menopause Flashcards
what diet and lifetsyle factors affects menopause?
stop smoking
alcohol and caffeine consumption
weight loss
stress reduction
regular exercise
no uterus HRT
if BMI over 30?
oestrogen only as a transdermal patch
otherwise oestrogen with progetserone
brand Elleste solo
Elleste solo
HRT
how can it be taken
routes?
monthly : oestrogen every day and progesteron last 14 days
3 monthly : progesterone only last 14 days of 3 month period, oestrogen every day
continuous: oestrogen and progesterone daily
oral, transdermal, vaginal creams / gels
genital tract symptoms of menopause?
dryness, dysparaeunia
risks of HRT
oestrogenic effects?
progestogenic effects?
breast cancer
CVD
VTE
breast tenderness, nausea, headaches
fluid retention, mood swings, depression
contraindications of HRT
pregnancy
breast cancer
endometrial cancer
htn
VTE
thrombophilia
vaginal bleed
severe liver disease
non hrt medications?
vasomotor
fluxetine
citalopram
venlafaxine
non hrt
vaginal dryness
lubricant
what occurs in menopause ?
hot flushes
sexual dysfunction
mood changes
holistic approach to managing menopause
lifestyle factors - diet, alcohol, smoking, weight loss
medical options : HRT, SSRI, lubricants and
- risks/ se
need for contraception >2 year is amenorrhoeic <50
MDT approach; GP, psychosexual counselling, gynaecology
define menopause
○ The last menstrual period
○ Cessation of regular ovarian function
avaerage age for menopause in Uk
51§§
where is inhibin b produced?
what is the impact in menopause
follicles within ovary
this leads to increased GnRH pulsatility
hot flush is otherwise known as ?
vasomotor symptoms
oestrogen has a modulating effect on serotinergic receptors in the thermoregulatory pathways of the brain
so lack of oestrogen > exaggerated peripheral vasodilatory responses to minor atmospheric changes in temperature
psychological impact of menopause?
depression (phq-9)
low mood
irriability
lack of energy
genital tract effects
vaginal dryness
dysparueania
pH increases - more susceptible for infection
atrophy - shrinkage and fusion of labia and narrowing of vaginal introitus
bone health
risk of osteoporosis
lifestyle measure
smoking
alcohol
exercise
nutruition
contraceptive needs/ sexual activity
hrt routes of adminstartion?
oral
transdermal
absolute contraindications for HRT
thrombophilia
factor V leiden
otoscelorosis
endometrial cancer
active liver disease
s/e oestrogens
breast tenderness / swelling
nausea
cramps
headaches
s/e progesterones
fluid retention
breast tenderness
mood swings
depression
acne
Perimenopause
change to periods and menopause symptoms but still having periods
categorise menopause symptoms
mental health
physical
> vaginal dryness / pain/ itch / dysparaenia
> UTI
headaches and migraines
> palpitations
charity that can support with menopause?
Daisy network
menopause matters
queermenopause
how can vaginal dryness be combatted?
vaginal oestrogen
pessary
cream (moisturisers/ lubricants)
vaginal ring
HRT and VTE risk
tablets are more risk causing
offer patch/gel
HRT and breast cancer risk
oestrogen only no change /
progesterone and oestrogen slight increase; risk higher when taken longer
risk falls when stop
POI investigation?
blood test meausre FSH
2 FSH tests 4-6 weeks apart
Mx of POI
HRT and / OCP
HRT better for BP
good for bone health
contrainidication for HRT
current / past breast cancer
oestrogen sensitive cancer
undiagnosed vaginal bleed
untreated endometrial hyperplasia
