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Women's Health > Menopause > Flashcards

Menopause Flashcards

1
Q

Define menopause?

A

Cessation of menstruation

At the age of 51 (on average)

Official after 12 months of amenorrhoea

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2
Q

Define perimenopause?

A

The period leading up to the menopause.

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3
Q

Why does menopause occur?

A

Because the ovaries stop releasing eggs, and stop releasing oestrogen.

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4
Q

What are the central effects of decreased oestrogen levels?

Why do they happen?

A

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

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5
Q

What are the local effects of decreased oestrogen levels?

Why do they happen?

A

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

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6
Q

List the short term symptoms of menopause.

How long do these last?

A

Vasomotor:

  • hot flushes
  • night sweats
  • sleep trouble

Generalised:

  • mood changes
  • irritability
  • headache
  • dry skin
  • joint pain
  • low energy

Last for 2-7 years

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7
Q

What are the medium term symptoms of menopause?

A

Urogenital atrophy:

  • recurrent UTIs
  • dysparenuria (painful sex)

Urinary incontinence and prolapse

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8
Q

What is dyspareunia?

A

Painful sex due to vaginal dryness

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9
Q

Having menopause early makes you at increased risk of developing which conditions?

A

Osteoporosis
Cardiovascular disease
Dementia

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10
Q

What are the non-pharmacological management options available for menopause?

A

Lifestyle advice
Reduce risk factors
Holistic approach
CBT

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11
Q

What are the pharmacological management options available for menopause?

A

Hormonal:

  • HRT
  • vaginal oestrogens

Non-hormonal:
- clonidine

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12
Q

What is clonidine and how does it help in menopause?

A

An alpha receptor blocker

Reduces hot flushes, and mood swings

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13
Q

What ligaments suspend the ovary in place?

Which one is most important?

A

Ovarian ligament
Broad ligament
Suspensory ligament

Suspensory ligament contains the ovarian artery, vein and nerve plexus

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14
Q

When is day 1 of the menstrual cycle?

A

The first day of bleeding

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15
Q

On what day of the cycle does ovulation occur?

A

Day 14

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16
Q

Briefly describe the menstrual cycle.

A

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

17
Q

What is HRT?

A

Hormone replacement therapy

Consists of either oestrogen, progesterone or both

18
Q

Which type of HRT would you advise for:

  • a lady with a uterus
  • if they have menorrhagia
  • post-hysterectomy?

Why?

A

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

19
Q

After her LMP, how long is a woman still possibly fertile?

A

2 years if her LMP was pre age 50

1 year if LMP was post age 50

20
Q

What are the disadvantages of HRT?

A

Increased breast cancer risk

Increased endometrial cancer risk

VTE (DVT, stroke)

Increased risk of CV disease

21
Q

You can still prescribe HRT to a woman diagnosed with breast cancer?

True or false?

A

False, you should stop it

22
Q

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?

A

True

Even if tumour was not OE receptor positive, should not offer HRT

23
Q

HRT acts as a contraceptive. True or false?

A

False

24
Q

What are the advantages of HRT?

A

Reduction of menopausal symptoms

Reduced long term problems of OE deficiency (osteoporosis, CV risk, dementia)

25
Q

Define premature ovarian insufficiency (POI).

A

Menopause occurring before 40 yrs

26
Q

Causes of POI?

A

Iatrogenic:

  • surgery
  • past chemotherapy
  • past radiotherapy

Natural:

  • idiopathic
  • autoimmune diseases
  • enzyme deficiencies
27
Q

You should encourage a woman with POI to take HRT for at least 2 years.

True or false?

A

False

You should encourage her to take HRT until she reaches average age of menopause (51)

Women's Health (23 decks)

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