Menopause Flashcards
What is the climacteric?
A period between 45-55 when ovulation becomes irregular as the body transitions to a nonreproductive state
What is the menopause, and when does it occur on average?
The last menstruation
At 51
When does premature menopause occur?
Before 45
Occurs in 1% of women
What are the symptoms of the menopause?
Early changes:
Hot flush
Insomnia, anxiety, lethargy, reduced libido
Female sexual dysfunction,
Longer term changes:
Drier and more wrinkled skin due to collagen loss
Hair loss
Breasts shrink
Cessation of menstruation
Vaginal atrophy
Prolapse
Urinary urgency and other in continence issues
Increased risk of cardiovascular disease
Bone:
Osteoporosis - due to calcium loss- enhanced bone frailty and fractures
Spine height loss
What investigations are indicated in menopause?
LH and FSH are high following menopause, though these may fluctuate in the climacteric period
Mammography three yearly after menopause
Endometrial biopsy to assess PMB
Bone density assessment if high risk for osteoporosis
What are the risk factors for osteoporosis?
Positive family history Steroid usage Low BMI Early menopause Increasing age Cigarettes and alcohol Low calcium intake Sedentary lifestyle Chronic disease
When is HRT indicated?
Current indications for the use of HRT are:
For the treatment of menopausal symptoms where the risk:benefit ratio is favourable, in fully informed women.
For women with early menopause until the age of natural menopause (around 51 years).
What are the benefits of HRT?
Short term:
Symptom relief
May be beneficial in regulating erratic bleeding during the climacteric
Long term: Reduces bone density loss Partly reverses established osteoporosis May reduce collagen loss in skin Reduces bladder dysfunction May increase libidos
What are the disadvantages of HRT?
Short term: Menstruation Headaches Breast tenderness Fluid retention Premenstrual symptoms Most of the above (apart from menstruation) diminish after three months
Long term:
Breast cancer is slightly increased (3% a year)
Thromboembolic disease risk increased
Increased risk of endometrial carcinoma
What forms may hormone replacement therapy come in?
Combination of oestrogen and progesterone, as oestrogen alone increases risk of endometrial cancer
Patch, implant, gel, pills
pills- 28 day cycle with oestrogen taken continuously and progesterone for 12 days out of the 28
Implant- in abdominal fat, lasts up to a year
What is the definition of post menopausal bleeding?
Vaginal bleeding occurring at least 12 months after cessation of menstruation
What are the causes of PMB?
Endometrial carcinoma Endometrial hyperplasia and polyps Cervical carcinoma Atrophic vaginitis Cervicitis Ovarian carcinoma Cervical polyps
Investigate with endometrial biopsy!!!!
How can Atrophic vaginitis be treated?
Oestrogen cream/pessary
What type of HRT should be recommended for women who have bled within the last year?
Low dose cyclical HRT -
This gives progesterone on the last 12 days of he 28 day cycle
Give for maximum of five years
Once amennorrhoeic for 1 year, give continuous therapy
What type of HRT should some who have not bled for one year have?
Low dose continuous combined HRT - tibolone
Oestrogen and progesterone are given throughout
