Menopause Flashcards
Menopause
Cessation of menstruation
Climacteric (perimenopause)
The period around the menopause and at least the first year after it
Post-menopause
12 months of no period
Average age of onset of menopause in the uk
51
Range of age of onset of menopause
48-52
Premature menopause
Before 40 (1%)
Cause of menopause
Age - depletion of primordial follicles
Causes of premature menopause
Idiopathic
Iatrogenic
Chromosomal (fragile X syndrome, FMR1)
Autoimmune
Others
Mechanism of menopause
Ovaries depleted of follicles
Decline of oestrogen production
Gradual decline with fluctuation over a few years
Gradual rise of FSH and LH (lack of negative feedback mechanism)
What is the age of menopause decided by
Size of primordial pool
Problems associated with premature menopause
Increased risk of mortality
Risk of cognitive dysfunction
Heart disease
Mood and sexual disorders
Bone mineral density
Autoimmune and thyroid disease
Short term symptoms of menopause
Vasomotor
Psychological
Urogenital
Skin
Long term risks of menopause
Osteoporosis
Cardiovascular disease
Vasomotor
Hot flushes
Sweats: mainly night
Palpitations
Headaches
Psychological
Irritability
Lethargy
Emotional lability
Forgetfulness
Loss of libido
Loss of concentration
Urogenital
Vaginal dryness
Dyspareunia- due to dryness
Urethral syndrome - mainly later on in the absence of HRT
Skin
Dryness of skin and hair
Brittle nails
Osteoporosis
Decreased amount of bony tissue per unit volume of blood
Wrist, femoral neck and vertebrae
Bone remodelling is uncoupled
5% loss of trabecular bone per year
Risk factors of osteoporosis
Race- European and Asian women
Nulliparity
Low body weight
Poor diet in childhood
Alcohol abuse
Heavy smoking
Steroids
Thyrotoxicosis, hyperparathyroidism, Cushing disease etc
Cardiovascular disease- myocardial infarction, angina and cerebrovascular stroke
Equal risk to me by age 70
Cause unknown
Family history is a determinant factor
Other variables: obesity, diabetes
Treatment of menopause
HRT
Sedatives and tranquillisers
Clonidine
Beta blockers
Maintaining pre-menopausal sexual activities
Calcium, vitamin D, calcitonin
Symptomatic treatment
HRT- hormone replacement therapy
Oestrogen
Progesterone if uterus intact - to reduce risk of endometrial cancer
Different formats
Different doses
HRT preparations
Oral
Skin patches
Vaginal cream
Skin cream
Nasal spray
Vaginal ring
Implants
Long term risk of HRT
Cardiovascular (E):
- Slight increase in CVS (oral vs transdermal)
- IHD no increased risk but no benefit
Breast cancer (E + P vs E):
Increased by 2 per 1000 if taken for >5 years.
6/1000 for 10 years use.
12/1000 for 15 years use.
VTE (venous thromboembolism): 1-3 in 10,000 women in the first year.
Cancer:
Slight increase in ovarian cancer (seq. HRT).
Endometrial Cancer: if unopposed E2.
