Menopause Flashcards
What is the menopause?
Clinically, women are described as being post-menopausal when?
What is the average age of menopause in the UK?
What is a normal age range for the menopause?
The permanent cessation of menstruation in a woman
When they have not had a period in over 1 year
51
45-54
Whatwould be classed as each of the following:
a) early menopause?
b) premature menopause?
c) late menopause?
a) 40-45
b) < 40
c) > 54
Physiologically, the cessation of the menstrual cycle coincides with what?
What effect does this have on the production of a) oestrogen and progesterone? b) LH and FSH?
Some oestrogen is still produced by what other tissues?
Depletion of all the follicles within the ovaries
a) cessation b) increased production
Adipose tissue, bone and brain
The perimenopause period can present how long before the cessation of periods?
As ovarian reserve declines, levels of LH and FSH increase to try and maintain oestrogen levels, which can lead to fluctuations in the level of what hormone?
What happens to fertility in the perimenopause period?
5 years
GnRH
It decreases
What effect can the perimenopausal period have on a woman’s periods?
If thee is post-menopausal bleeding, what should you be worrying about the most?
Can cause irregular periods and inter-menstrual bleeding
Endometrial cancer
What are some physical symptoms of the menopause?
Hot flushes
Night sweats
Insomnia
Palpitations
Joint aches
Headaches
What are some psychological symptoms of the menopause?
Moodswings and irritability
Anxiety
Difficulty concentrating
What are some sexual symptoms of the menopause?
Vaginal dryness
Lack of libido
Dypareunia
What are some systemic symptoms of the menopause?
Osteoporosis
Increased CV risk
What is included in the term ‘vasomotor changes’ when describing symptoms of the menopause?
Hot flushes and night sweats
How long do hot flushes tend to persist for?
How long does an individual hot flush tend to last?
Hot flushes can be spontaneous, or they can be triggered by what?
This can be a predisposing factor for what other type of symptoms?
Usually around 2 years, but can persist for up to 15 years
3-5 minutes
Stress, changes in temperature or caffeine/alcohol consumption
Psychological symptoms
After the menopause, the mucosa of the vagina becomes thin and atrophic and sensitive to trauma. What symptom does this often present as?
What happens to the vaginal pH after the menopause? What is the effect of this?
Dyspareunia
It increases to between 5-7.5 - makes women more prone to vaginal infections
The ovaries produce oestrogen and also a small amount of testosterone. The loss of both of these after the menopause leads to what symptom?
The urethra and bladder are also sensitive to oestrogens, so a lack of oestrogen causes the urethral mucosa to thin and collagen to decrease. What effect does this have on post-menopausal women?
Loss of libido
More prone to urinary infections and stress incontinence
10 years after the menopause, what effect has it had on bone mineral density? What can this lead to in older women?
Why does a lack of oestrogen cause an increased CV risk?
It is around 70% of what it used to be - predisposes women to fractures
Re-distributes body fat, increases blood pressure, reduces glucose tolerance, alters lipid metabolism and causes endothelial dysfunction
A diagnosis of the menopause can be made from what two things?
You only need to perform blood tests to check menopausal status in who?
A single raised level of LH and FSH does not confirm menopausal status. What does?
Classic symptoms of the menopause, and a change in the pattern of periods
Women aged < 45 where you think there might be an underlying cause
Two tests should be done, at least 6 weeks apart
What are some conservative management options for helping symptoms of the menopause?
Diet and exercise - consider soy products as these contain plant oestrogens
Weight loss (helps with hot flushes)
Decrease alcohol, caffeine, stress
What are the ways to manage menorrhagia in the perimenopausal period?
Mefanamic acid (NSAID) and/or tranexamic acid (anti-fibrinolytic) - these should only be taken when actually on the period
Progesterones (stops endometrial proliferation)
Endometrial ablation or hysterectomy
What is the best treatment for vasomotor symptoms of the menopause?
What are its risks?
Hormone replacement therapy
Increased risk of endometrial cancer
Increased CV risk if using it outwith 10 years of the menopause
Giving oestrogen alone as HRT gives an increased risk of what type of cancer?
It should only be given alone when?
Endometrial
The woman has had a hysterectomy or is taking some other form of progesterone e.g. Mirena coil
What is the best hormone replacement therapy plan to minimise the risk of endometrial cancer?
Oestrogen and progesterone together (topical or oral)
Overall, what are the main benefits of HRT?
Better symptom control and quality of lide
Reduces risk of fractures
Reduces risk of bowel cancer
Overall, what are the main risks of using HRT?
VTE
CV risk
Breast cancer
Gallbladder disease
Overall, the risks of using HRT are small when?
The risks of using HRT are large when?
If < 10 years since the menopause
If > 20 years since the menopause
What are some treatment options for vasomotor symptoms of the menopause which are not HRT?
Clonidine
SSRIs
Vaginal moistuisers (Regelle, Yes)
Vaginal lubricants (Sylk)
Describe the difference in the use of cyclical vs continuous HRT?
Use cyclical HRT when the woman has menopausal symptoms but is still menstruating
Use continuous HRT once a woman is post-menopausal
