menopause Flashcards
what is the menopause
last ever menstrual period
what is the climacteric
onset of symptoms of the menopause
when is early menopause
<45 years
when is premature menopause
<40 years
when is the average onset of menopause
51 years
when is late menopause
> 54 years
what are the effects of oestrogen
secondary sexual characteristics hair distribution, body shape and fat distribution effects on collagen bone growth proliferates endometrium
how to diagnose the menopause
pattern of periods
symptoms
blood tests if <45 years to exclude other ddx
why should you not check FSH and LH
they are pulsatile so are not constant amounts of hormone
when the ovaries stop responding so well to the hormones the amount of hormone increases
what can cause levels of FSH and LH to rise
just prior to ovulation
raised with stopping COC pill or depo injection
breastfeeding
medications (e SSRIs)
what are the physical symptoms of the menopause
hot flushes night sweats palpitations insomnia joint aches headaches
how long do hot flushes normally last
2 years
can last up to 15 years
psychological symptoms of the menopause
mood swings irritability anxiety difficulty concentrating forgetfulness
sexual symptoms of the menopause
vaginal dryness
libido
later symptoms of menopause
frequency recurrent UTI dysuria incontinence dry hair and skin atrophy of breasts and genitals
conservative management of menopause
diet (plant oestrogen eg soy products) weight loss exercise lifestyle caffeine
management of menorrhagia
mefenamic acid tranexamic acid progesterones intra-uterine system endometrial ablation hysterectomy
what is mefenamic acid
NSAID
reduces blood flow to uterus
what is tranexamic acid
anti-fibrinolytic
clots dont break down
how do progesterones reduce menorrhagia
makes body think you are pregnant so doesn’t proliferate the womb so much
why should you not give oestrogen only ie give progesterone as well
oestrogen only increases the chance of endometrial cancer because of the unopposed proliferation
pros of HRT
symptoms control
improved quality of life
reduced osteoporotic fracture
reduced bowel cancer
possibly protective against Alzheimer’s and Parkinson’s
HRT <10 years after menopause fewer risks and less CV events
cons of HRT
increased risk of VTE CVA breast cancer gallbladder disease HRT >20 years after the menopause greater risk of harm
non-HRT treatment options
clonidine
SSRIs
regelle
sylk
