Menopause Flashcards
Define menopause
The last menstrual period a woman has
retrospective diagnosis
What is early menopause?
aged <45
What is premature menopause?
aged <40
What is late menopause?
aged >54
What is peri-menopause?
the transition from pre-menopausal to post menopausal
and is the time where symptoms are experienced
What role does GnRH play in the physiology of menopause?
GnRH stimulates release of FSH and LH
What are the changes in hormone levels in menopause?
increased FSH and LH (with FSH being more pronounced)
change in the balance of oestrogen (lowered E2, proportionally increased E1)
What form of oestrogen is produced by the ovaries and how is this done?
E2 (estradiol)
FSH and LH stimulate the follicular cells within the ovary - theca cells to produce androstenedione which the granulosa cells use to produce estradiol.
What hormones are produced by granulosa cells?
Oestrogen
Progesterone
Less circulating oestrogen causes what?
reduced proliferation of the endometrium
Why are overweight women more at risk of endometrial cancer?
The adipose tissue produces oestrogen (E1) which stimulates uncontrolled endometrial growth
List the symptoms of menopause
night sweats palpitations fatigue, insomnia joint pain (arthralgia) dizziness/headache reduced libido hot flushes low mood, anxiety irritability, reduced concentration, forgetfulness dry skin thinner har loosening of the pelvic floor (prolapse) urinary: frequency, nocturne, incontinence, recurrent UTI
What are the long term effects of menopause?
osteoporosis
increased risk of CVD and CVA
How is the diagnosis of menopause made?
Clinically after 1 year of amenorrhoea
if early: investigate FSH levels >430, 2 readings (6 weeks apart)
When can FSH levels be raised, other than with menopause?
When ovulating
Breastfeeding
just stopped COCP or depoprovera
on SSRI medication
How do we manage menopause with lifestyle factors?
weight loss
smoking cessation
complimentary therapies
How do we manage menopause?
Lifestyle factors
HRT
Vaginal dryness: topical oestrogen (regelle, Yes, silk) - vaginal lubricants
condone - for menopausal flushing
How can HRT be administered?
orally, transdermal patch
injection , mirena coil, intravaginally (pessary ring)
What are the different types of HRT?
Oestrogen only
Combined - oestrogen/progesterone
(sequential method/continuous)
Who can use oestrogen only HRT?
women without a uterus
as unopposed oestrogen is a risk factor for endometrial cancer
Who can use combined HRT?
Any women with a uterus
if still needing contraception - use combined HRT plus the mirena coil as HRT alone is insufficient
Describe the sequential regimen of HRT
oestrogen for 28 days
progesterone for the 2nd half of the cycle
mimics the natural process
can only use it for 2 years
Describe continuous HRT and who can use it
those post menopausal (LMP >1 year ago) or who have used sequential HRT for 2 years
there will be no period after 6 months of Tx
What are the benefits of HRT?
Reduced symptoms
reduces risk of colorectal cancer
prevention of osteoporosis
