Menopause Flashcards
Definition of menopause?
Average age
Cessation of menstruation, diagnosed after 12 months of amenorrhoea
51 years
What is perimenopause, what is characterised by?
Period leading up to menopause
Characterised by irregular periods and menstrual symptoms
Don’t measure FSH levels if >45
Definition of premature menopause, and the cause
Premature menopause, is onset of menopause before 45
Can be primary of secondary:
- idiopathic
- autoimmune, antibodies against follicles
- genetically determined low follicles
- follicular dysgenesis
- iatrogenic: chemo, radio, bilateral oopherectomy
What are the the broad short term symptoms of menopause?
- Menstrual irregularities: increased amount of blood, cycle may increase or shorten
- Vasomotor symptoms: hot flushes, night sweats, reduced sleep QOL
- Psychological symptoms: depression, anxiety, low self esteem, lost of concentration, memory issues
- other; headaches, joint pains, fatigue, dry itchy skin/brittle nails
What are the medium term symptoms
Clue genitourinary symptoms?
Genital: vaginal atrophy, itching, dryness, burining, reduced sexual desire and arousal, dyapaeurenia
urinary; frequency, recotvaginal prolapse with incontinence, frequent UTIs, post-menopausal bleeding
What are the long term symptoms of menopause?
- CVD- stroke, PAD, CHD, due to dyslipidaemia and redistribution of fat around the abdomen
- Dementia- more common in premature
- Osteoporosis- do FRAX score to calculate 10 year probability of osteoporosis
In menopausal women with osteoporosis which fractures are most likely to occur?
What do you do to investigate this
- Wrist or Colles fracture (outturned wrist)
- Hip
- Spine
After FRAX score- do DEXA score serially
Menopause is a clinical diagnosis but what investigations may be performed to diagnose menopause?
- FSH- will be raised- 2 samples- 2 weeks apart
- TFT’s, catecholamines (phaechromocytoma)- important to exclude these
- LH- oestradiol-progesterone- oestrogeon low if menopause, if progesterone then anovulation ie PCOS
- DEXA scan if at risk of osteoporosis do every 2-3 years
What is hormone replacement therapy, which hormones are being replaced?
- Oestrogeon (natural oestradiol, oestriol, oestreone)
- Progesterone ie with Mirena
- Androgens (to increase libido)
When is transdermal oestrogen indicated?
- Gastric upset ie Crohn’s
- Slow absorption (epilepsy, mirgaine)
- Increased risk of VTE ie obese, coagulation defects
- medical conditions- hypertension
In menopausal women, how long should contraception be given for?
Clue: <50 years or >50 years
<50 years: fertile for two years
>50 years: fertile for a year
What type of HRT would you give to patient without a uterus/mirena IUS?
- Oral or transdermal (gel/patch) oestradiol
What type of HRT would you give to women with uterus?
Clue think post-menopausal and perimenopausal
Combined oral and progesterone
Perimenopausal- Cyclic progesterone combined with oral/patch oestrogeon or Mirena IUS
Postmenopausal- Continious progesterone combined with transdermal/ oral progesterone
- BAZIDOXIFENE and oral oestrodiol
How long should HRT be given up to in menopause and premature menopause?
- for five years- then review if symptoms come back
- premature- until 51 which is median age of onset
What are the risks of HRT?
- BREAST CANCER- risk reduced when HRT stopped
- VENOUS THROMBOEMBOLISM
- Cardiovascular risk- only increased if begin HRT >60 and cardiovascular risks present. Oral HRT increase stroke slightly
