Menopause Flashcards
what is the climacteric
another name for menopause
what is the menopause
Last ever period a women will have- retrospective diagnostic after a year period free
what is perimenopausal
when a women in going through the menopause
what is the average age of menopause
51
when is early, preamture and late menopause
Early menopause <45yrs
Premature menopause <40yrs
Late menopause >54yrs
what can cause early menopause
natural
iatrogenic- oophyrectomy, chemo
how is premature menopause diagnosed
vaso motor symptoms, pattern of periods and hormonal blood tests
what cells secrete oestrogen
granulosa
what are the effects of oestrogen
Secondary sexual characteristics
Hair distribution, body shape & fat distribution
Effect on collagen
Bone growth
Proliferates endometrium- causing periods
(menopausal loose oestrogen so the reversal of all of these occurs)
when is FSH and LH raised
Raised just prior to ovulation
Raised with stopping Combined oral contraceptive pill or depoprovera
Raised with breastfeeding or certain medication (SSRI)
why does a single raised FSH/ LH level not confirm menopause
as released in pulsatile fashion
do two blood tests 6 weeks apart
if a women is >45 with symptoms of menopause and irregular periods do you need to test for menopause to diagnose
no- unless she has had hysterectomy then exclude cancer
what are the physical symptoms of the menopause
Hot flushes Night sweats Palpitations Insomnia Joint aches Headaches
how long do hot flushes last
3-5 mins each for average 2yrs
10% for 15yrs
how does social adversity affect symptoms
are compounded by stress and happiness
what are the psychological symptoms of menopause
Mood swings Irritability Anxiety Difficulty concentrating Forgetfulness
what are the sexual symptoms of menopause
Vaginal dryness (loss of collages in vaginal tissue) Loss of libido (stress, loss of testosterone)
what are the later symptoms of the menopause
urinary symptoms: Frequency Recurrent UTIs Dysuria Incontinence
Dry hair & skin
Atrophy of breast and genitals- change in fat distribution
what are the features of Perimenopausal Dysfunctional Uterine Bleeding
Irregular periods
Inter-menstrual bleeding (Sporadic oestrogen production- endometrium thickens but don’t have regular hormones for ovulation)
Post menopausal bleeding
what do you have to rule out with Perimenopausal Dysfunctional Uterine Bleeding
endometrial cancer
what is the conservative management for menopause symptoms
Diet Weight loss Exercise Lifestyle Caffeine CBT Mindfulness
not licensed- Dietary supplements that contain plant oestrogens- e.g. soy
what is the treatment for menorrhagia in menopuase
Mefenamic acid (NSAID that affects the prostaglandins in the uterus, reduced blood flow)
Tranexamic acid (stop body from breaking down clots)
Progesterones (pop, depot)
Intra-uterine system- mirena
Endometrial ablation
Hysterectomy- last resort
what hormone replacement options are available for menopause
general rule: Topical HRT only +/- mirena for the shortest amount of time before the age of 60
Oestrogen alone (risk of cancer and VTE)
Oestogen and progesterone (reduced risk
Topical or oral
Give sequential HRT with progesterone towards end on cycle to have bleed
If want bleed free give continuously (only for women who have had a year of amenorrhoea)
why might HRT be given after a hysterectomy
ablation to see if any endometrial tissue left, if some left will bleed
when during menopause is HRT safe to give
within 10 years of it beginning
what are the CI to HRT
Breast cancer Undiagnosed abnormal vaginal bleeding Endometrial cancer Pregnancy Active thrombo-embolic disorder Recent Myocardial infarction Active liver disease with abnormal LFT Porphyria cutanea tarda
what are the benefits of HRT
Symptom control
Quality of life
Reduced Osteoporotic fracture
Reduced Bowel cancer
Possibly protective Alzheimer’s & Parkinson’s diseases
HRT <10years after menopause fewer risks and less cardiovascular events
No increase cardiac risk if started before age 60
HRT with oestrogen alone is associated with no, or reduced, risk of coronary heart disease
HRT with oestrogen and progestogen is associated with little or no increase in the risk of coronary heart disease
what are the risks of HRT
VTE (2-7 extra /1000) CVA Breast cancer (6 extra /1000) Gallbladder disease HRT >20 years after the menopause greater risk of harm
E2 no increased risk Br can
E & prog slight increased risk but stops with stopping
does oral or transdermal HRT have higher risk of VTE
oral
what greatly increases risk of breast Cx with HRT
obesity
what are the non HRT options for menopause Tx
Clonidine (originally an anti hypertensive, affects temp regulation in hypothalamus, not as effective as HRT)
SSRIs (for mood)
vaginal lubricants: Regelle, Yes, Sylk
