Menopause Flashcards
What is menopause?
Last period 12 months ago
What is the average age of menopause?
45-55
How are the investigations for menopause?
FSH is a very unreliable marker of menopause in normal menopausal women
What are the hormonal changes in menopause?
Gradual rise in FSH Fluctuations in estrodiol and progesterone Decreased ovarian inhibin B Androgens stay the same Estradiols eventually fall
What determines the age of menopause?
Genetics
Smokers go through menopause 1-2years early
Hysterectomy: generally will go through earlier
What is the concern with irregular anovulatory cycles?
Prolonged unopposed oestrogen > may lead to endometrial hyperplasia and cancer risk
What are the consequences of menopause?
Short-term
- Vasomotor symptoms - most common
- Vaginal dryness and atrophic vaginitis
- Sleep disturbance
- Mood disturbance
Medium to long-term
- Reduced done density > osteoporosis
- Increased risk of CV disease and Alzheimer’s
What are the vasomotor symptoms?
Hot flushes
Night sweats
General temperature intolerance
How does vaginal dryness present?
Painful sex
Pain with wiping
What is perimenopause? How long does it last?
Period of decline +/- symptoms
8-10 years
When do you investigate ?menopause
Always, menopause is a diagnosis of exclusion
How long do menopausal symptoms last?
40% women have symptoms up to 10 years after menopause
When do you give progesterone in HRT?
Whenever the uterus is present due to risk of endometrial hyperplasia
How does HRT effect osteoporosis?
It may reduce rapidity of loss
When do you DEXA scan in menopause?
Those with risk factors - Low Ca intake - Low body weight - Eating disorder - Immobilisation - Smoking - Medical conditions (Prolonged corticosteroids therapy, Premature menopause, Malabsorption, Chronic liver disease, Hyperparathyroidism)
How much exercise should you do to prevent osteoporosis?
More than 3 hours per week of weight bearing exercise
What is premature menopause? How do you confirm the diagnosis?
Amenorrhoea for greater than 4 months occurring before the age of 40
FSH more than 40IU/ml on two occasions
Exclude other causes
What are the complications of premature menopause?
Menopausal symptoms Possible increase CV risk Increase osteoporosis risk Loss of fertility Altered body image Increased risk of depression
What are the causes of premature menopause?
Iatrogenic - surgery, chemo, radio Idiopathic Genetic Autoimmune Other
How do you Ix premature menopause?
FSH, E2 on at least occasions
Prolactin, TFT Pregnancy test - to exclude causes of secondary amenorrhoea
Karyotype and fragile X if POF under 40 years
Exclude out flow obstruction
In what age groups is HRT recommended?
Until 51 years
What is the best administration mode of HRT?
Transdermal - lowest risk of DVT
What are the modes of administration?
Tablets Patches Gel Intrauterine COCP
When is the COCP used for HRT?
Younger women as its higher dose
What are alternative treatments to HRT?
Lifestyle modification
- Clothing
- Air conditioning
- Smoking cessation
What are the benefits of HRT?
Reduces frequency and severity vasomotor symptoms by 75-85%
Improves vaginal dryness
Maintains or improves bone density and reduces fracture risk
May improve QOL and sleep, muscle aches and pains
Reduce diabetes risk
Reduced colorectal cancer risk
What are the contraindications to HRT?
Hormone receptor positive cancer Hx DVT Smoking Uncontrolled HTN Unexplained vaginal bleeding
Relative
- Migraines
What are the risks of HRT - oestrogen alone?
Increased risk of stroke
Increased risk of VTE
Cholecystitis
What are the risks of HRT - combined alone?
Increased risk of stroke Increased risk of VTE Cholecystitis Increase breast tissue Increase risk of breast cancer with more than 5 years use Unscheduled bleeding Increased incidence of stroke and CHD
What is tibolone? How is it efficacious?
Synthetic steroid
Improves vasomotor symptoms, libido, and vaginal dryness
Improves BMD
What are some non-hormonal therapies?
Effect vasomotor symptoms only
- Gapapentin
- SSRI/SNRI
- Clonidine
How long do you put someone on HRT for?
5 years
In which type of patient is it useful to measure FSH? When do you measure it?
Young women or when the diagnosis is uncertain
Day 2-6
How much calcium should be had to prevent osteoporosis?
1200mg/day
How does caffeine affect bone health?
Negatively
How does low E2 affect health health?
• Increase in bone remodelling
- E2 suppresses bone reabsorption by suppressing osteoclast activity ie E2 deficiency directs increased bone reabsorption.
• Directly impairs gut calcium absorption.
• Directly increases renal calcium excretion.
What is the relationship between HRT and CV risk?
Contraversal
Likely neutral in younger women, may have adverse effects in older
Does not prevent or treat CVD
Do you start HRT in women with CVD?
Caution against it, transdermal is best if so
