menopause Flashcards
What is menopause?
-Cessation of menses.
-Diagnosis is made 12 months after the last period (Retrospective Clinical Diagnosis)
in a pt who is in the average age of 49-55
-The average age is 51
What do you call menopause that happens between 40-48year of age?
-Early Menopause
What if menopuase starts from 30-40?
- Primary Ovarian Insufficiency/
- Premature ovarian failure.
What is perimenopause?
- Refers to the variable time
- Starts a few years before and
- Continues a for a year after the menopause.
*Variable Cycle Length (+/- 7 days different from normal)
*>/= 2 skipped cycles
and a interval of amenorrhoea (>60 days)
-Perimenopause includes the Climacterium.
What does Climacterium mean?
- Refers to the time after the cessation of reproductive function.
- Marked by a change in menstrual cycle.
What causes Iatrogenic/Premature Menopause?
- Hystrectomy
- Oophorectomy
- Chemo Radiation
causes iatrogenic/premature menopause.
What is the physiology of menopause?
- In human body there is Finite Ovarian
Follicular Capacity. - During the average age of menopause, follicles run out
- There is cessation of Folliculo-genesis.
- This results in reduced oestrogen circulation.
- Reduced oestrogen circulation causes menopausal symptoms.
What will reduced oestrogen circulation in blood cause?
Acute
Intermediate and
Long term Sx
What are the acute Sx of decrease in oestrogen circulation in menopuase?
- Acute Symptoms (within months of hypo-oestrogenism)
- Vasomotor Symptoms (Hot Flushes)
- Night sweats
- Insomnia
- Mood Changes
- Headaches
- Anxiety and irritability
- Poor memory and concentration
- Loss of self esteem.
- Amenorrhoea
What are the intermediate Sx?
- Genital tract Atrophy
- Dyspareunia and loss of libido
- Urethral Syndrome
- Skin thinning
- Urinary incontinence ?
- Joint pain?
- Uterine vaginal prolapse.
What are the long term Sx?
- Osteoporosis
- Coronary heart disease
- Cerebrovascular accidents
What are the commonest sx that pt in menopauase present with?
- Vasomotor Sx
- Hot flushes (commonest) - Menstrual Irregularity
- Urogenital Sx
- Dryness
- Incontinence
- Urgency
- Prolapse
Menstrual Irregularity in peri-menopause:
-Anovulatory type
(Skips period and has heavy bleeding)
-Exclude organic cause
*Do Pap smear
*Do endometrial sample
to exclude non-benign cause
Management:
-Menopause Hormonal Therapy.
- Progestogens if contraception requires.
3. NSAIDs
Urogenital Atrophy in perimenopause:
- Vaginal dryness and Atrophy
- Urinary incontinence
- Urogenital prolapse
Management:
If only vaginal dryness and atrophy, can give topical vaginal oestrogen
if prolapse= conservative vs surgical options
What are the indications of Menopausal Hormonal Therapy?
- Severe vasomotor Symptoms.
- Topical form for Urogenital atrophy.
- Osteopaenia/osteoporosis
* Controversial - Premature Ovarian failure
- Early Menopause
What are the contraindications of MHT?
- Breast Cancer, family history
- Previous venous thromboembolus
- Inherited thrombophilias
- Active Liver disease
- Undiagnosed Abnormal vaginal bleeding
- Cradiovascular disease
Types of MHT:
- Estrogen only Therapy (ET)
- For pts without uterus - Estrogen-Progestin Therapy (EPT)
- For patients with intact uterus.
*Sequential EP
(Progestin will come, later on on day 14, till day 28 and then will be withdrawan,
pt will get withdrawal bleeding)
-useful in early perimenopausal age group.
If pt has vasomotor sx and ireegularity bleeding then sequential EPT.
*Continuous Combined EPT.
(Have equal dosages of oestrogen and progestin)
at what age should MHT not be used?
> 60 years of age
What is the mx of menopause?
1.Lifestyle Modification
-healthy diet, moderate excercise,
smoking
- Menopausal Hormonal Therapy.
- Clonidine (for vasomotor sx)
- Biphosphonates
SERMs (for osteoporosis) - Psychotheraphy for selected pts.
- Annual f/u and review.
Complementary Treatment for menopause:
- Vitamin D and
Calcium supplementation - Herbal Remedies and phyto-eostrogens
- Significant or unproven risk profile
What is the contraindication of unopposed oestrogen/ estrogen only therapy?
- Contraindicated in pt with an intact uterus
- Unopposed oestrogen will lead to endometrial cancer
- Dont just repeat prescriptions
dd of post menopausal bleeding:
- Cervical cancer (do pap smear)
- Endometrial cancer (do endometrial sampling)
- Endometrial hyperplasia (do transvaginal u/s to get ET)
- Endometrial polyps
- Vulvovaginal atrophy
- Can use topical oestrogen cream (Premarin)
can be used even if oral oestrogen contrindicated.
