menopause Flashcards
how long is amenorrhoea present for menopause to have been reached
12 months
what level of FSH confirms menopause
> 40 (2 FSH levels >30)
what is the climacteric
time of decreased fertility leading up to the last period, becomes less responsive to FSH and LH
presenting features
menstrual irregularity; vasomotor- sweats, paps, flushes; atrophy of oestrogen dependent tissue- genitalia, breasts; vaginal dryness- infection, dyspaurenia, stress incontinence, bleeding; osteoporosis
how long does a woman need to be on contraception for
until at least >1 year amorrhoea
what may hot flushes respond to
clonidine, tibolone
what can you give for vaginal dryness
local oestrogen
what can oestrogen be used for (HRT)
flushes, atrophic vaginitis. postpones bone loss
what does HRT increase the risk of
breast, endometrial, ovarian cancers
what should a woman with a uterus receive if on HRT
cyclical progestogens to decrease risk of endometrial cancer from unopposed oestrogen. or tibolone
what is tibolone
weak steroid with oestrogenic, progestonic and androgenic effects
what can you give if atrophic vaginitis is main problem
oestrogen pessary or cream
contraindications to HRT
oestrogen dependent cancer, past PE, undiagnosed PV bleeding, incr LFT, pregnant, breastfeeding, phlebitis
side effects HRT
incr weight, pre menstrual syndrome, cholestasis, vomiting
what should be checked annually
breasts, bp, weight, abnormal bleeding
what is the risk of VTE in HRT use
double
causes of post menopausal bleeding
oestrogen therapy, atrophic vaginitis, endometrial adenocarcinoma, endometrial hyperplasia, endometrial polyps, cervical carcinoma, cervical lesions, ovarian tumour, bleeding from urinary tract
what is atrophic vaginitis
inflammation of the vagina due to thinning and shrinking of the tissue and decreased lubrication
