Menopause Flashcards
What is menopause?
- No menstruation for 12 consecutive months
- Between the ages of 45 and 55 years
- Perimenopause: Symptoms may start a few months to years
before menstruation stops - Changes in menstruation: cycle length may become
shorter or longer, skipping months
Early menopause
Before 45 years old
Causes
- Surgical removal of ovaries
- Cancer treatment: Radiotherapy, chemotherapy
- Idiopathic (Premature ovarian failure)
Symptoms of menopause
Acute
- Cessation of menses
- Hot flushes, night sweats
- Mood swings, depression
- Decrease memory, difficulty concentrating
- Headaches
Medium-term (5-10 years in)
- Vaginal dryness, dyspareunia
- ↑ vaginal pH –> increased UTI
risk
- Loss of libido
- Stress and urge urinary
incontinence
- Skin thinning, brittle hair due
to loss of collagen
- Generalized aches and pains
Long-term
Cardiovascular
- Hypertension
- Ischemic heart disease, atherosclerosis
- Central abdominal fat redistribution (independent risk
factor for CVS, DM) Osteoporosis
- Fragility fractures
Psychological
- Mood issues
- Cognitive disorders: dementia
Effect of estrogen on CVS
- Protects against cardiovascular disease
- Beneficial effect on cholesterol
- Reduces the risk of plaque formation in the arterial walls
Management of menopause
- Lifestyle and education
- Keeping room temperature cool
- Lighter clothing
- Avoid triggers: spicy foods, caffeine, smoking, alcohol
- Exercise
- Cognitive behavioural therapy
- Support – Daisy network for POI, Woman-to-woman support group
- Pelvic floor exercises (keegel to prevent uterine prolapse)
- Moisturizers, lubricants - Medical
a. Hormonal
b. Non-hormonal alternatives
Medical - Hormone pharm
- Hormonal replacement therapy
- Replaces the hormone estrogen lost during the menopause
- Aims to relieve symptoms related to estrogen deficiency – hot flushes, vaginal dryness, and osteoporosis
- Reduces risks of osteoporosis, cardiovascular disease, stroke, dementia
Sequential combined vs continuous combined regime
Sequential combined regime
E every day, P 50% of the time (trisequens)
- Bleeding generally lighter and shorter than own menses
- Recommended for peri-menopausal woman (ie. woman < 45yo who have menopausal sx)
-> helps to control and regulate their bleeds
-> helps to prevent future sx once they are post-menopausal
Prolonged use ↑ risk of endometrial cancer (30%)
- Only statistically significant after 10 years or more
- No substantial ↑ risk remains at 5 years after cessation
Continuous combined regime
E+P every single day (femoston Conti)
- Bleed free
- Irregular bleeding in > 50% during 1st 3 months
- Recommended for true menopausal woman who no longer have menopause ie no bleed
-> helps to prevent unopposed oestrogen to reduce risk of endometrial cancer
Possible progestogen-associated side effects
- Dysphoria
- Perpetual sense of premenstrual tension
Risks of HRT
Cardiovascular Disease
Stroke
Venous Thromboembolism
Breast Cancer
- Use the most suitable type of treatment for patient
- Use at the lowest effective dose
- Use for the shortest duration of time necessary
When is HRT usually started?
Before age of 60 OR
Within 10 years of menopause
Contraception use in menopause
If > 50yo, continue for 1 year post LMP
If < 50yo, continue for 2 years post LMP
Contraindications to use of HRT
- Hormone-dependent malignancy (endometrial ca, past or present history
of breast cancer) - Thromboembolic disease
- Pregnancy
- Liver disease
- Uninvestigated abnormal per vaginal bleeding
- Acute intermittent porphyria
- SLE, cardiac disease (relative)
Options to use for estrogen (HRT)
Estradiol
- Transdermal (patch, gel)
- Tablets
- Subcutaneous implants
Vaginal preparations (cream, ring, tablets)
Options to use for progesterone (HRT)
Oral/transdermal
Mirena
Tibolone
1st line route of administration for estrogen (HRT)
Transdermal
