Menopause Flashcards
Underlying cause of the menopause
Depletion of ovarian follicles leading to decreased oestrogen and progesterone levels
Definition of menopause
A retrospective diagnosis made after 12 months amenorrhoea
Early menopause
Menopause between age 40-45
Premature menopause
menopause before 40
Causes of premature menopause (4)
Radiation-induced
Chemotherapy-induced
Surgery-induced e.g. oophorectomy
treatment with GnRH analogues e.g. goserelin
Factors which may contribute to early/premature menopause (5)
Smoking, low SES, age at menarche, parity, BMI
main symptoms of the menopausal transition
vasomotor- hot flushes and sweats urinary/genital symptoms- dryness, dyspareunia, recurrent UTI sleep disturbance Mood changes Loss of libido Brittle nails, thin skin, hair loss
Investigations in menopausal women (5)
FSH TFTS Blood glucose Up-to-date cervical screening and mammogram Possible pelvic ultrasound
Diseases associated with post-menopause (5)
osteoporosis CV disease redistribution of body fat Urogenital atrophy Alzheimers disease
Recommended calcium intake for peri/postmenopausal women
700mg/day
Indications for HRT (2)
Relief of vasomotor symptoms in fully-informed women with no contraindications and a favourable risk:benefit ratio.
In women with premature/early menopause for relief of symptoms and bone mineral preservation
Benefits of HRT (5)
Reduction in vasomotor symptoms Improvement in quality of life Improvement in urogenital symptoms Reduction in osteoporosis risk ?protection against Alzheimer's
Risks of HRT (4)
Increased risk of vte, breast cancer, endometrial cancer, stroke
The risk of which adverse effects of HRT are a) increased and b) decreased by inclusion of a progestogen?
a) breast cancer, VTE
b) endometrial
How long does the risk of breast cancer take to return to normal after cessation of HRT?
5 years
Contraindications to HRT (6)
Pregnancy/breastfeeding Active angina/previous MI Previous VTE Suspected, current or past breast cancer Endometrial cancer Active liver disease with deranged LFTs
Which type of HRT is most suitable for
a) without a uterus
b) women who still have a period
c) post-menopausal women with a uterus
a) oestrogen-only, continous HRT
b) cyclical combined hrt
c) continuous combined HRT
What is an option for a patient who still desires contraception?
Mirena IUS, with added oestrogen in tablet/gel/patch form
What is a good option for a patient whose primary concern is atrophic vaginitis?
Topical oestrogens
Oestrogenic side effects (5)
Breast tenderness, leg cramps, bloating, nausea, headaches
Progesterone side effects (5)
PMS-like symptoms, breast tenderness, backache, pelvic pain
What is the NICE guidance relating to herbal/complementary treatments such as red clover?
These arent regulated and quality may be variable;also not enough evidence to state that they are safe in women with oestrogen-dependent cancer e.g. breast, endometrium
Alternative drugs to HRT for vasomotor symptoms (2)
GABA analogues e.g. gabapentin
SSRIs e.g. citalopram
