Menopause Flashcards
What is the menopause and why is it usually a retrospective diagnosis?
Last ever menstrual period
- retrospective as is only usually diagnosed after a year of amenorrhoea
What is the average age of menopause in the UK?
51
What ages would be considered an early or premature menopause?
Early menopause <45yrs
Premature menopause <40yrs
What age is considered a late menopause?
Late menopause >54yrs
Why do periods stop?
- need ovulation for periods to occur
- women are born with around 1 million eggs, but these are all lost by the age of 50
=> if no ovulation is occurring the woman cannot bleed
What effects of oestrogen are essentially “reversed” in the menopause?
- Secondary sexual characteristics
- Hair distribution, body shape + fat distribution
- Effect on collagen
- Bone growth
- Proliferates endometrium
HOw is the menopause diagnoseD?
Vasomotor Symptoms
Pattern of periods
Blood tests? (sometimes)
What vasomotor symptoms do women often find the most debilitating?
- Hot flushes
- last for 3-5 mins
- severe in around 20%
Why must multiple blood tests be taken to diagnose the menopause?
- one single raised FSH/LH doesnt confirm
- Normal FSH/LH doesnt exclude
- Usually 2 blood tests 6 weeks apart
Why else may FSH levels be raised on a menopausal blood test?
- prior to ovulation
- Combined oral contraceptive OR Injection
- Breastfeeding
- Effect of certain medication (e.g. SSRI)
Why may a patient with a hysterectomy be more difficult to diagnose with menopause?
- No abnormal bleeding pattern seen
Women who are happier in life experience less menopausal symptoms. TRUE/FALSE?
TRUE
What psychological symptoms can occur during menopause?
Mood swings Irritability Anxiety Forgetfulness Difficulty Concentrating
What other physical symptoms are common in menopause?
Night sweats Palpitations Insomnia Joint aches Headaches
What sexual symptoms are experienced by women in the menopause?
Vaginal dryness
Libido
What symptoms of the menopause usually appear later than others?
Urinary
- Frequency
- Recurrent UTIs
- Dysuria
- Incontinence
- Skin and hair changes
- Atrophy of breast and genitals
What are the different types of perimenopausal dysfunctional uterine bleeding?
Irregular periods
Inter-menstrual bleeding (between periods)
Post menopausal bleeding
If a woman experiences post-menopausal bleeding, what diagnosis do you want to rule out first?
Endometrial cancer
What conservative management can be used in the menopause?
- Diet/Weight loss/Exercise
- Reduce caffeine
- CBT/Mindfulness for hot flushes/mood swings
What treatments can be used for menorrhagia?
- Mefenamic acid (NSAID - decreases blood to uterus)
- Tranexamic acid (antifibrinolytic - stops clot breakdown)
- Progesterones
- Intra-uterine system(IUS) - used for HRT, contraception, protection against endometrial cancer
- Endometrial ablation
- Hysterectomy
If oestrogen only HRT is given, this can increase a woman’s risk of endometrial cancer. TRUE/FALSE?
TRUE
How can HRT be given?
- Patch
- Oral
- Oestrogen only (+ mirena coil to prevent cancer)
- Combined
What are the contra-indications for HRT?
Breast cancer Abnormal vaginal bleeding Endometrial cancer Pregnancy Active thrombo-embolic disorder Recent MI Active liver disease with abnormal LFT Porphyria cutanea tarda
Why is HRT given after a subtotal hysterectomy?
- cervix is left in during this procedure
=> small bits of endometrium may also be left - certain types of HRT will cause this to bleed and show there is tissue left
What Non-HRT methods are used to control symptoms of menopause?
- Clonidine (antihypertensive with temperature regulation => useful if HRT contraindicated)
- SSRIs
Vaginal Lubricants:
- Regelle
- Yes
- Sylk
