Menopause Flashcards
How is menopause defined?
Absence of menses for >12 months (retrospective Dx)
Give 4 signs/ symptoms of menopause
Amenorrhoea
Vasomotor (hot flushes, night sweats, palpitations)
Urogenital (vaginal dryness, dyspareunia, recurrent UTI)
Psychological (poor concentration, lethargy, anxiety, depression, short term memory impairment)
What should the FSH/LH/ serum oestradiol be in menopause?
FSH/LH: High (as unopposed)
Oestradiol: Low
How should menopause be managed?
If have uterus: systemic oestrogen combined with progesterone to protect against endometrial carcinoma
If don’t have uterus: systemic oestrogen (note CI eg DVT)
How can HRT be given if there is a history of DVT/ stroke?
Topically/ Transdermally
When should HRT be offered in menopause?
When lifestyle adaptations (eg exercise + alcohol reduction) have been insufficient
When is cyclical/ sequential HRT indicated?
In perimenopausal women
How should cyclical/ sequential HRT be administered?
If regular periods: monthly- oesterogen every day + progesterone for last 14 days
If irregular periods: oestrogen every day for 3 months + progesterone for last 14 days
Withdrawal bleed occurs when on progesterone
To who should continuous HRT be administered? How?
Post menopausal women
Oestrogen + progesterone every day
List 7 absolute CI to HRT
Breast cancer (current + past)
Undiagnosed vaginal bleeding
Untreated endometrial hyperplasia
Hx of VTE
Pregnancy
Severe liver disease
Current thrombophilia (eg FV Leiden)
What are alternatives to HRT for vasomotor symptoms of menopause?
1st line = SSRIs (eg fluoxetine)
2nd line = citalopram/ venlaxafine
What are alternatives to HRT for vaginal dryness in menopause?
Lubricants
What are alternatives to HRT for bone health can be used in menopause?
Osteoporosis Tx eg bisphosphonates
For how long should effective contraception be used for in menopause?
12 months after the last period in >50y
24 months after the last period in <50y
What conservative measures can be used in menopause?
Hot flushes
regular exercise, weight loss + reduce stress
Sleep disturbance
avoiding late evening exercise + maintaining good sleep hygiene
Mood
sleep, regular exercise + relaxation
Cognitive Sx
regular exercise + good sleep hygiene
Why must unopposed oestrogen be avoided in women with a womb?
Risk of endometrial cancer
For how long do symptoms of the menopause last on average?
2-5y
What are the risks of HRT treatment?
VTE: slight increase in risk with all forms of oral HRT. No increased risk with transdermal HRT.
Stroke: slightly increased risk with oral oestrogen HRT.
Coronary heart disease: combined HRT may be a/w a slight increase in risk.
Breast cancer: increased risk with all combined HRT although the risk of dying from breast cancer is not raised.
Ovarian cancer: increased risk with all HRT.
What are the longer term complications of the menopause?
osteoporosis
increased risk of ischaemic heart disease
What is the main cause of symptoms in the menopause?
Reduced levels of oestrogen
In women with BMI >30 and a hysterectomy, what HRT should be given?
Transdermal patch oestrogen only
In which 7 patient groups is transdermal HRT indicated?
GI disorder affecting oral absorption
Previous or FH of VTE
BMI >30
Variable BP control
Migraine
Current use of hepatic inducing enzymes medication
Gall bladder disease
