Menopause Flashcards
What is menopause and when does it occur
The time of ovarian failure and cessation of menstrual period that occurs in women at a mean age of 51
What molecule, released from the ovaries in the early menopausal transition starts to decrease why is this?
Levels of inhibin B are decreased due to a fall in follicular number
What does the decline in inhibit B result in
an increase in serum GSH level due to a loss of the negative feedback effect of inhibit B on FSH secretion
Describe the changes in estradiol with the menopause
Initially relatively preserved, possibly due to increased aromatase activity stimulated by the elevated FSH
What happens to estradiol after menopause
It declines due to a depletion in ovarian follicles and so is not longer being secreted
What do the ovaries continue to secrete and under what control
Androgens under the continued stimulation of LH
How is menopause clinically diagnosed
amenorrhoea for 12 months in a woman over the age of 45
Describe some menopausal symptoms
Hot flushes
urogenital symptoms: vaginal dryness, dysuria, frequency, stress incontinence and recurrent ITU
Mood changes and sleep disturbances
What are some other causes of menstrual changes that must be ruled out
Pregnancy
hyperprolactinaemia
thyroid dysfunction
What might atypical hot flushes and night sweats be associated with
medications phaeochromocytoma thyrotoxicosis carcinoid syndrome underlying infection malignancy
What is the most effective treatment of rate relief of menopausal symptoms
HRT with oestrogen
What must be added to the oestrogen in women who have not had a hysterectomy and why
Progestin - unopposed oestrogen can result in endometrial hyperplasia and carcinoma
Who is HRT not recommended in
those with a previous history of:
breast cancer
Coronary heart disease
stroke or venous thromboembolism
those with risk factors for these conditions
Describe the sequential cyclical regimen of HRT
oestrogen is given continuously and a progestin is added for the first 12-14 days of each month
Describe the container combined regimen of HRT
Oestrogen and lower doses of a progestin are given on a daily basis
Who generally prefer the cyclical regimen
younger women and newly post menopausal women
Who generally prefer the continuous combined regimen
older women who do not want month withdrawal bleeds
How long can a woman be on HRT for
1-3 years but generally no more than 5 years
What should be given for hot flushes
Oestrogen continuous regime
How is oestrogen given to treat hot flushes
Transdermal patch (side effect is a skin reaction)
How do women come off of HRT
Some can come off abruptly but others need to taper down slowly
What treatment can be given to women with mild urogenital symptoms
Regular vaginal moisturising agents and lubricants during intercourse
How can low dose vaginal oestrogen be delivered
Tablet, ring or cream - depends on the patients choice
What is the first line treatment for osteoporosis in postmenopausal women
Bisphosphonates (alendronate)
What should postmenopausal women with osteoporosis receive
adequate calcium and vitamin D
What information should a postemenopasual woman be given
the importance of relevant lifestyle measures including exercise and smoking cessation
fall prevention
