menopause Flashcards
symptoms of menopause + when do they start + how long do they last?
hot flushes + night sweats for up to 5y anxiety + depression vaginal dryness + atrophy infection prone urinary frequency short term memory
increased risk IHD + osteoporosis
symptoms felt from when oestrogen falls in climacteric (just before) + usually last 4y but up to 12y
long term effects of menopause
osteoporosis
CVD + stroke
menopause - management
lifestyle:
eat healthy + stop smoking - CV risk
exercise, avoid caffeine + spice, lighter clothing
if herbal - THR label
medical:
HRT
oestrogen cream or lubricant in vagina - helps dryness/atrophy. no systemic effects.
CBT / SSRIs
HRT - what’s in it? benefits?
oestrogen replacement - helps symptoms, osteporosis, + if <65y, coronary artery disease risk
progesterone - opposes oestrogen to prevent endometrial ca risk
HRT - SEs
nausea + breast tenderness
fluid retention + weight gain
HRT - complications
stroke
breast cancer
endometrial ca if no progesterone
VTE if not patch
menopause - average age
51
when should contraception be used till after menopause?
1y after last period if > 50y
2y after last period if < 50y
HRT - contraindications
hx breast cancer, VTE, stroke, MI
HRT - modes of administration
systemic - oral, patch, gel
vaginal - pessary, cream, ring
HRT - which type?
no uterus - oestrogen only. oral or patch
uterus, perimenopausal - cyclical HRT
uterus, postmenopausal - continuous HRT
cyclical HRT - what’s the course?
oestrogen daily + 2w progesterone (→ bleed):
regular periods - last 2wk of cycle
irregular periods - every 3mo
continuous HRT - what’s the course?
continuous oestrogen + progesterone
no bleed
HRT - duration
no maximum
risk increases >65y
ovarian cancer risk if >5y
HRT counselling - structure
confirm menopause symptoms + effect on QOL periods + bleeding PMH + FH - clots, cancer uterus?
risks, SEs + benefits
types + RoA
discuss contraception - POP or mirena
