Menopause 2 Flashcards
What are the vasomotor symptoms in menopause ?
night sweats, hot flashes, and flushes
What is the treatment of vasomotor symptoms in menopause ?
1st line - HRT therapy
Who would you offer the combined oestrogen and progesterone HRT to and who would you offer the solo oestrogen replacement therapy to ?
- Oestrogen and progestogen to women with a uterus
- Oestrogen alone to women without a uterus.
What is the treatment of menorrhagia which may occur in perimenopausal phase ?
1st line = mierena (progesterone)
2nd line = Tranexamic acid although contraindicated in thromboembolic disease (mefenamic acid if pain, more for reducing pain but both are often used together)
3rd line = progestogens or norethisterone
4th line = endometrial ablation
What is the treatment of vaginal dryness in women with menopause (rememebr still talking about perimenopause if they get these symptoms)
Topical oestrogens
What would you consider using to treat someone with psychological symptoms in menopause ?
- Consider HRT to alleviate low mood that arises as a result of the menopause.
- Consider CBT to alleviate low mood or anxiety that arise as a result of the menopause.
No clear evidence for SSRIs to ease low mood in menopausal women who have not been diagnosed with depression - use if diagnosed with depression (refer to psychology)
Dad says that if in a women who doesnt want HRT then you would use SSRI and then refer for CBT (takes months to get someone CBT)
What is the conservative management advice offered to all women experincing symptoms ?
- Diet
- Weight loss
- Exercise
- Lifestyle
- Caffeine
What is the benefit of HRT therapy over single treatment of symptoms in menopause ?
It alleviates most of the symptoms experienced in menopause
If women experiencing vasomotor symptoms esp hot flushes but doesnt want to use HRT what would be the next treatment option?
Clonidine
What are the benefits of HRT therapy ?
- Reduction in vasomotor symptoms
- Improvement in psychological symptoms
- Improvement in urogenital symptoms - e.g. vaginal dryness and sexual function
- Reduction in osteoporosis risk
- HRT in women <60 decreases CVD risk
- Reduced risk of bowel cancer
- Possibly protective Alzheimer’s & Parkinson’s diseases
What are the main risks of HRT therapy ?
- Thromboembolic disease (VTE and PE),
- Stroke
- Breast cancer mainly once taken for over 5 yrs the risk increases - oestrogen only doesnt but combined does increase risk
- Endometrial (uterine) cancer - increased risk with oestrogen only, but no increased risk with combined
- Gallbladder disease.
What are the contraindications to HRT therapy?
- Pregnancy
- Undiagnosed abnormal vaginal bleeding
- Active or recent blood clot or myocardial infarction (heart attack)
- Suspected or active breast or endometrial (womb) cancer
- Active liver disease with abnormal liver function tests
- Porphyria cutanea tarda
What are the side effects of HRT therapy?
- Bleeding -HRT taken in perimenopause, (usually combined) induces a monthly bleed in about 85% of women.
- Nausea
- Fluid retention
What is the difference in HRT therapy for postmenopausal women and perimenopausal women ?
Cyclical HRT therapy for perimenopasusal women - this is where you take oestrogen every day and take progesterone only at certain times (cyclicly) - this often brings back someones periods
Continuous HRT therapy for postmenopasusal women (havent had period for 12months) - continuous oestrogen and progesterone taken everyday
How is premature ovarian failure diagnosed ?
Diagnose premature ovarian insufficiency in women aged under 40 years based on:
- menopausal symptoms, including no or infrequent periods (taking into account whether the woman has a uterus) and
- elevated FSH levels on 2 blood samples taken 4–6 weeks apart.
