Menopause Flashcards
What % of women have POI before 40?
1%
What % of women have POI before 30?
0.1%
Etiology POI
Familial 10%
Chemo, radio, surgery
Genetic conditions (turners, fragile x)
Autoimmune
Menopause diagnosis in age >45?
Symptoms alone
Menopause diagnosis in age 40-45?
Early menopause
5% of women
40-45
3/23 Oligo/amenorrhoea
FSH >30 2 samples 4-6 weeks apart
(unless on CHC or high dose progestogens)
POI
Diagnosis menopause in <40
<40
3/12 Oligo/amenorrhoea
Two FSH levels 4-6 weeks apart: >30
When to check FSH for menopause
- Age 40 - 45 with menopause symptoms and change in menstrual cycle
- <40 and menopause suspected
- POI
Symptoms of menopause
Last around 7 years
1/3 last longer
- Vasomotor (hot flushes/night sweats). 70 - 80%.
- GU sx, dry, pain, dysuria
- Mood, anxiety
- MSK
- Sexual difficulties
- Disturbance to cycles
- Disturbed sleep
- Low energy
- Impaired concentration, brain fog.
Average age of early perimenopause
47
cycles 6 to 7 weeks apart
Menopause symptom may start
Average age of late perimenopause?
49
Cycles few months apart and worsening of menopause symptoms
Long-term health implications
- Osteoporosis
- Increased risk of CVD
Progestogen for HRT in perimenopause
- sequential giving monthly bleed
Progestogen for HRT in postmenopause
Continuous, no bleeds
Types of progestogen for HRT
Micronised are plant derived, natural and bioidentical with slightly lower risk of breast cancer and no impact on VTE.
Synthetic progestogens: tablet, patch or IUS, impact VTE and higher risk of breast cancer
Testosterone indicated in HRT
Low libido and and drive
Possibly for mood and energy
Replaced at physiological level unlikely to cause adverse effects.
Consider if eastern alone not helpful
5 mg a day gel (unlicensed for women but used)
Check baseline level and against 3 months to ensure within female physiological range
HRT and breast cancer
Small increased risk in combined HRT only
Eastern alone Little/no risk
FHX not CI
Alcohol and obesity likely to have a greater impact than HRT.
The most women benefits outweigh risk of breast cancer
HRT use = lower mortality
Lifestyle measures for menopause
- Diet low salt/fat, high ca, vit D
- Exercise
- Smoking (increases risk CVD and osteoporosis).
- alcohol 2/3 units day and alcohol free day
- relaxation meditation/yoga
Advantages of HRT over COCO for POI?
Either can be used but HRT maybe more beneficial for bone health, BP, lower CVD risk
When does HRT increase risk of endometrial cancer?
> 5 years use of sequential HRT
Continuous use may reduce risk
Dose of progesterone for continuous use
0.5mg/day norethisterone
2.5mg medroxyprogesterone
Daily dose of progesterone for sequential HRT?
1mg norethisterone 10 days
200mg micronised PO progesterone 12 days
10mg medroxyprogesterone 10-14 days
10mg dydrogesterone 14 days
Dose of progesterone in high dose oestrogen HRT?
300mg micronised progesterone 12 day for sequential
200mg 10 days/month for cont use
Use of LNG-IUD for HRT
Only mirena licensed for 4 years
But evidence suggests 5 years protection
Lower dose devices need to add in further progesterone
