has had a hysterectomy - you can give estrogen by itself
Special concerns for any vaginal bleeding after one year of amenorrhea
must be investigated
high suspicion for malignancy
endometrial polyps
endometrial hyperplasia
If estrogen HRT is being used, patients may have
spotting
Postmenopausal Care and Screening
Pap every 3-5 years
Mammogram
Osteoporosis/ Cardiovascular/ Colon cancer risk
Pelvic organ prolapse is when
descent toward the vaginal introitus of some or all:
- anterior vaginal wall (cystocele)
- posterior vaginal wall (rectocele)
- uterus (enterocele)
Pelvic organ prolapse develops _______ and _______ with age
gradually
increases
Pelvic organ prolapse often seems to the pt to be
sudden and concern for a tumor
Pelvic organ prolapse risk factors
obesity
chronic constipation
operative delivery
multiparity
chronic cough
heavy lifting for work
Pelvic organ prolapse clinical presentation
smooth/striated appearing, pink bulging tissue at vaginal opening
Cystocele can make voiding difficult
Rectocele can impair bowl evacuation
Prolapse can feel heavy, cause dull backache - but does not cause severe pain
Pelvic organ prolapse treatment
watchful waiting with reassurance if not bothersome
pelvic floor exercises
pessary
surgical repair (if uterus then hysterectomy)
Vaginal obliterative procedure in select pts
