Menopause Flashcards
what is the average age of menopause?
51 years
what is menopause and how is it diagnosed?
cessation of menstruation
diagnosed after 12 months of amenorrhoea or onset of symptoms after hysterectomy
what symptoms characterise perimenopause/post menopause and how long can they last?
central effects of decreased oestrogen:
vasomotor - hot flushes and sweating
MSK - joint and muscle pain
psycho/sexual - low mood, lack of energy, irritability, loss of concentration, low libido
local effects: vaginal dryness, and atrophy
can last on average 2-7 years
what are the medium term impacts of menopause? and what problems can it cause?
urogenital atrophy
- dyspareunia
- recurrent UTIs
- post-menopausal bleeding
-urinary incontinence?
-prolapse?
(peak incidence of these = 55-65 year olds)
what are the long term impacts of the menopause?
Osteoporosis: Effects reliably reversible with oestrogens
Cardiovascular disease: Adverse changes in lipid - Increased prevalence with early menopause
Dementia: Increased prevalence with early menopause
Risk reduction strategies should start at the time of the
menopause
what are the different options for management of the menopause?
life style advice and reduce modifiable risk factors
hormonal: HRT
non hormonal: clonidine, SSRI, gabapentin
non pharmaceutical: CBT
what are the benefits of HRT?
Relief of menopause symptoms
Bone mineral density protection
Possibly prevent long term morbidity
what risks can come from HRT?
baseline risk of all of these varies but:
Breast and ovarian cancer
- oestrogen only is only small risk, combined = higher risk
- related to treatment duration and reduces after stopping HRT
VTE
- 2 to 5-fold increased risk of venous thrombosis compared with nonusers.
- higher risk with combined HRT
- given transdermally it does not increase risk
Cardiovascular disease
- in over 60s only, does not increase in <60 yo
- presence of CVD risk factors is not CI to HRT so long as optimally managed
Stroke
- not increased with transdermal
who should have transdermal HRT?
Gastric upset eg Crohns
Need for steady absorption eg migraine/epilepsy
Perceived increased risk of VTE
BMI >30kg/m2
Older women ‘higher risk of HRT’
Medical conditions eg hypertension
Patient choice
define premature ovarian insufficiency (POI)
Menopause <40 yrs
how to diagnose POI?
FSH >25IU/l in 2 samples >4 weeks apart
AND
4 months of amenorrhoea
causes of POI?
Majority of cases – idiopathic
Other natural causes
- Chromosome abnormalities
- FSH receptor gene polymorphisms
- Inhibin B mutations
- Enzyme deficiencies
- Autoimmune disease
Iatrogenic
- Surgery
- Chemotherapy
- Radiotherapy
what should be given to people with POI and how long for?
Why?
HRT
at least until the average age of menopause
- Alleviate symptoms of estrogen deficiency
- Minimise long term risks of estrogen deficiency
- Induce secondary sexual characteristics in adolescents
do women in the menopause need contraception?
women are fertile for 2 years if menopause starts <50 years
women are fertile for 1 year if menopause start >50 years
should have contraception for this time ideally
other than HRT, what other pharmacological options are there for management of menopause?
Alpha adrenergic receptor agonist: Clonidine
SSRI: Fluoxetine Paroxetine Citalopram Sertraline
SSRI-SNRI: Venlafaxine
Anti-epileptics: Gabapentin
