Menopause Flashcards
Symptoms of menopause
Early
• Vasomotor, period change, insomnia, mood change, cognitive function, loss of collagen, fat redistribution, hair loss
Medium
• Vagina: dryness, soreness, dyspareunia
• Bladder: Frequency, urgency, dysuria, UTIs
Late
• Bone deficiency, 1/3 after 20 years (loss of oestrogen causes calcium loss) causing osteoporosis
• Increased risk of cardiovascular disease and stroke after menopause
Examination findings in menopause?
Amenorrhoea universal, hot flushes, fatigue, insomnia, poor concentration, vaginal dryness and atrophy, urinary problems, sexual dysfunction
Risk factors and management of premature ovarian failure?
Risk Factors
• Bilateral salpingoopherectomy (BSO), mumps, pelvic TB, automimmune disorders, chemotherapy, ovarian degenesis, myotonic dystrophy
Management
• Give HRT until the age of 51 (average age of menopause)
Risk factors for osteoporosis?
- Fam hx
- Steroid usage
- Low BMI
- Early BMI
- Increased age
- Smoking
- Alcohol
- Low calcium intake
- Sedentary lifestyle
- Chronic disease
Investigations in menopause?
- LH and FSH only useful if diagnosis in doubt as they fluctuate daily in the climetaric (pre-menstrual period)
- Post menopause FSH <30
- Mammography advised every 3 years following menopause
- Endometrial biopsy for PMB
- Bone density assessment for women at increased risk of osteoporosis
What is HRT?
- Oestrogen + progesterone (if not had hysterectomy) – only oestrogen if they have (progestogen reduces risk of endometrial hyperplasia cancer)
- Oral, patch, gel, implant, spray or vaginal ring
- Up to 5 years for menopausal symptoms, can be lifelong for osteoporosis. With premature, should take up to median age of natural menopause (52).
Contraindications to HRT?
- Absolute: current breast or endometrial cancer, undiagnosed vaginal bleeding, thrombosis, breast mass, active liver disease
- Relative: endometriosis, fibroids, fam or past hx of breast cancer or thrombotic disease, liver disease
Advantages of HRT?
- Short term relief from symptoms
- May regulate irregular bleeding
- Protective against osteoporosis
- Reduces sensory urgency
- Improved hair and skin appearance
- Protective against Alzheimer’s, tooth loss and bowel cancer
Disadvantages of HRT?
- Menstruation unless period free preparation
- Oestrogenic and progestogenic side effects
- Increased risk of breast Ca
- VTE and possible CVD
- Risk of endometrial Ca
Causes of PMB?
Atrophic vaginitis (most) Endometrial ca and hyperplasia (20%) Cervical ca, cervicitis, ovarian ca, cervical polyps
Risk factors for endometrial cancer?
- Early menarche, late menopause (prolonged oestrogen exposure results in greater proliferation of endometrium – more likely to become Ca)
- HRT (unopposed oestrogen)
- Polycystic ovaries – each cyst in an ovary is a follicle, stimulated but not released. Never get corpus luteum or release of progesterone – reduced ovulation and repeated oestrogen
History and examination in PMB?
History - Menopause diagnosed by 12 months of no bleeding – bleeding after 12-month gap considered PMB.
Exam - Bimanual examination of pelvis
Speculum and cervical smear
Investigations in PMB?
FAST TRACK, 10% of women with PMB have endometrial cancer
• Urgent USS
o 5mm thickness or above
o Urgent hysteroscopy and biopsy.
Management of endometrial hyperplasia?
- With atypical cells seen – immediate hysterectomy
- No atypical cells seen – high dose progestogens
o Oral or Oral and Mirena coil
Management of endometrial cancer?
Refer to gynae oncology