Menopause Flashcards
Def: Pre-menopause
Regular periods
Def: Peri-menopause
Irregular periods (Less or more frequent)
≥7 day differences in length between consecutive cycles
Def: Post-menopause
No periods > 12 months
Def: Premature ovarian insufficiency
Menopause occurring < 40 years old
Def: Early menopause
Menopause occurring ages 40-44
What is the average age of menopause in the UK
51
What is the average duration of menopause symptoms?
7.4 years
What is the average number of symptoms of menopause?
7
When are menopause symptoms usually most severe?
Late peri- to early post-menopause
What are some of the impacts of menopause symptoms?
Effect on home, work, social and sex liufe
What are some symptoms that won’t improve in the menopause?
Dry vagina
Painful sex
Urinary symptoms
What are the levels of FSH and oestrogen during menopause?
Variably high FSH
Low oestrogen levels (Causing high FSH)
What are the most common 3 menopause symptoms?
- Night sweats
- Hot flushes
- Mood swings
What are some other symptoms of menopause?
- Memory loss
- Aches and pains
- Period problems
- Anxiety
- Brain fog
- Dry skin and hair (Itchiness)
- Weight gain
- Dizziness
- Tiredness
- Palpitations
- Depression
- Painful sex (Dyspareunia)
- Recurrent UTI symptoms
- Headaches
- Pins and needles
- Lack of energy
- Irritability
- Loss of sex drive
- Insomnia
What are some other names for vulvo-vaginal atrophy?
Genitourinary syndrome of the menopause (GMS)
Urogenital atrophy
What is the main age cut-off for FSH testing in the menopause?
45 as FSH will fluctuate with the menopause
(Unless women aged >50 who want to stop contraception before 55)
Investigations in women >45 with atypical menopause symptoms
2 x FSH levels 6 weeks apart
Investigation of women 40-45 with menopausal symptoms and/or iatrogenic amenorrhoea (E.g. hysterectomy)
2 x FSH levels 6 weeks apart
Investigation of women < 40 with menopausal symptoms
FSH
E2
TFT
Glucose
Prolactin
Free androgen index (FAI)
Investigations of women <35 with menopausal symptoms
Chromosomal and autoimmune screening
How do FSH results affect HRT usage?
HRT can be started independant of FSH results
Contraception basics in peri-menopausal women aged < 40
- Premature insufficiency of ovaries may be transitional →
- Continue with contraception
Contraception basics in peri-menopausal women aged 40-49
- Contraception can be stopped:
- 2 years after last “natural” menstrual period (Not while on hormonal contraception, etc)
- 2 years after 2 results of FSH ≥ 30 IU/L, taken at least 4 weeks apart
Contraception basics in peri-menopausal women aged ≥50
- Contraception can be stopped:
- 1 years after last “natural” menstrual period (Not while on hormonal contraception, etc)
- 1 years after 1 results of FSH ≥ 30 IU/L
Contraception basics in peri-menopausal women aged ≥55
- Contraception can be stopped even if still having periods due to poor oocyte quality
- Might consider continuing contraception for another year or two if periods are troublesome (I.E. non-contraceptive indications)
Lifestyle management options for menopause
- Healthy diet (Exclude phytoestrogens)
- Regular exercise (Weight bearing, outdoors)
- Healthy weioght
- Good sleep hygeine
- No smoking
- Limited alcohol and caffeine
- Reducing stress (Yoga, mindfullness, relaxation techniques)
- CBT
Environmental management options for menopause
- Cooler ambient temperature
- Good ventilation
- Suitable clothing (Intelligent fabrics, cotton)
- Neck, and-held or desk fans
- Neck cooling scarf
- Cooling spray
Non-hormonal management options for menopause (Not much evidence)
- Herbal medications - St John’s Wort, Black Kohosh, Sage
- Non-hormonal medical treatment - SSRIs, Gabapentin, Oxybutinin, Clonidine
- Complementary medicine - Acupuncture, homeopathy, aromatherapy, hypnotherapy, acupressure
Benefits of HRT in menopause
- Reduction in vasomotor symptoms (Hot flushes, night sweats)
- Improvement of low mood association with the peri-menopause
- Improvement of sexual and cognitive function
- Reduction of osteoporosis risk and fragility fractures
- Prevention and treatment of urogenital and vulvovaginal atrophy (Can usually be controlled by vaginal oestrogen alone)
- Decreased risk of cardiovascular disease < 60
Risks of HRT in menopause
- Increased breast cancer risk
- Same risk as CHC, alcohol drinking, smoking
- Much lower risk than high BMI
- Oestrogen only HRT can decrease breast cancer risk
- Increased VTE risk (Oral HRT)
- Increased CVD risk > 60
Contraindications for HRT in menopause
- History of breast cancer or endometrial cancer
- Coronary heart disease, TIA or stroke
- Active liver disease
- Unexplained vaginal bleeding
HRT in women with premature ovarian insufficiency:
- Give HRT until the average age of menopause (51)
- CHC (Continuously) could be considered as alternative unless contraindicated
- HRT does not add risks compared to women without POI
- Continue with contraception
HRT in women with early menopause:
Consider strongly giving HRT until the average age of the menopause (51)
What are the 2 main categories of HRT?
Oestrogen only (Estradiol)
Oestrogen + Progesterone
How can HRT be taken?
Trans-dermally
Orally
What are the 3 main forms of transdermal HRT?
Gel
Spray
Patch
What is the main indicator of whether to give oestrogen only or oestrogen + progesterone HRT
Hysterectomy or Mirena coil
If yes, then oestrogen only is given
Why is oestrogen only HRT only given in cases of hysterectomy or Mirena coil?
Unopposed oestrogen increases risk of endometrial hyperplasia and therefore endometrial carcinoma
Hysterectomy removes the endometrium and Mirena coil opposes oestrogen
Describe the treatment regime for HRT treatment for peri-menopause
oestrogen + progesterone is given sequentially (2 weeks a month)
Describe the treatment regime for HRT treatment for post-menopause
oestrogen + progesterone is given continuously (Period free)
1st line management of vasomotor and mood symptoms of menopause
HRT
Is there an age limit on HRT?
No
How can HRT be stopped?
Can be both gradually stopped or immediately stopped depending on patient choice
What are the benefits of trans-dermal HRT?
No VTE risk
Better for symptom control
Lower CVD risk
Indications for transdermal HRT
- Individual preference
- Poor symptom control with oral HRT
- GI disorder affecting oral absorption
- Increased VTE risk (E.g. Obesity, FHx)
- Variable blood pressure control
Side effects of oestrogenic HRT
- Bloating
- Breast enlargement
- Breast tenderness
- Fluid retention
- Headaches/Migraines
- Leg cramps
- Mood swings
- Nausea§
Side effects of progestrogenic HRT
- Acne
- Anxiety
- Bloating
- Breast enlargement
- Breast tenderness
- Depression
- Headaches/Migraines
- Hirsutism
- Lower abdo/pelvic/back pain
- Mood swings
