Menopause Flashcards
menopause
cessation of menses >1 yr due to loss of ovarian function
menopause avg age of onset
50-52 yrs
why might menopause occur sooner
DM
smoker
vegetarian
malnourished
estrogen deficiency changes
vasomotor instability (hot flash) mood change osteoporosis dyspareunia urinary incontinence
atrophic vagintis
thin, yellow discharge
vaginal pH >5.5
pruritus
PE of menopause
decreased bone density, skin is thin and dry
menopause most sensitive initial test
FSH assay
FSH > 30 IU/mL (increased)
menopause labs/hormone levels
increased FSH, LH but decreased estrogen (depletion of folicules)
no change in androstenedione
what is the most predominant estrogen after menopause
estrone
complications of menopause
loss of estrogen’s protective effects = increased osteoporosis, cardiovascular risk and increased lipids
management of hot flashes
**estrogen, progesterone ***
clonidine, SSRI, Gabapentin
management of vaginal atrophy
estrogen (transdermal or intervaginal)
osteoporosis intervention
bisphosponates and SERM (Raloxifene, Tamoxifen)*
weight bearing exercise, calcium, vitamin D, calcitonin
menopause and HRT
estrogen only - benefits
most effective symptomatic treatment
transdermal or vaginal > PO
no increased risk of breast cancer
menopause and HRT
estrogen only - risks
increased risk of endometrial cancer - better for those with no uterus
thromboembolism (CVA, DVT, PE)
menopause and HRT options
- estrogen only
2. estrogen and progesterone
menopause and HRT
estrogen + progesterone types
continuous (same daily dose, doesn’t cause menstrual bleeding)
sequential (cycling) dose change = bleeding possible
estrogen + progesterone HRT benefits
symptomatic relief, decreased heart, stroke and osteoporosis risk
PROTECTS against endometrial cancer (intact uterus)
estrogen + progesterone HRT risk
possible increased risk of breast cancer
thromboembolism risk
psychological symptoms of menopause
irritability anxiety depression sleep changes appetite changes poor concentration insomnia
physical s/s of menopause
fluid retention (edema, bloating) weight gain breast pain constipation back pain uterine cramps
CI to HRT
undiagnosed vaginal bleeding
acute vascular thrombosis
liver disease
history of endometrial or breast cancer
holistic substances and menopause
soy
black cohosh
ginseng
