Menopause Flashcards
What is the average age to go through menopause?
51
What is termed early menopause?
<45 years
What is termed premature menopause?
<41 years
Why do you get high FSH in menopause?
the oestrogen negative feedback isnt working from the anterior pituitary due to lack of oestrogen
What oestrogenic affects are all lost in menopause?
sexual characteristics hair distribution, body shape and fat distribution effect on collagen bone growth endometrial proliferation
How does menopause present?
hot flushes - 60-80% of menopausal women, last 3-5 mins night sweats palpatations insomnia joint aches headaches mood swings irritibility anxiety vaginal dryness lack of libido
What are the later symptoms of menopause?
atrophy of breasts and genitals
dry hair and skin
incontinence and dysuria - due to lack of tissue support
recurrent UTIs
What conservative management can be done for menopause?
weight loss diet low caffeine CBT mindfulness diet
What is the medical management for menorrhagia?
1st line: mefenamic acid and tranexamic acid
2nd line: endometrial ablation and hysterectomy
What is the role of mefenamic acid?
reduces prostaglandin synthesis and inhibits binding of prostaglandin E2 to its receptor
What is the role of tranexamic acid?
stops clots breaking down
How does oestrogen HRT work?
causes a bleed when given at the end of a cycle
Why is oestrogen HRT not normally given?
causes endometrial cancer - better to give progesterone too
How does combined HRT work?
no bleeding at all
How is HRT given?
topical or oral
What is the best possible HRT use?
combined topical HRT +/- mirena coil for shortest time possible before age 60
What are the contraindications for HRT?
breast cancer endometrial cancer recent MI abnormal LFTs undiagnosed abnormal vaginal bleeding active thromboembolic disorder pregnancy porphyria cutanea tarda
When is HRT most beneficial?
<10 yrs after menopause
When is HRT most harmful?
> 20 years after menopause
What are the benefits of HRT?
reduced bowel cancer
symtpom control and quality of life
reduced osteoporotic fracture
possibly protective against Alzheimers and Parkinson’s
What are the risks of HRT?
VTE
breast cancer
gallbladder disease
CVA - only oral
What are alternative options to HRT?
clomidine - regulates temperature in the hypothalamus
SSRIs - for mood
Regelle, Yes and Sylk - vaginal lubricants
