Menopause Flashcards
definition of menopause?
ceasing of menstruation
average age of menopause?
51
early menopause?
<45 years
premature menopause?
<40 yrs
late menopause?
> 54 yrs
physiology of menopause?
1 million ova present at birth within the follicles
decrease over life so less eggs and less oestrogen produced from the granulosa cells of the follicles
FSH and LH continue to be produced from anterior pituitary and increase due to feedback system once oestrogen decreases
5 effects of oestrogen?
secondary sexual characteristics hair distribution, body shape and fat distribution effect on collagen bone growth proliferates endometrium
how is menopause diagnosed?
largely a clinical diagnosis
vasomotor symptoms
pattern of periods
blood tests may be used but not really diagnostic (high FSH and LH can be due to lots of things and doesnt confirm menopause)
when will FSH and LH be raised?
released in pulsatile fashion
raised prior to ovulation
rasied with stopping COCP or depoprovera
raised with breastfeeding or certain medications (SSRIs)
why is menopause difficult to confirm in women who have had a hysterecromy?
they dont get any change in bleeding pattern
physical symptoms of menopause?
hot flushes night sweats plapitations insomnia joint aches headaches
average duration of hot flushes?
on average last around 2 years
each flush lasts around 3-5 mins
what can cause women to have more severe menopausal symtoms?
evidence suggests that women that are happier in life have less severe symptoms
psychological symptoms of menopause?
mood swings irritability anxiety difficulty concentrating forgetfulness
what can contribute to psychological symptoms in women?
menopause occurs at time where there is often a lot of life stress
- children moving out, elderly parents, work responsibility etc
sexual symptoms of menopause?
vaginal dryness (due to collagen loss) loss of libido
later symptoms in menopause?
recurrent UTIs (due to collagen loss) dysuria incontinence dry skin and hair atrophy of breast and genitals
describe perimenopausal dysfunctional uterine bleeding
irregular periods
inter-menstrual bleeding
post menopausal bleeding
conservative management in menopause?
diet weight loss exercise lifestyle caffeine CBT mindfulness
medical management of menorrhagia?
mefenamic acid (NSAID) tranexamic acid (amino acid derivative which prevents breakdown of clots) progesterones (POP, depot, IUD etc) endometrial ablation hysterectomy
how is hormone replacement therapy (HRT) given?
oestrogen and progesterone (oestrogen alone can increase endometrial cancer risk)
can be topical or oral
can have combined continuous therapy so there is no time off or bleeding if patient prefers or theres a history of endometriosis or partial hysterectomy
risks of HRT?
might have slight increase in VTE, heart disease, gallbladder disease and breast cancer risk but deemed safe within 10 years of menopause
contra-indications for HRT?
breast cancer undiagnosed abnormal vaginal bleeding endometrial cancer pregnancy active thrombo-embolic disease recent MI active liver disease with abnormal LFTs porphyria cutanea tarda
benefits of HRT?
symptom control
QoL
reduced osteoporotic fractures
reduced bowel cancer risk
may protect against alzheimers and parkinsons
HRT <10 yrs after menopause has fewer risks and less cardio events
non HRT medical management of menopause?
clomidine (alpha gaonist hypotensive) SSRIs regelle (vaginal moisturiser) Yes sylk (vaginal lubricant)
