Menopause Flashcards
In Perimenopause FSH levels increase, why
Ovarian function decreases and so does oestrogen production. So FSH stimulates ovaries to produce oestrogen
What is the normal age for menopause in the UK?
51
What are the physical symptoms of menopause?
• hot flushes
• night sweats
• muscle pain
• heart palpitations
• skin/hair changes
• weight gain
What are the psychological changes?
• anxiety
• low energy
• cognitive changes
• mood disturbances
• sleep disturbances
What are the gynaecological symptoms
• vaginal dryness
• low libido
• urinary incontinence
• menstruation irregularity
What is considered a red flag symptom in menopause
Vaginal bleeding
Which medication can cause similar side effects to menopause symptoms
• opiates
• nitrates
• SSRIs
• CCB
What are some differential diagnosis?
• anxiety
• panic attacks
• alcohol induced symptoms
• drug induces symptoms
• TB
• secondary amenorrhoea
Complications of Postmenopausal women?
• CVD
• osteoporosis
• stroke
Complications in perimenopausal women
• CVD
• osteoporosis
• T2DM
• TB
Link between TB & Menopause
Hot flush and night sweats
Define perimenopause
Last menstruation <1 year ago
Define postmenopause
Last menstruation >1 year ago
Oral, patches and gels for those who take oestrogen only
Oral - Elleste solo
Patches - Evorel (1 patch, twice weekly)
Gel - estrogel (1.5mg daily)
Oral and patches for those on Sequential combined
Oral - Ellet’s duet
Patches - Evorel sequi (1 patch, twice weekly)
Gel - oestrogel + progesterone
Oral, patches and gel for those on continuous combined
Oral - kilofem (OD)
Patches - Evorel conti (one patch twice weekly)
HRT ADRs?
• headaches/migraines
• breast tenderness
• back pains
• bloating
• nausea
• diarrhoea
• Fluid retention
• leg cramps (oestrogen)
• hair loss
(Period like)
HRT CI
• breast cancer
• oestrogen dependent cancer
• VTE
• atrial thromboembolism disease (mi, angina)
• liver disease
• pregnancy
HRT risks
• breast, ovarian, endometriosis cancer
• stroke
• VTE (especially with oral)
• CVD (not >65)
How often should you monitor a patient on HRT
3 months then annually
When would it be appropriate to stop HRT
• when risks outweigh benefits
• patient is ready to stop
Who would be best for transdermal HRT
• risk of VTE
• high BMI >31
• preference oral
• on a hepatic indusing enzyme
• migraines
• lack of symptoms control with oral
HRT prevents osteoporosis, how?
Osteoarthritis- thinning of bones
Oestrogen helps with bone health
Cholecalciferol 400 unit dose can be taken to support bone health, what could you monitor
Plasma calcium conc
If management with HRT is not appropriate what other drugs can help with vasomotor symptoms etc?
• pregabalin
• gabapentin
• SSRI
• clonodine
• CBT
Which one of the previous drugs are also used in HTN
Clonidine
Up in till how long is ullipristal appropriate to use after unprotected conception
<120 hours
Up in till how long is levenogesterol appropriate to use after unprotected conception
<72 hours
What is the dose of Alendronic acid for postmenopausal women
10mg once daily
= 70mg weekly
What are the 2 first lines of bisphosphonates - oral
In post menopausal osteoporosis
Alendronic acid OR risedronate sodium
How often in bone density screening recommended in postmenopausal women at average risk
2-3 years
