menopause Flashcards
what is menopause?
when women havent had a period for a whole year
why has there been an increase in the age at which you reach menopause?
bc of an increase in life expectancy
what is the average age of menopause?
51-52 years
when does early menopause occur?
20% of women aged 40-45 years
when does premature menopause occur?
1% of women <40 years
what is climacteric?
time leading up to and around the menopause (perimenopause)
Transitional phase where reproductive function declines and ceases
what are symptoms of climacteric?
Changes in length of menstrual cycle
Hot flushes and night sweats
If menopause at 50 years, climacteric begins a year earlier
If menopause <40 years, climacteric begins 4 years earlier
what are the short term symptoms of the menopause?
- Vasomotor = hot flushes, night sweats, headaches, palpitations
- Psychological =depression, mood swings, insomnia, memory loss and panic.
- Urogenital = urinary frequency, dysuria, stress and urge incontinence, vaginal dryness.
- Collagen = dry inelastic skin, brittle nails, hair loss, joint/muscle pains
what are the long term consequences of menopause?
- CVS = ischaemic heart disease, hyperlipidemia
- Skeletal = osteopenia and osteoporosis
- Skin = inelastic, thin flaky skin, easy bruising
- Genito-urinary = more likely to get prolapse, incontinence.
- Physiological = Alzheimer’s disease
what is second degree utero-vaginal prolapse?
uterus presses down near vaginal opening
makes it more difficult to do exercise
what is procidentia?
uterus pressing in the vaginal opening
how does Alzheimer’s affect the brain?
loss of density of white matter
what is the pathophysiology of osteoperosis?
Resorption > osteogenesis –> reduction in bone mass
decreased bone density = easier fractures
what ethnicity is osteoperosis most and least common in?
Commonest in white women and lowest risk in Afro-Carribeans
how does osteoperosis present?
Changes in posture (walking) –> Dowager’s Hump: loss of bone density in vertebrae
easier fractures = decreased bone density
how is menopause diagnosed?
- Triad of Diagnostic Features = typical symptomatology, blood tests (FSH increases after menopause: as oestrogen levels go down, FSH tries to stimulate the ovaries more) and 12 months’ amenorrhoea
- Serum Oestradiol Levels = only useful <45 as wide range of normality.
- Bone Mineral Densitometry = helps in the diagnosis of osteoporosis
how is menopause treated?
hormone replacement therapy
if the uterus is present, how is menopause treated and why?
oestrogen and progesterone
High level of oestrogen will hyper stimulate endometrium of uterus if progesterone not given (causes endometrial atrophy). This can lead to endometrial cancer.
how is menopause treated if the uterus isnt present and why?
oestrogen
Because no hyper stimulation of endometrium so progesterone not necessary.
what are the routes of administration of HRT?
oral, patches and gels, implants and injections, intravaginal creams, nasal sprays.
what are common side effects of HRT?
- Heave cyclical/unscheduled irregular bleeding (oestrogen stimulates endometrium)
- Bloating, fluid retention and weight gain (associated with progesterone)
- Mastalgia (sore breasts)
- Headaches, muscle cramps and abdominal pain.
- Depression may occur in some women
what are complications of HRT?
• Breast cancer (risk increases if you have more than 5 years of use)
• Thrombo-embolic events
o Deep vein thrombosis may cause stroke.
• Oestrogen alone may lead to endometrial cancer, but endometrial protection is given.
what are contraindications of HRT?
- Breast cancer
- Endometrial Cancer
- TED (thyroid eye disease).
- Endometriosis
- Fibroids
- IHD (ischemic heart disease)
what are non-hormonal treatments of HRT?
• Bisphosphonates and calcitonin
• Selective estrogen receptor modulators
o Stimulate increased oestrogen secretion.
• Clonidine and venlafaxine
