Menopause Flashcards
What is the definition of menopause?
Permanent cessation of menstruation, characterised by at least 12 months of amenorrhoea in otherwise healthy women over the age of 45 who are not using hormonal contraception.
What is the average age of menopause in the UK?
51
What is the age cut off for premature ovarian insufficiency and early menopause?
POI = <40
Early menopause = 40-44
What are some clinical features of menopause?
Vasomotor: hot flushes, night sweats
Sexual: vaginal dryness, reduced libido, problems with orgasm, dyspareunia
Psychological: depression, mood swings, lethargy, reduced concentration
Symptoms most severe in late peri- and early post menopause and improve with time except GU problems
What are some investigations for menopause?
Pregnancy test
FSH 2x 6 weeks apart:
- Women >45 atypical symptoms
- Women 40-45 with menopausal symptoms and/or iatrogenic amenorrhoea
FSH, E2, TFT, glucose, prolactin, FAI:
- Women <40
Check chromosomes and exclude autoimmune disorders:
- Women <35
What are some lifestyle changes for managing menopause?
Healthy diet and weight
Regular exercise
Good sleep hygiene
No smoking
Limit alcohol and caffeine
Reducing stress (yoga, mindfulness, relaxation techniques)
CBT
What are some environmental changes for managing menopause?
Cooler ambient temperature
Good ventilation
Suitable clothing
Neck, hand-held or desk fans
Neck cooling scarf
Cooling spray
What are some non-hormonal medications for menopause?
Herbal medicine (eg St. John’s Wort)
Antidepressants, gabapentin
Acupuncture, homeopathy
How should HRT be given to women experiencing menopause?
Therapeutic trial independent from blood results and/or amenorrhoea
Very effective for symptom control
Oestrogen and progesterone for women with uterus
Oestrogen alone to women without uterus
Vaginal oestrogen for urogenital atrophy
How should women with premature ovarian insufficiency be treated with HRT?
Give HRT until average age of menopause and continue contraception
How should women with early menopause be treated with HRT?
Strongly consider giving HRT until average age of menopause and continue contraception
What are some risks of HRT?
VTE (oral preparation)
Stroke (oral preparation)
Breast cancer (oestrogen and progesterone preparations)
Small increase in risk of coronary heart disease (oestrogen and progesterone preparations)
What are some benefits of HRT?
Reduces osteoporotic fractures
May improve muscle mass and strength
Potential reduced risk of coronary heart disease (oestrogen alone preparation)
What are some contraindications to taking HRT?
History of breast cancer
CHD
TIA/stroke
Unexplained vaginal bleeding
Active liver disease
