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Repro and Sexual Health > Menopause > Flashcards

Menopause Flashcards

1
Q

What is the menopause?

A

Onset of the menopause is heralded by the cessation of menses for at least 12 consecutive months, without some other reason for amenorrhoea

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2
Q

What is the average age for the menopause?

A

51 years

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3
Q

What is defined as early and premature menopause?

A

<45 years

<40 years

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4
Q

What is defined as late menopause?

A

> 54 years

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5
Q

What is the physiology of the menopause?

A

Reduced oestrogen due to lack of follicle production and lack of granulosa cells
Therefore FSH and LH will be raised due to a lack of negative feedback

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6
Q

What are the effects of oestrogen?

A 
Secondary sexual characteristics
Hair distribution, body shape and fat distribution 
Effects of collagen 
Bone growth 
Proliferates endometrium
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7
Q

What are the main categories of symptoms for the menopause?

A

Vasomotor
Irregular periods
Psychological
Sexual

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8
Q

Why should FSH and LH not be measured in perimenopausal woman over 45?

A

Released in a pulsatile fashion

Single raised or normal level does not confirm or rule out the menopause

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9
Q

What things are known to increase FSH and LH levels?

A

Raised just prior to ovulation
Raised with stopping COC or depo provera
Raised with breastfeeding or certain medications (SSRI)

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10
Q

What are the main physical symptoms of the menopause?

A 
Hot flushes
Night sweats
Palpitations 
Insomnia
Joint aches
Headaches
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11
Q

What percentage of woman will have hot flushes?

A

60-80%

20% have severe symptoms

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12
Q

How long do hot flushes on average last?

A

Average is 2 years
10% for 15 years
Last for 3-5 mins

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13
Q

What psychological symptoms are associated with the menopause?

A 
Mood swings
Irritability 
Anxiety 
Difficulty concentrating
Forgetfulness
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14
Q

What sexual symptoms are assoc with the menopause?

A

Vaginal dryness

Libido

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15
Q

What physiological change leads to vaginal dryness seen in the menopause?

A

Lack of collagen

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16
Q

What hormonal change leads to reduced libido seen in the menopause?

A

Testosterone

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17
Q

What are the later symptoms of menopause?

A 
Urinary frequency 
Recurrent UTIs 
Dysuria 
Incontinence 
Dry hair and skin 
Atrophy of breast and genitals
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18
Q

Describe the perimenopausal dysfunctional uterine bleeding?

A

Irregular periods
Inter-menstrual bleeding
Post menopausal bleeding

19
Q

What is the concern with post menopausal bleeding?

A

Endometrial cancer

20
Q

What is the conservative management of the menopause?

A 
Diet; phytoestrogens such as soy 
Wt loss
Exercise
Caffeine
CBT
Mindfulness
21
Q

What are the treatment options for menorrhagia?

A 
Mefenamic acid 
Tranexamic acid 
Progesterones 
Intrauterine system 
Endometrial ablation 
Hysterectomy
22
Q

What are the mode of actions for mefenamic acid and tranexamic acid?

A

Mefenamic acid; NSAID, affects prostaglandins in uterus and decreases blood supply to womb
Tranexamic acid; anti fibrinolytic to stop body from breaking down clots

23
Q

What are the different forms of HRT?

A

Oestrogen alone
Oestrogen and progesterone combined
Topical or oral
Continuous or sequential

24
Q

When should woman with early menopause be advised to continue HRT?

A

Continue until at least the natural age of menopause (around 51)

25
Q

Should FSH be measured in woman presenting with the menopause >45?

A

No

26
Q

What is the 1st line treatment for women with vasomotor symptoms and low mood or anxiety?

A

HRT

27
Q

What can be considered to alleviate low mood or anxiety?

A

CBT

28
Q

When should transdermal instead of oral HRT be considered?

A

Increased risk of VTE
BMI over 30
Breast cancer risk

29
Q

When should vaginal oestrogen be offered to post menopausal women?

A

Urogenital atrophy (including those on systemic HRT) but ONLY after examination to exclude other pathologies

30
Q

Why is mirena IUS used in menopausal symptoms?

A

Does NOT help menopausal symptoms

Can be used for endometrial protection

31
Q

Contraindications for HRT?

A 
Breast ca
Undiagnosed abnormal vaginal bleeding
Endometrial cancer
Pregnancy
Active thromboembolism disease 
Recent myocardial infarction 
Active liver disease with abnormal LFT
Porphyria cutanea tarda
32
Q

What are the benefits of HRT?

A

Symptom control
Increased QOL
Reduced osteoporotic fracture
Reduced incidence of bowel cancer
Protective for alzheimer’s and parkinson’s
HRT <10 years after menopause fewer risks and less CV events

33
Q

What are the risks assoc with HRT?

A 
VTE
CVA
Breast ca
Gallbladder disease
HRT > 20 years after menopause greater risk of harm
34
Q

Why can clonidine be given in menopausal women?

A

Regulates temperature at the level of the hypothalamus

35
Q

What is the mode of regelle, yes and sylk in the menopause?

A

Vaginal lubricants

36
Q

What is the referral criteria to the postmenopausal bleeding clinic?

A

Post menopausal women (>12 months after LMP)
Vaginal bleeding on continuous HRT more than 6 months after start of HRT
Vaginal bleeding persisting 6 weeks post stopping HRT

37
Q

What are the benefits of systemic HRT?

A

Reduction of vasomotor symptoms
Improvement of low mood assoc with perimenopause
Prevention and treatemnt of vulovovaginal/ urogenital atrophy
Reduction of osteoporosis risk and fragility #
Improvement of sexual function

38
Q

What are the recommended investigations for menopause below 40?

A 
2 x FSH 4 to 6 weeks apart (menopausal levels >30)
Testosterone
Sex hormone binding globulin 
Prolactin
TFT
Autoimmune studies
39
Q

Describe the HRT given to women with a hysterectomy?

A

Continuous oestrogen only HRT

40
Q

Describe the HRT given to perimenopausal women with an intact uterus?

A

Sequential combined HRT

41
Q

Describe the HRT given to postmenopausal women, aged 54 or after >4 years on sequential HRT?

A

Continuous combined HRT

42
Q

Describe the general rules around contraception in the perimenopause?

A

Perimenopausal woman can get pregnant
HRT is NOT a contraceptive unless using IUS/ estradiol regimen
Contraception required for 2 years post LMP if <50 or 1 year if >50

43
Q

Which contraceptive methods can be used in perimenopausal women?

A

CHC and DMPA may be stopped at 50 years but can be continued if benefits outweigh risks but NOT in conjunction with HRT
1st line CHC in women over 40 contains 30 mcg EE or less and a 2nd generation PG (LNG, NE) to lower VTE and CVD risk
POP, SDI or Cu-IUD can be used in conjunction with HRT

Repro and Sexual Health (77 decks)

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