menopause Flashcards
when can you diagnosis the menopause?
Menopause is a retrospective diagnosis and can be made after a woman has had no peroids for 12mths
- Average age is 51yrs
- Can vary
what is post-menopause?
describes the period from 12mth after final menstrual period onwards
what is perimenopause?
Perimenopause: refers to the time around menopause experiencing vasomotor symptoms and irregular periods
- Includes time leading up ot last menstrual period and then 12mths following
what is premature menopause?
: menopause before aged 40
which hormones drop in menopause?
oestrogen and progesterone
which hormones are high during menopause?
- LH and FSH are high response in negative feedback to of absence of oestrogen
what causes the changes in sex hormones?
Menopause is caused by lack of ovarian follicular function and results in changes in sex hormones associated with cycle
describe the process of primordial follicles maturing?
Inside ovaries: process of primordial follicles maturing
- Mature into primary and secondary follicles
- FSH stimulates futher development of secondary
- As follicles grow granulosa that surround them secrete increasing amounts of oestrogen
describe the hormonal process of menopause?
Process of menopause:
- Decline in development of ovarian follicles
- No development = reduced production of oestrogen
- No oestrogen = no negative feedback loop to pituitary increases levels of FSH and LH
how does failing follicular development lead to anovulation?
Failing follicular development = anovulation
- Resulting in irregular menstrual cycles
- Without oestrogen endometrium does not develop leading to lack of menstruation
- Lower levels of oestrogen also cause perimenopausal symptoms
how many recognised menopausal symptoms are there?
36
name some perimenopausal symptoms?
- Hot flushes
- Emotional lability or low mood
- Premenstrual syndrome
- Irregular periods
- Joint pains
- Heavier/ lighter periods
- Vaginal dryness and atrophy
- Reduced libido
what does the menopause put you more at risk of?
lack of oestrogen also increases risks of other conditions:
- CVS and stroke
- Osteoporosis
- Pelvic organ prolapse
- Urinary incontinence
how do you diagnosis menopause is those <45?
need FSH blood test to aid diagnosis when:
- Under 40yrs and suspected premature menopause
- Women aged 40-45 with menopausal symptoms or change in menstrual cycle
when do you need contraception til?
- 2yrs after LMP in <50
- 1yr after LMP >50
when does fertility majorly decline?
40
these pregnancies are incredibly high risk
what might hormonal contraception do through the menopause?
mask symptoms
make diagnosis hard
what methods of contraception are recommended during menopause?
- Use barrier, mirena coil/ copper coil, POP, Progesterone implant, depo injection, sterilisation
why should depo only be used by those <45?
under 45 due to risk of decreasing bone density
if hormonal pill, which can be used for contraception?
- COCP: can be used <50 if no contra-indications, but should use POP as less likely for VTE
what are treatment options of menopause?
- No treatment
- HRT
- Tibolone:
- clonidine
CBT
SSRI
testosterone
vaginal oestrogen
vaginal moisturisers
what is tibolone?
synthetic steroid hormone that acts as continuous combined HRT
when can tibolone be started?
only after 12 mths of amenorrhoea
what is clonidine?
acts as agonists of alpha-adrenergic and imidazoline receptors
