Menopause Flashcards
Explaining menopause to a patient.
Before menopause the ovaries (usually) release an egg each month, which then triggers the normal cascade of hormone
changes that result in regular periods and cyclical changes.
As the ovaries ‘fail’, they begin to release their eggs erratically, which in turn causes erratic hormone levels.
Periods
become erratic and we enter a stage of ‘hormonal chaos’ where hormone levels are unpredictable and ‘all over the place’.
This is why you may have symptoms such as hot flushes (when the ovary hasn’t released an egg for a while and hormone
levels drop) and then suddenly the hot flushes disappear (because your ovary spontaneously released an egg and gave
you a ‘dose of hormones’ naturally).
This ‘spontaneous release of an egg’ is why you need to use contraception for at least
12 months from your last natural period.
This period of time, called the ‘menopausal transition’, can take up to 4–5 years.
Very rarely do the ovaries ‘switch off’ overnight (unless they are removed surgically). Eventually, the ovaries fail
completely, no eggs are released and hormone levels drop to postmenopausal levels.
Explaining symptoms of menopause to women
Everywomen reacts differently
20%= nil sx at all 20% = have severe, disabling symptoms 60% = fall into the middle
Definition of Menopause
Cessation of menstrual cycle secondary to loss of follicular activity
It is a retrospective diagnosis –> Amenorrhoea for 12 months
What are the symptoms?
oestrogen deficiency resulting in;
vasomotor symptoms
- hot flushes
- light headed feelings
Psychosocial
- irritability
- mood changes
- unloved feelings
- anxiety
- sleeplessness
- tiredness
Locomotor
- pain in back
- joint pains
- muscle pains
- dry skin
- crawling feeling under skin
- dec libido
Urogenital
- vaginal dryness
- dyspyruenia
- heavy bleeding
- urinary incontinence
Benefits and risks of HRT?
Benefits
- dec hot flushes, night sweats, sleep disturbance
- dec risk of bowel cancer
- dec fractures
Risks
- inc breast ca
- inc abnormal mammogram result
- inc stroke
- inc VTE
- breast tenderness
- spotting/pv bleed
role of progesterone in menopause?
protect lining of the uterus (as oestrogen can overstimulate the endometrium)
In menopause is it possible for 2 eggs to be released?
Yes, second egg can be released during period
Contraception advice for peri-menopausal women?
<50 years - offer for >2 years after LMP
>50 years - offer for >1 year after LMP
What are the hormonal changes that occur?
Peri menopausal - LH starts increasing gradually (in response to low levels of oestrogen produced by the ovary.
Peak of FSH is at 2-3 years post last period.
Estradiol levels peri menopause fluctuates, post menopause, oestrogen levels are low
Endometrial thickness normal in
- pre menopause
- peri menopause
When is it most accurate time of test?
pre menopause
< or equal to 12 mm
peri menopause
< or equal to 5mm
if performed on days 4-7 of cycle (after menses has ceased)
Principles of starting HRT
<60 yrs of age
< 10 years since onset of menopause
Can continue on >60yr olds but should not initiate
do vaginal dryness and urinary frequency resolve naturally with time?
not generally
What is premature menopause?
menopause that occurs if a woman is <40 years of ageAbout 1% suffer premature menopause
Breast Cancer and HRT
> Risk of BCa in all women is 1 in 9 in their lifetime
Risk of BCa in hysterectomy with E only = nil increase in 7yrs
Risk of BCa in women with intact uterus on E+P = small increase 0.1% per year (so increase in 4-5 yrs) is 8/10,000 women per year.
According to WHI study risk of BCa in women taking combined HRT is rare (less 1.0 per 1000 women per yr)
Note: 2 glasses wine increase risk of breast cancer than HRT
Contraindications to HRT
Women >60yrs and >10yrs after menopause Current or past hx of breast/endometrial/ovarian ca Cardiovascular Disease Liver disease Current or past hx of DVT Abnormal vaginal bleeding SLE
