Menopause Flashcards
The WHO has defined the ______ as signifying
the permanent cessation of menstruation, resulting
from the loss of ovarian follicular activity
menopause
Premenopausal: up to ______ years before the
last menstrual period.
5
_________ the presence of early
menopausal symptoms with vaginal bleeding (usually
irregular).
Perimenopausal:
Postmenopausal: the phase beginning
_________ months after the last menstrual cycle.
12
Osteoporosis is
usually addressed in the context of the menopause
because it is found mainly in postmenopausal middleaged
and elderly women and can be largely prevented
by correcting________
oestrogen deficiency.
In the postmenopause phase, FSH
rises to levels _______times that of the follicular phase
of the cycle while ______ levels rise about threefold
10–15
LH
Contraception is advisable for_______ after the
last period for women over 50 years and two years
for those under 50 years
12 months
The modern treatment of HRT at the menopause
not only reduces climacteric symptoms and enhances
the quality of life in the short term but also reduces
the risk of
1
2
3
bowel cancer, osteoporosis and fractures
Emphasis of the The Women’s Health Initiative study
Points to emphasise:
• there is no firm evidence of an increased risk of
breast cancer with use of HRT_______
• HRT cannot be recommended in _______
• women choosing to cease HRT should reduce
their dose _________
<5 years
asymptomatic menopausal women to prevent osteoporosis
gradually over 2–3 months
In 2013, an international meeting formulated a Global Consensus Statement on Menopause Hormone Therapy (MHT). What is their endorsement?
A key recommendation
is that ‘MHT is the most effective treatment for vasomotor symptoms associated with menopause at
any age, but benefits are more likely to outweigh risks
for symptomatic women before the age of 60 years or
within 10 years after menopause
HRT in menopause
If _______, the OCP cyclical HRT (noncontraceptive)
or progestogen-only regimens such as
LNG-IUD can be used.
If menopausal—use ______
perimenopausal
HRT.
_________ and gels are the most favoured estrogen Tx `worldwide
Transdermal patches
______ and ______ are usually restricted
to women who have mild menopausal symptoms
and a dry vagina, or who cannot tolerate parenteral
medication
Vaginal creams or tablets
________ is given to women with a uterus and
may be given continuously or cyclically. If it is not
given, many women will develop hyperplasia of
the uterus and there is a 5–10 times increased risk
of endometrial cancer with unopposed oestrogen
Progestogen
What and how is Progesteron Tx given for post menopausal women?
If given cyclically (postmenopausal) it
is given for the first to the fourteenth day of the
calendar month, generally as Provera or Primolut
N
Progestogen alone can be given for menopausal
symptoms in a woman with an_______
oestrogen-dependent tumour
Progestogens should be given in the smallest
possible dose, to prevent _______
endometrial hyperplasia.
A progestogen must be used with oestrogen if the
woman still has a ________
uterus
________ is usually reserved for women whose
libido does not improve with HRT and those with
a premature menopause but this indication is
controversial and it should be used with caution
because of the lack of data about adverse effects
Testosterone
How to give Testosterone in menopausal women
If available it is given as an implant of 50 mg and will
last 3–12 months
What to give in addition while on Testosterone Tx
An oestrogen implant of 50 mg should be given concurrently
This is a selective tissue oestrogenic activity regulator
with combined oestrogenic, progestogenic and
androgenic properties that can be used as an excellent
alternative to conventional HRT in postmenopausal
women.
Tibolone
Positive effects of Tibolone are on 1 2 3 4
vasomotor and urogenital symptoms, sexual function, bone density and fracture risk
When is Tibolone given?
It should be considered for women who
are surgically postmenopausal or who have not had a natural menstrual bleed for at least 12 months.
AE of Tibolone
Adverse effects with breakthrough bleeding and
virilisation are a concern
Dose of Tibolone
Dose: tibolone 2.5 mg (o) daily
The main absolute contraindications of HRT are:
active oestrogen-dependent neoplasms, such
as endometrial and breast cancer, deep venous
thrombosis, acute thrombophlebitis and undiagnosed,
abnormal vaginal bleeding
HRT is protective for_____ but not ____
bowel cancer
ovarian cancer
It must be emphasised that HRT, especially the_______, is not a contraceptive.
combined
sequential formulation
The main short-term
risk of oral HRT in women aged 50–59 is _____
venous
thromboembolism
How to manage premenstrual syndrome
decrease progestogen dose or change to alternative progestogen
What is the cause of Nausea and breast disorders in postmenopausal women?
initial sensitivity to oestrogen
How to manage nausea and breast DO?
reduce oestrogen to starting or low dose or use intravaginal oestrogen
Heavy bleeding
Action: _______
Breakthrough bleeding
Action: ________
Irregular bleeding
Action: _______
Intolerance of bleeding
Action: use continuous regimen
No bleeding
Action: reassure that this is not a problem
decrease oestrogen
increase progestogen
investigate + endometrial sampling
A useful working rule is to aim for treatment for a
maximum of ______and then review with an aim of
using HRT for _______ if appropriate for that person
2 years
5 years
Current evidence is that combined oestrogen and
progestogen therapy will not increase the risk of
breast cancer for up to _______ and oestrogenonly
therapy will not increase risk for at least
_____
5 years of use,
7.2 years
Vaginal dryness
The first-line therapy is a non-hormonal preparation
such as _______. If these are ineffective,
_________ preparations can be
useful,
Replens or K-Y Gel
low-dose vaginal oestrogen
