menopause Flashcards
what age does menopause typically happen
51 y/o, symptoms last 7 years (varies)
- permanent cessation of menstruation
- It is caused by the loss of follicular activity
- clinical diagnosis - when no period for 12 months
contraception around menopause
> 50s -12 months after last period
<50s - 24months after last period
longer term complications of menopause
osteoporosis
increased risk of ischaemic heart disease
lifestyle management of menopause
regular exercise (avoid late evening), reduce stress, weight loss, good sleep hygiene
contraindication to HRT
- current/previous breast cancer
- any oestrogen-sensitive cancer
- undiagnosed vaginal bleeding
- untreated endometrial hyperplasia
vasomotor symptom management in menopause (hot flushes)
fluoxetine, citalopram or venlafaxine
(non-HRT option)
how does HRT work
the use of a small dose of oestrogen (combined with a progestogen in women with a uterus) to help alleviate menopausal symptoms
side effects of HRT
- nausea
- breast tenderness
- fluid retention + weight gain
complications of HRT
increased risk of -
- breast cancer
- endometrial cancer
- VTE - transdermal does NOT
- stroke
- ischaemic heart disease
why does HRT increase the risk of breast and endrometrial cancer respectively
breast - by the addition of progestogen
- risk relates to duration of use
- risk declines when stopped, gone after 5 years
endometrial - due to oestrogen
- oestrogen alone should not be given as HRT to women with a womb
- reduced by addition of progestogen (but not eliminated)
atrophic vaginitis presentation
- vaginal dryness
- dysparenunia
- occasional spotting
O/E - vagina appears pale/dry
atrophic vaginitis management
vaginal lubricants / mosturisers
if these dont help -> topical oestrogen
types of urogenital prolapse
- cystocele, cystourethrocele
- rectocele
- uterine prolapse
less common - urethrocele, enterocele (herniatioon of pouch of doug, inc small intestine, into vagina)
risk factors for urogenital prolapse
increasing age
multiparity
vaginal deliveries
obesity
spina bifida
prolapse presentation
sensation of pressure/heaviness “bearing down”
urinary symptoms - incontinence, frequency, urgency
prolapse management
- conservative - weight loss, pelvic floor ex
- ring pessary
surgery
surgical mangement of prolapse
cyctocele/cystourethrocele - anterior colporrhaphy, colposuspension
uterine prolapse - hysterectomy, sacrohysteropexy
rectocele - posterior colporrhaphy
lichen sclerosus
inflammatory condition affecting genitalia, more common in elderly females
leads to atrophy of epidermis with white plaques forming
lichen sclerosis presentation + diagnosis
white patches that may scar
itch is prominent
pain during sex/urination
diagnosis = clinical
(biopsy if atypical features)
management lichen sclerosus
topical steroids + emollients
follow up ! increased risk of vulval cancer !
vulval intraepithelial neoplasia (VIN)
pre-cancerous skin lesion of vulva, may result in SQUAMOUS skin cancer if untreared
average age affected = 50y/o
risk factors for developing vulval intraepithelial neoplasia
HPV - 16&18
smoking
herpes simplex virus 2
lichen sclerosus !
vulval intraepithelial neoplasia presentation + diagnosis
itching, burning
raised well defined skin lesions
biopsy - punch/excisional
HPV testing - PCR
management of vulval intraepithelial neoplasia
topical
- imiquimod
- 5-fluorouracil
surgical - wide local excision, laser ablation, partial vulvectomy
follow up - monitor with repeat colposcopy + biopsy is recurrence
management of stress incontinence
pelvic floor muscle training (3 months)
surgical - retropubic mid-urethral tape
duloxetine - if surgical mx declined
duloxetine MoA in stress incontinence
a combined noradrenaline and serotonin reuptake inhibitor
increased synaptic concentration of noradrenaline and serotonin within the pudendal nerve → increased stimulation of urethral striated muscles within the sphincter → enhanced
