Menopause Flashcards
What is menopause?
A woman’s last ever menstrual period
What is the climacteric period?
Time leading up to menopause when symptoms appear
What is average age for menopause to occur?
51 years old
When is menopause considered premature?
If it occurs before the age of 40
When is menopause considered late?
If it occurs after the age of 54
When is menopause considered early?
If it occurs before the age of 45
Absence of what hormone causes the menopause?
Oestrogens
What cells secrete oestrogen?
Granulosa cells
Which sex harmones control the release of oestrogen?
FSH and LH from the anterior pituitary
State the physiological effects of oestrogen on the body
Secondary sexual characteristics Hair distribution Body shape Fat distribution Prevents reduction in collagen Bone growth
What effect does oestrogen have on the endometrium?
Proliferates and thickens the endometrium
List diagnostic options for menopause
Symptoms
Pattern of periods
Blood tests in women under 45yo or hysterectomy
How are blood tests used to diagnose menopause?
FSH and LH levels taken twice two weeks apart
What happens to FSH and LH levels following menopause?
They increase as there is no oestrogen to negatively feedback to inhibit release
List some physical symptoms of menopause
Hot flushes (very common) Night sweats Palpitations Insomnia Joint aches Headaches
List some psychological symptoms of menopause
Mood swings Irritability Anxiety Difficulty concentrating Forgetfulness
List some sexual symptoms of menopause
Vaginal dryness
Libido loss
List some late-on features of menopause
Frequency Recurrent UTIs Dysuria Incontinence Dry hair and skin Atrophy of breasts and genitals
State the types of perimenopausal dysfunctional uterine bleeding
Irregular periods
Intramenstrual bleeding
Post-menopausal bleeding
Why does perimenopausal bleeding occur?
Excess unopposed oestrogen without enough progesterone (no ovulation)
List common causes of post-menopausal bleeding
Atrophic vaginitis
Cervical polyps
Endometrial hyperplasia
Endometrial cancer
When is bleeding following menopause considered post-menopausal bleeding?
After 1 year of having menopause
Outline conservative management options for menopause
Diet (soy) Weight loss Exercise Lifestyle Caffeine Alcohol
Which NSAID can be given for post-menopausal bleeding? How does it help?
Mefenamic acid
Reduces blood supply to uterus to minimise bleeding
Which antifibrinolytic can be given for post-menopausal bleeding? How does it help?
Tranexamic acid
Delays clot breakdown
Why could progesterone agents be given for post-menopausal bleeding?
Stabilise womb lining and make it less likely to proliferate
What treatment offers endometrial protection for up to 4 years against menorrhagia?
Intra-uterine system (releases low-dose progesterone)
List management options for menorrhagia
Mefenamic acid Tranexamic acid Progesterone Intra-uterine system Endometrial ablation Hysterectomy
What symptoms does HRT help treat?
Vasomotor symptoms (hot flushes/night sweats).
Mood swings.
Vaginal and bladder symptoms
Which harmones are typically given in HRT? Which routes of administration can be used?
Progesterone and oestrogen
Topical, oral
List some benefits of HRT
Symptom control Reduces risk of osteoporotic fracture Reduces risk of bowel cancer Possibly protective against AD and PD Possibly less cardiovascular events
List some risks of HRT
VTE
CVA
Breast cancer
Gallbladder disease
In what situations, should HRT be avoided?
Patient is at risk of breast cancer
Patient is at risk of VTE
Which antihypertensive can be used for management of menopause?
Clonidine
Which class of antidepressants can be used for management of menopause?
`SSRIs
Which moisturisers or lubricants can be used for management of menopause?
Regelle
Yes
Sylk
State an absolute contraindication to HRT
Active or recent arterial thromboembolic disease
In woman with a uterus or with a partial hysterectomy offer…
Combined (oestradiol plus progestogen) HRT preparation
In women with a full hysterectomy offer…
Oestrogen-only preparation
In women diagnosed with premature menopause offer…
Sex steroid replacement with a choice of HRT or a combined oral contraceptive (unless contraindicated, for example in women with hormone-sensitive cancer)
