menopause Flashcards
what is menopause?
Cessation of menstruation
Average age 51 years
Diagnosed after 12 months of amenorrhoea
Onset of symptoms if hysterectomy
What is perimenopause?
Period leading up to the menopause
Characterised by irregular periods and symptoms eg hot flushes, mood swings, urogenital atrophy
What are the vasomotor symptoms of menopause?
hot flushes and sweats
what are musculoskeletal symptoms of menopause?
joint and muscle pain
what effect does menopause have on the vagina?
dryness and vaginal atrophy
short term impact of menopause?
vasomotor symptoms (hot flushes and sweats)
generalised symptons: mood changes, loss of memory, headaches
medium term impact of menopause?
urogenital atrophy dyspareunia UTIs PMB incontinence and prolapse
long term impact of menopause?
osteoporosis-reversible with oestrogen
cardiovascular disease
dementia
management of menopause?
lifestyle
reduce modifiable risk
HRT
Clonidine (non hormonal)
CBT
Benifits of HRT in menopause?
relief of menopause symptons
bone protection
side effects of HRT?
beast cancer
VTE (venouse thrombo embolism)
Cardiovascular disease
are the risks of HFT increased if oesterogen is combined with progesteron?
HRT with oestrogen alone – little or no change in risk
HRT with oestrogen + progesterone – increased risk
Increased risk is related to treatment duration and reduces after stopping HRT
when not to use HRT?
in women with breast cancer
VTE and HRT use?
Oral > Transdermal
(same for the risk of stroke too)
Transdermal = baseline population
Transdermal – BMI >30 or increased risk of VTE
cardiovascular disease and HRT?
HRT does not increase cardiovascular risk when started in women < 60 years
The presence of cardiovascular risk factors is not a CI to HRT as long as they are optimally managed
Does HRT adverse affect diabetes?
Oral or TD does not increase
HRT is not generally associated with an adverse effect on BG control
should progesteron be used in HRT>
Progesterone should be used for at 12-14 days every 4 weeks - sequential
Protects the endometrial from the stimulatory effects of unopposed Estrogen
who should have transdermal HRT?
Gastric upset eg Crohns
Need for steady absorption eg migraine/epilepsy
Perceived increased risk of VTE
Older women ‘higher risk of HRT’
Medical conditions eg hypertension
Patient choice
what is premature ovarian insufficiency?
menopause <40yrs
natural or latrogenic (sugery, chemo/radio)
primary or secondary
majority of cases are idiopathic
what is the diagnosis test for premature ovarian insufficiency?
FSH >25IU/l – 2 samples >4 weeks apart + 4 months of amenorrhoea
premature ovarian insufficiency and HRT?
women with premature ovarian insufficiency are encouraged to use HRT at least until the average age of the menopause.
can you use HRT in over 60s?
no
