Menopause Flashcards
Perimenopause
Begins with first menopausal features:
E.g. Vasomotor sx, menstrual irregularity
Ends 12 months after last menstrual period
Premature menopause
Menopause before 40 yrs
1% women
No cause found in most
HRT indicated until 51
Causes of post-menopausal bleeding
Endometrial carcinoma Ovarian carcinoma Endometrial hyperplasia Cervical carcinoma Atrophic vaginitis Cervicitis Cervical polyps
Menopause
12 consecutive months amenorrhoea Ovaries stop responding to LH and FSH Follicle activity ceases End of menstruation Median age: 51
Consequences of menopause
CVD Vasomotor sx Urogenital sx Sexual problems Osteoporosis
Vasomotor symptoms of menopause
Hot flushes
Night sweats:
- sleep disturbance
Usually
Urogenital problems of menopause
Vaginal atrophy:
- dyspareunia, itching, burning, dryness
Urinary symptoms:
Frequency, urgency, nocturia, incontinence, recurrent infection
Osteoporosis and menopause
1/3 >50yrs have >1 osteoporotic fracture DEXA to measure bone mineral density: T score Normal: 1 to -1 Osteopenic: -1 to -2.5 Osteoporotic: less than -2.5
Risk factors for osteoporosis
Genetic: fhx of fracture
Constitutional: low BMI, early menopause (5mg/day pred
Disease: Autoimmune disease, malabsorption
Investigating amenorrhoea
FSH: day 2 & day 5
2 samples 2 weeks apart >35IU/L
Oestradiol:
HRT in women without a uterus
Oestrogen alone
Increases risk of endometrial cancer
HRT in women with a uterus
Oestrogen & progestogen
To oppose oestrogen action on endometrium
Increases risk of breast cancer
Types of HRT
Oral: increases risk of VTE and gallbladder disease
Transcutaneous
Subcutaneous
Non oestrogen based menopause therapy
Night sweats & hot flushes:
Progestogens + SSRIs
Vaginal atrophy:
Lubricants + moisturisers
Osteoporosis treatment:
Bisphosphonates:
Strontium ranelate: reduces risk of vertebral and hip fracture
Raloxifene: oestrogen receptor modulator
Parathyroid hormone peptides: reduce risk of vertebral fractures
Denusomab: RANKL mab, reduces osteoclast activity, 6 mthly subcut
Topical oestrogens for urogenital menopause symptoms
Low dose oestrogens, local administration
Oestriol: cream or pessary
Oestradiol: tablet or ring
DEXA scan
Dual energy X-ray absorptometry
2 different energies of X-ray differentiate betw soft tissue & bone
BMD =g/cm2 often converted into:
T score, relating to avg male/ female peak bone mass
Z score, relating to age group
Primary ovarian failure
Onset of menopause
Risks of HRT
VTE: risk highest in 1st year
If fhx of VTE consider thrombophilia screen
CI with personal Hx VTE
Stop immed if VTE occurs
No continued risk of VTE once HRT stopped
