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Womens health > Menopause > Flashcards

Menopause Flashcards

1
Q

Define menopause?

A

12 months after last period

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2
Q

What is the average age of menopause in Australian women?

A

48-55 years old

Massecheuts womens health study 51.3 years old.

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3
Q

Define perimenopause and average age of perimenopause?

A

can range from 39 to 51 years old.
variable symptoms including bleeding problems, vasomotor symptoms, insomnia, dry vagina, low libido, night sweats, mood swings.

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4
Q

Why are menopausal women at risk of osteoporosis?

A

Loss of oestrogen as a anti osteoclast action.

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5
Q

Are there any ways of predicting how long a women will experience menopausal symptoms?

A

No, hormone tests are not useful.

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6
Q

What is the value of measuring the anti mullerian hormone and menopause?

A

Can be useful when combined US to check number of follicles. On its own, not a useful predictor of ovarian reserve and time till menopause.

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7
Q

How would you interpret a set of hormone blood tests including FSH, LH, Oestrogen?

A

In menopause, FSH may be elevated 10-20 times
LH may be elevated 3 times
Oestradiol is the principal oestrogen produced by the ovaries. In menopause, the small amount of oestrogen is produced by peripheral conversion of androstenidiene.

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8
Q

What is the mean duration of vasomotor symptoms?

A

average time is 5.5 years, some women get no symptoms. Some women may get symptoms longer.

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9
Q

Outline the 3 main groups of menopausal symptoms?

A

Vasomotor - hot flushes, night sweats
Urogenital symptoms - vaginal dryness, dyspareunia, urinary frequency
Sleep disturbance

Other symptoms include 
Mood swings
weight gain 
aches and pains
reduced concentration and memory 
fatigue
skin changes
thinning scalp
decreased libido.
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10
Q

In a women who presents with suspected hotflushes, what history and physical examination would you perform?

A 
history of presenting illness - vasomotor symptoms, urogenital, sleep disturbance. Associated symptoms 
General medical included CVD, obstetric and gynacological. 
sexual health 
menstrual history
Risk factors for OP
Smoking, alcohol, physical activity 
breast exam 
Papsmears
Blood pressure
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11
Q

Name 1 questionaire you can administer to ascertain her symptoms of menopause?

A

Green score - found on UK menopause matters in website.

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12
Q

In a patient with suspected menopause, what investigations would you order?

A

Don’t do FSH, LFH, oestrogen and testosterone, unless younger than 45 years old.
investigatons targeted at preventative measures for fatigue and CVD
FBC, and ferritin for iron deficiency
LFT just in case need HRT
Lipids - HDL tends to fall when loss oestrogenic activity.
TSH
BMD in those medically indicated, ie early menopause
Mammogram
Papsmear
US uterus - is concerned about bleeding.

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13
Q

In patients with a previous hysterectomy, what forms of HRT would you prescribe?

A

Vaginal oestrogen in patients with primarily urogenital symptoms.
Continuous oestrogen in patients with a hysterectomy.

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14
Q

In a patient with premature menopause, what forms of HRT would you prescribe?

A

If less than 40 years of age, prescribe HRT until 50 years old unless contraindicated, or low dose COCP

Tibolone (not PBS listed)

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15
Q

In a patient during the menopausal transition, what form of HRT could you consider?

A

Low dose COCP in women with low CVD profile.

or

continuous oestrogen plus cyclic progesterone days 16-28 plus contraception ie barrier, sterilise, implanon.

Or

continuous oestrogen plus mirena IUD.

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16
Q

In a post menopausal lady with a uterus, what forms of HRT could you consider?

A

continuous oestrogen + cyclic progesterone if less than 12 months since menopause

Continuous oestrogen plus continue progresterone if menopause > 12 months

or
Tibolone (not PBS) use if > 12 months since menopause.

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17
Q

Does HRT cause weight gain?

A

No

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18
Q

Why would you consider a transdermal preparation over a oral HRT?

A

Transdermal HRT carries a lower risk of VTE, stroke, hypertriglyeridaemia.

19
Q

In women with an intact uterus, treated with unopposed oestrogen, how long does it take for endometrial hyperplasia to occur?

A

6 months, so need progesterone as well.

20
Q

Outline the bleeding patterns in women using HRT?

A

Obviously in post menopausal women, there will be no bleeding.
In women on continuous oestrogen and progesterone will have ammenorrhoea > 90%.

In women on cyclical progesterone and continuous oestrogen, most experience withdrawing bleeding after the last dose of progesterone, some women may get bleeding during the progesterone pills taken from 16 to 18 days.

21
Q

What is your response to a women who asks you about the use of remifemin for the treatment for her menopause?

A

Blackcohosh - meta analysis - suggest no difference between taking placebo.

22
Q

Name 2 foods that contain naturally occurring phytoestrogen?

A

soybeans and lentils

but much weaker than human oestogen.

23
Q

What would be your advice be in patient who presents with HRT related migraines?

A

Try transdermal
Lower dose
Avoid systemic progestins
Use continuous therapy, no cyclical progesterone.

24
Q

A 51 year old women who still gets irregular periods presents to you and asks at what age can she stop her oral contraception?

A

Can be advised to stop at 55 years old, as > 96% will be menopausal by this age.
Can measure FSH on at least 2 occasions over 2 months, may be helpful to predict ovarian failure.
If high risk of CVD, probably ask them to change to non hormonal or LARC.
Don’t use FSH in women younger than 50 years old and in women who are on COCP, as FSH not reliable in women using combined hormones.

25
Q

A 48 year old lady who said she hasn’t had a period for 9 months, ask you when she should stop the use of condoms?

A

Since under 50 years old, need 24 months since last period

if over 50 years old, 12 months after last period.

26
Q

A 51 year old lady who is o microlut and hasn’t had a period for 12 months, ask you, when can she stop the pill?

A

Measure FSH on two ocassions, if both > 30 then can stop contraception after 1 year.

27
Q

A 46 year old women who had a mirena inserted 12 months ago, ask you how long they need the mirena for for contraception?

A

Can use it up to 7 years, if inserted at age > 45 years old.

28
Q

A 52 year old lady who presents with predominantly vasomotor and insomnia symptoms, what would be your pharmacological treatment recommendation?

A

HRT most effective
Tibolone if > 1-2 years since menopause.
Clonidine 25 to 50microg BD - risk of dry mouth and visual disturbance.
SSRI
Gabapentin 100mg TDS up to 300mg TDS

29
Q

What treatments would you offer a menopausal patient with predominentely genitourinary symptoms?

A

HRT, topical preparations, tibolone, lubricants.

30
Q

List 2 treatments in menopausal women that are provent to potentially improve mood?

A

Tibolone and SSRI.

31
Q

Outline the risk of breast cancer in women on HRT?

A

In oestrogen only therapy, there is not increased risk for up to 7 years. In combined HRT, extra 4 cancers per 1000 women, baseline risk 11 per 1000 women, for up to 5 years of use.

32
Q

Outline the risk of endometrial cancer in women on HRT?

A

Oestrogen only - increased risk related to the duration of usage.
COmbined HRT- no increased risk.

33
Q

Outline the risk of CAD in women who are on HRT?

A

Higher risk in women > 60 years old.

Combined HRT doens’t increase risk in women

34
Q

Outline the risk of stroke in women on HRT

A

Risk associated with oral HRT
Study suggest transdermal HRT doesn’t seem to increase risk.
extra 2 cases per 1000 women, baseline risk 4 per 1000 women.

35
Q

Outline the risk of VTE in women on HRT?

A

Transdermal lower risk

Extra 5 cases per 1000 women, baseline risk of VTE 3 per 1000 women.

36
Q

Name 1 oral and transdermal cyclical combined HRT?

A

Trisequens (oral)

Estalis sequential, 50/140 or 50/250

37
Q

Name 1 oral and transdermal continnuous combined HRT?

A

Oral kligest, angeliq, kliovance

Patches - Estalis continuous 50/140, 50/250

38
Q

Name 1 oral and transdermal oestrogen alone HRT?

A

oral - premarin

Patches - climara

39
Q

Why would you not use tibolone (livial) in women

A

High incidence of irregular bleeding,
tibolone - acts oestrogen receptors - like a steroid.
Should not use in older women as increase risk of stroke.

40
Q

Can HRT be used as contraception?

A

No, as doses too low to suppress ovarian function.

41
Q

What age should women be advised to stop their COCP, if there are no contraindications to its ongoing use in their patient?

A

51 year old
After 51, the cardiovascular risks outweigh its benefits.
Then use barrier methods after this.

42
Q

Outline the general treatment advice for a patient with menopausal symptoms?

A

Triggers - heat, clothes, anxiety, relationships, depression, work, finances
Hormones, anti depressants.
Lifestyle, smoking, alcohol, diet, exercise, hobbies
Psychological - counselling

43
Q

Name one alternative therapy for the treatment of hot flushes that has some evidence for its benefit beyond placebo?

A

Red clover a type of isoflavone, plant phytoestrogen.

Some evidence.

Womens health (10 decks)

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