Menopause Flashcards
Define menopause
Permanent cessation of menstruation caused by failure of ovarian follicular development and oestrogen production
What age is classified as early menopause?/
Under 45 years old
What age is classified as premature menopause?
Under 40 years old
What is surgical menopause/
Permanent cessation of menstruation after bilateral oophorectomy
What is premature menopause?
Cessation of menstruation due to depletion of ovarian follicles before age of 40 (premature ovarian failure)
What is perimenopuase?
Physiological period in a women’s life before menopause when there is a regression of ovarian function
What is the average age for menopause?
51
What are the 4 phases of menopause?
- pre-menopause
- peri-menopause
- menopause
- post menopause
Outline pre-menopause
- slightly less oestrogen secreted
- LH + FSH levels may rise
- reduced fertility
- cycles are relatively unchanged
Outline peri-menopause
- transition phase/climacteric
- follicular phase shortens
- early or absent ovulation (changes to cycle)
When does menopause occur?
When ovaries are totally depleted of follicles + no amount of stimulation from gonadotropins can force them to work
How do you diagnose menopause?
Diagnose without lab tests in healthy women over 45 years old with:
- peri-menopause: irregular periods, vasomotor symptoms
- menopuase: no period for >12 months + no using hormonal contraception
Who can you use FSH tests to diagnose menopause on?
- women 40-45 years with menopausal symptoms
- women under 40 years when menopause in suspected
When should you not use FSH tests to diagnose menopause?
In women using combined oestrogen + progesterone contraception or high dose progesterone
Early symptoms of menopause
- hot flushes
- sweating
- insomnia
- irregular periods
Intermediate symptoms of menopuase
- vaginal atrophy
- dysparenunia
- skin atrophy
- urge-stress incontinence
Late symptoms of menopuase
- osteoporosis
- atherosclerosis
- coronary heart disease
- cardiovascular disease
- Alzheimer’s
Due to lack of protective effect of periods + oestrogen
What are the changes that occur to the menstrual pattern during menopause?
- intermenstrual bleeding
- Menorrhagia
- mid-cycle bleeding
- itregular cycles
How does changes in oestrogen cause changes in menstrual pattern in menopause?
- hyperplasia of endometrium (thickening)
- this causes late menstrual period the irregular bleeding + spotting
- no corpus luteum due to no progesterone
- increased rick of carcinoma
What psychological changes can occur during menopause?
- irritability
- confusion
- lethargy
- memory loss
- loss of libido
- brain fog
What changes to appearance can occur during menopause?
- skin
- weight
- hair
- voice
- skin loses elasticity + becomes thin due to loss of elastin + collagen
- increased weight due to irregular food habits as a result of mood changes
- more deposition of fat around hips, waist + buttock
- hair becomes dry + coarse
- possible hair loss
- voice deepens as vocal cords thicken
Menopausal effects on the urinary system
Tissue lining urethra + bladder becomes thinner + less elastic:
- loss of pelvic tone
- urinary incontinence
- reduced elasticity of bladder > frequency, urgency + nocturia
- increased risk of UTI
Menopausal effects of GI tract
Decreased motor activity of entire digestive tract > constipation
Menopausal changes in genital organs
How are these changes treated?
Due to lack of oestrogen:
- thinning of vaginal skin > superficial dyspareunia + bleeding
- lack of glycogen > increase in vaginal pH > increased risk of infection
.
Topical oestrogen
Menopausal changes to the breast
- low oestrogen levels decrease fat + tissue in breast
- mammary gland tissue shrinks
- breasts sag as connective tissues lose elasticity
Menopausal bone changes
- calcium loss
- reduced oestrogen enhances osteoclast ability to absorb bone
- risk of osteoporosis + fragility fractures
Conservative management of menopause
- regular exercise
- avoid triggers
- sleep hygiene
- keep hydrated + eat healthy
- need for contraception until periods stopped
Benefits of hormone replacement therapy for menopause
- reduced vasomotor symptoms
- improvement in mood changes
- improvement in urogenital symptoms
- reduced osteoporosis risk
- reduced risk of colorectal cancer
Treatment of vasomotor or mood changes in menopause
Oral or transdermal HRT
- Combined oestrogen + progesterone if with uterus
- oestrogen only is no uterus
Risks of hormone replacement therapy
What type increases risk?
- Venous thromboembolism: oral
- Coronary heart disease: no increased risk if start before 60 years old
- Stroke: tablets
- Breast cancer: combined oestrogen + progesterone
- Endometrial cancer: oestrogen only
Advantages and disadvantages of oral HRT
advantages:
- cheap
- effective
.
disadvantages:
- first pass metabolism
- variable plasma levels
- higher dose needed
Advantages and disadvantages of transdermal HRT (patch/gel)
advantages:
- avoids first pass metabolism
- reduced risk of VTE
- continuous administration
.
disadvantages:
- cost
- skin reactions
Advantages and disadvantages of vaginal HRT
advantages:
- good for urogenital symptoms
- minimal systemic absorption
.
disadvantages:
- unlikely to treat other symptoms
Advantages and disadvantages of mirena intrauterine system HRT (progesterone coil)
**advantages*:
- lasts for 4 years to provide progesterone
.
disadvantages:
- only provides progesterone for endometrial protections
- patients still need oestrogen another way
