Menopause Flashcards
Describe the hormonal changes which lead to the features of the menopause
Ovaries prod lower levels of oestrogen + progesterone
Define menopause
No menstrual periods for 12 consecutive months and no other biological or physiological cause can be identified
What is physiological menopause?
The normal decline in ovarian function due to ageing begins in most women between ages 45 and
55 on average 50
What is pathological menopause (premature ovarian insufficiency)?
The gradual or abrupt cessation of menstruation before 40 years
What is the pre-menopause phase?
Changes in menstrual cycle start to occur
Follicular phase shortens
Ovulation early or absent
Less oestrogen secreted = LH and FSH levels rise, FSH more (reduced negative feedback)
Reduced fertility
Outline the peri menopause phase
End of reproduction capacity
Terminating with the completion of menopause
Outline the menopause phase
Permeant cessation of menstruation caused by ovarian follicular devel failure
Describe the post-menopausal phase
Time after which a women has experience 12 consecutive months of amenorrhea without a period
Outline the cause of menopause
Ovaries are totally depleted of follicles = oestrogen levels fall dramatically = no -ve feedback = FSH and LH levels rise
How is the menopause diagnosed?
No blood test >45y, symptoms only
FSH >40 2x 4-6w apart
What are the consequences of oestrogen def?
Early = hot flushes, insomnia, menstrual irregularity
Intermediate = vaginal atrophy, skin atrophy, painful sex, urge-stress incontinence
Late = osteoporosis, atherosclerosis, Alzheimer’s disease
How does the menopause effect the vasomotor system?
80% get transient increases in temp
Changes can = panic attacks, anxiety, insomnia
Cycle of increased temp varies
How does the menopause effect uterine bleeding?
Spotting, heavy, mid-cycle, longer time between, longer/shorter periods
What psychological changes are seen during menopause?
frequent headache
irritability
fatigue
depression and insomnia
Although these are often said to be due to changes in the hormonal levels, they are more likely to be related to the loss of sleep due to night sweat
Diminished interest in sex may be due to emotional upset or may be secondary to painful intercourse due to a dry vagina
Outline the changes in the ovaries seen during menopause
Ovaries become smaller = oestrogen prod declined
For a while androgen prod still occurs – aromatase converts to oestrogen
What changes are seen in general appearance during menopause?
Skin = loses elasticity
Weight = gain result of irregular food habits, more deposition of fat around hips, waist, buttocks
Hair = dry and coarse
Voice = deeper due to thickening of vocal cords
How is the digestive/urinary system effected by the menopause?
D = motor activity diminished
U = tissue lining the urethra and the bladder become drier, thinner and less elastic
How do the genital organs change due to the menopause?
Uterus = small and fibrotic due to atrophy of muscles
Cervix = smaller, appears to be flush with the vagina
Vulva = fat loss, sparse hair
Breast = flat and shrivelled
How are the bones affected by menopause?
Increased osteoclast activity = increased risk of osteoporosis
How does the menopause effect the CVS?
Total cholesterol increased
Triglycerides increase
BP increase
Carb tolerance decreases
List the advantages of HRT in the post- menopausal woman
Can improve wellbeing
Most effective treatment for hot flushes and low mood
Can limit osteoporosis
Reduce vaginal dryness
List the disadvantages of HRT in the post- menopausal woman
Increased risk of breast Ca, VTE, stoke, CVD
SE - headaches, breast tenderness, bloating, muscle cramps, irregular bleeds
How is the menopause managed naturally?
Exercises - running, swimming, yoga
Smoking cessation, reduce alcohol/caffeine intake
Maintain BMI <30, balanced diet
Outline the types of HRT
Sequential = within 12m of last period, minimises risk of irregular bleeding
Continuous combined = no period for 12m, can get bleeding first 3m
Tibolone
Vaginal oestrogen = pessaries, cream, ring - improve vaginal and urinary symptoms
Which type of HRT is given in which circumstance?
Transdermal oestrogen = hysterectomy
Micronized progesterone, Mirena IUS = no hysterectomy (protect endometrium)
Oral = pts that tried transdermal with no effect
What are the non-hormonal treatments for the menopause?
Vaginal lubricants and moisturisers
Alternative - acupuncture, reflexology, homeopathy
Psychological - CBT
