Menopause Flashcards
What do the ovaries produce in reproductive years?
Estradiol, testosterone and androstenedione
What do the ovaries produce postmenopausally?
Androstenedione and testosterone (androgens then being converted by peripheral tissues into estrone)
What is the first and last hormone to be affected in menopause?
FIRST - FSH
LAST - oestradiol
How do circulating hormone levels differ in someone that is post-oopherectomy vs. postmenopausal?
People that have had a oopherectomy have far less testosterone and androstenedione
When should HRT be continued until?
At least until the natural average age of menopause (i.e. 51)
What proportion of older women have osteoporosis?
1 in 3
At what age is peak bone mass achieved?
25
What type of osteoporosis is more common in postmenopausal women?
Type 2
Type 2 affects men and women equally and in characterised by the loss of trabecular and cortical bone mass
What proportion of women will experience irregular bleeding within the first 3 months of using HRT?
80%
An ET of what, in a woman bleeding in the progesterone phase of sequential HRT, would warrant further investigation?
> 7mm
Where sinister causes of bleeding whilst on HRT have been excluded, what should be done?
Increase or change the type of progesterone
What is the mechanism of action of bisphosphonates in the treatment of oestrogen deficiency osteoporosis?
- Bind to the hydroxyapatite binding sites at the bone surface inhibiting their breakdown
- Also inhibit osteoclast mediated bone resorption
- May inhibit apoptosis of osteoblasts and osteocytes
When should progestogen only methods of contraception be used until?
Age 55
or
Check FSH levels - if FSH levels >30IU/L, can stop using contraception in 12 months
What is the most common cause of PMB?
Atrophic endometritis and vaginitis - accounts for 60-80% of cases
What type of progestogen may reduce the risk of VTE?
Micronised progesterone
How does osteoporosis occur in someone NOT using HRT?
An imbalance between osteoclastic and osteoblastic activity
Lack of oestrogen results in increased osteoclast activity, and therefore increased bone resorption
How does the bone structure change in osteoporosis?
- Fewer trabeculae
- Thinning of cortical bone
- Widening of hervasian canals
How should a low FRAX score be managed?
Lifestyle advice + HRT
How should a intermediate FRAX score be managed?
DEXA scan
How should a high FRAX score be managed?
Offer treatment
What are the possible DEXA scores?
+1 - -1 = normal
-1 - -2.5 = osteopenia
< -2.5 = osteoporosis
What dose of calcium/vit D should be offered as part of lifestyle management in relation to bone health?
Calcium 1000mg + Vit D 1000 IU
What is the definition of menopause?
12 months after last period
What is the burden of menopause Sx?
75% experience menopausal Sx,
25% describe severe Sx, 1/3rd experience long-term Sx