Menopause Flashcards
what is the definition of menopause
- this is a year after the women had her last menstrual periods
how many people does menopause occur in
12 million
what is the average age of menopause
52 - in markscheue
(51.4) or 51-52
what is the life expectancy of a women
82
what is the early menopause
20% of women aged 40-45yrs
what is premature menopause
1% of women lower than the age of 40
what is perimenopause/ climacteric
this is the time leading up to and around the menopause
- it is the transitional phase during which reproductive function decline and ceases
if menopause occurs around the age of 50 than the perimenopause can last for..
1-3 years
what are the climacteric symptoms
Changes in length of menstrual cycle
Hot flushes / night sweats
If menopause at 50 yrs, climacteric begins a year earlier
If menopause less than or equal to 40 yrs, climacteric begins 4 years earlier
what are the symptoms of menopause due to
- an decrease in oestrogen this is mainly due to the ovarian reserve being depleted
what are the types of symptoms experienced in menopause
- short term symptoms
- long term symptoms
Name the short term symptoms that occur
- vasomotor
- psychological
- urogenital
- collagen
describe the short term symptoms that occur
Vasomotor - hot flushes and night sweats, headaches, palpitations
Psychological - depression, mood swings, insomnia, memory loss, panic
Urogenital urinary frequency, dysuria, stress & urge incontinence, vaginal dryness, dyspareunia (pain with sex)
Collagen - dry inelastic skin, brittle nails, hair loss, joint/muscle pain
what is the most frequent short term symptom
- vasomotor symptoms
- these are mainly related to oestrogen
in how many women do psychological symptoms occur in
occurs in 50% of women
what are the long term consequences of menopause
CVS Skeletal skin genito-urinary psychological
describe the long term consequences of the symptoms of menopause
CVS - hyperlipidemia, ischaemic heart disease
Skeletal - osteopenia & osteoporosis
Skin - inelastic thin flaky skin, easy bruising
Genito-urinary – atrophic changes, prolapse, incontinence,
depressed libido & dyspareunia
Psychological - Alzheimer’s Disease
how is oeseoporosis pathophysiological caused in women with menopause
- In the bones there is a balance between reabsorption and oestogensis in menopause resorption increases by oesotgensis decreases thus there is a reduction in bone mass
what women is otesoporsis common in
Common in white women
- (50% have 1 fracture by 82 years)
Lowest risk in Afro-Carribeans
what happens to the uterus during menopause
can prolapse
- there can be utero-vaginal prolapse - this is when the uterus is 2nd degree as it does not go through the vagina
- there can be 3rd degree prolapse this is when it goes completely through the vagina
how can you diagnose menopause
- triad of diagnostic features include - typical symptomatology, 12 months amenorrhoea, FSH greater than 15 iu/ml
- serum estradiol levels (decreases) - these are only useful at the age of less than 45 years, these
Bone mineral densitometry (this decreases as well)
- this is helpful int he diagnosis of osetoprosis
what are the 2 treatments for menopause
- hormone replacement therapy (HRT)
- non-hormonal treatments
what are the two types of HRT
if uterus present :
oestrogen + progesterone
If uterus absent :
oestrogen alone
why do you give oestrogen and progesterone as a hormone related therapy if you have a uterus
-If you only give oesrogen – lining will become thick and lead to metaplasia therefore you need to give progesterone at the same time
what are the routes of administration for HRT
Oral Patches and gels Implants & Injections – 6 months Intravaginal creams, pessaries, rings Nasal sprays
what is the problem with oral absorption
- it is not very stable but it may help for a little bit
how often do you change the HRT transdermal patches
change them twice a week
what are the gels and creams that can be used
oestrogel
- Gel rub on arm and leg
2 lines per day
- If more symptoms they can go up to 3 or go down to 1 line
- If they have a uterus you need to give progesterone
what are the common side effects of HRT
Heavy cyclical / Unscheduled irregular bleeding
Bloating, fluid retention and weight gain
Mastalgia – pain on the breast
Headaches, Muscle cramps, Abdominal pain
Depression
what are the serious complications of HRT
Breast cancer - risk increases >5yrs of use, by approx 2-6/1000 women
Thrombo-embolic events
- DVT / PE affect approx 5/10,000 women on HRT, and most commonly occur in
the first year of use
what are some non-hormonal treatments
Biphosphonates & Calcitonin : Decrease osteoclast activity
Selective estrogen receptor modulators (SERM)
Clonidine & Venlaflaxine : Reduce vasomotor symptoms
what are the lifestyle issues with menopause
Vitamins
Herbs
Phyto-oestrogens
Exercise
No smoking
