Menopause Flashcards
Define menopause?
Cessation of menstruation
At the age of 51 (on average)
Official after 12 months of amenorrhoea
Define perimenopause?
The period leading up to the menopause.
Why does menopause occur?
Because the ovaries stop releasing eggs, and stop releasing oestrogen.
What are the central effects of decreased oestrogen levels?
Why do they happen?
Vasomotor: hot flushes, sweats due to fluctuating oestrogen levels affecting hypothalamus
MSK: joint and muscle pain
Low mood
Decreased libido
The excess production of FSH messes with hypothalamus
What are the local effects of decreased oestrogen levels?
Why do they happen?
Vaginal and labial atrophy leading to dryness, bleeding and pain during sex
Because oestrogen stimulates the vagina and labia keeping them healthy. When there’s no more oestrogen there is atrophy
List the short term symptoms of menopause.
How long do these last?
Vasomotor:
- hot flushes
- night sweats
- sleep trouble
Generalised:
- mood changes
- irritability
- headache
- dry skin
- joint pain
- low energy
Last for 2-7 years
What are the medium term symptoms of menopause?
Urogenital atrophy:
- recurrent UTIs
- dysparenuria (painful sex)
Urinary incontinence and prolapse
What is dyspareunia?
Painful sex due to vaginal dryness
Having menopause early makes you at increased risk of developing which conditions?
Osteoporosis
Cardiovascular disease
Dementia
What are the non-pharmacological management options available for menopause?
Lifestyle advice
Reduce risk factors
Holistic approach
CBT
What are the pharmacological management options available for menopause?
Hormonal:
- HRT
- vaginal oestrogens
Non-hormonal:
- clonidine
What is clonidine and how does it help in menopause?
An alpha receptor blocker
Reduces hot flushes, and mood swings
What ligaments suspend the ovary in place?
Which one is most important?
Ovarian ligament
Broad ligament
Suspensory ligament
Suspensory ligament contains the ovarian artery, vein and nerve plexus
When is day 1 of the menstrual cycle?
The first day of bleeding
On what day of the cycle does ovulation occur?
Day 14
Briefly describe the menstrual cycle.
Hypothalamus secretes GnRH
Which stimulates pituitary to secrete FSH and LH
These cause follicles to develop
FSH causes release of oestrogen, LH causes release of FSH
Oestrogen negatively feeds back to pituitary inhibiting further release of FSH
Oestrogen levels rise causing LH surge which causes ovulation (egg released from follicle)
Progesterone causes uterus lining to develop
Empty follicle produces oestrogen and progesterone, which causes development of uterus wall
If egg is not fertilised then oestrogen and progesterone levels fall
Start of next cycle
What is HRT?
Hormone replacement therapy
Consists of either oestrogen, progesterone or both
Which type of HRT would you advise for:
- a lady with a uterus
- if they have menorrhagia
- post-hysterectomy?
Why?
With a uterus: should give O+P HRT because the P is needed to prevent O causing excessive proliferation of uterus wall
Menorrhagia: offer mirena coil plus O only HRT, as the coil contains enough P to oppose the O (preventing excessive proliferation)
Post-hysterectomy: can give O only HRT as not worried about O’s impact on uterus
After her LMP, how long is a woman still possibly fertile?
2 years if her LMP was pre age 50
1 year if LMP was post age 50
What are the disadvantages of HRT?
Increased breast cancer risk
Increased endometrial cancer risk
VTE (DVT, stroke)
Increased risk of CV disease
You can still prescribe HRT to a woman diagnosed with breast cancer?
True or false?
False, you should stop it
You should not offer HRT to women with a history of breast cancer?
True or false?
What if their tumour was not oestrogen receptor positive?
True
Even if tumour was not OE receptor positive, should not offer HRT
HRT acts as a contraceptive. True or false?
False
What are the advantages of HRT?
Reduction of menopausal symptoms
Reduced long term problems of OE deficiency (osteoporosis, CV risk, dementia)
