Menopause Flashcards
Blood test for menopause?
Unreliable
FSH usually gradual rise
Menopause hormones?
Decreased estradiol/progesterone
Androgen same
Premature menopause is when?
Smoking and menopause?
1-2 years earlier if smoker
Hysterectomy for menopause?
Reduced age of menopause
Menopause cause?
Run out of oocytes
Accelerated loss of ovarian primordial follicles at what age?
37
Risk of irregular anovulatory cycles?
Prolonged unopposed estrogen
Endometrial hyperplasia and cancer
NEEDS investigations
Consequences of menopause? Short term?
Vasomotor symptoms (hot flushes)
Vaginal dryness, atrophic vaginitis
Sleep disturbance
Mood disturbance
Medium to long term consequences of menopause? More likely if early menopause
Bone density
Risk of #s
Alzheimer’s
Cardiovascular
Ask what for menopause?
What is impacting them the most? Directs management
What happens if you have irregular periods in the perimenopausal time?
Need to investigate, could be endometrial cancer, pregnant,
When do hot flushes end?
50% Most women: will last 5-8 years
What are skeletal toxin?
Excess alcohol and caffeine
Iatrogenic causes of premature menopause?
Chemo or radiation for cancers
When is early menopause?
40-45
When is premature menopause?
Before 40
Other reasons for premature menopause? Genetic?
Turner’s, fragile X
Autoimmune
Dx of premature menopause?
Amenorrhoea greater than 4 months
Dx of premature menopause?
FSH, E2 on two occasions
Prolactin, TFT bHCG
Karyotyping
What is in HRT?
Estrogen to treat symptoms
Progesterone to protect endometrium
Best way to give HRT?
Transdermal, less likely to get DVTs
What to do with premature menopause HRT?
Take COC
HRT used for how long?
Shortest time, lowest dose to take care of symptoms
Oestrogen alone bad how?
Risk of trike
VTE, PE
Cholecystitis
Endometrial hyperplasia and cancer for woman with uterus
Combined HRT risks?
Breast cancer IF >5 years
Contraindications for HRT
Hormone sensitive cancers
Tibolone is?
Weak estrogen
What do no hormonal therapies change?
Only vasomotor symptoms
NOT depression, sleep, urogenital.
What available non-hormonal therapies?
Gabapentin
SSRI/SNRI
Clonidine
