Menopause Flashcards
What is the definition of Menopause and perimenopause?
Definition – 12 months of amenorrhoea after the age of 45 (40-45 = early menopause)
Perimenopause – period of time before the menopause where cycles may become irregular and most of the menopausal symptoms occur
What percentage of women going through the menopause require treatment?
Occurs in all women but only 25% will require treatment for their symptoms
What causes menopause to occur?
Age
Premature ovarian failure
Medical/Surgical menopause
What are the signs and symptoms of menopause?
Vasomotor symptoms – flushes, nights sweats
Oestrogen breakthrough bleeding (> fortnightly) – lack of progesterone in anovulation
Irregular periods
Urinary incontinence due to connective tissue atrophy
Vaginal dryness and vaginal atresia lading to dyspareunia
Sleep disturbances
Lack of energy
Mood problems – anxiety and depression and memory problems
Long term
Osteoporosis
Thromboembolism
Increase in cardiac disease proportional to men
What investigations can be done to check for menopause?
FSH measurement (expect > 40 Iu/L) TFTs
What lifestyle changes can women make to help with menopausal symptoms?
Hot Flushes – exercise, weight loss and reduction of stress
Sleep disturbance – avoid late evening exercise and good sleep hygiene
Mood – sleep, regular exercise and relaxation
Cognitive symptoms – regular exercise and good sleep hygiene
How is the correct HRT regimen decided upon?
In order to find the correct HRT regime, there are 3 main areas to address - whether there is a uterus or not, whether the patient is perimenopausal or menopausal and whether a systemic or local effect is required.
What are the contraindications for HRT of any sort?
Contraindications – current or past breast cancer or any oestrogen sensitive cancer, undiagnosed vaginal bleeding, or untreated endometrial hyperplasia
Is combined HRT prescribed in a cyclical or continuous regimen?
HRT should be cyclical if their last known menstrual period was < 1year ago
HRT should be continuous if they have taken cyclical for at least 1 year, it has been 1 years since their LMP or it has been at least 2 years since their LMP if they had premature menopause (<40yrs)
What are the side effects and risks of combined HRT?
Combined HRT - increased risk of endometrial cancer, breast and ovarian cancers, DVT (if oral) and coronary artery disease. Combined HRT may cause breakthrough bleeding and all types of HRT may cause weight gain.
When is it suitable to use ERT and what are the side effects/risks?
ERT – only in women who have had a hysterectomy. As unopposed oestrogen drastically increases endometrial cancer risk, also increased risk of ovarian and breast cancer, stroke and DVT can cause weight gain (if oral)
What routes can the hormones in HRT be given?
Routes of administration
Oestrogen – oral, transdermal, subcutaneous or vaginal
Progesterone – oral, transdermal or intrauterine (Mirena)
What non-systemic hormonal treatments can be offered for menopause?
Vasomotor symptoms – SSRIs (paroxetine, fluoxetine etc. not sertraline) and SNRIs (venlafaxine), clonidine and gabapentin
Psychological symptoms – CBT
Vaginal dryness – Vaginal moisturisers and lubricants, and topical oestrogen cream (can be given as well as HRT) especially for urogenital atrophy.
When should HRT be stopped?
Stopping treatment should occur gradually and attempts should be made regularly, it is important to let women know this to help reduce reoccurrence. Although vaginal oestrogen is often required long term.
Where is menopause managed?
Should be treated in primary care unless: ineffective, side effects or unexplained bleeding.
