Menopause Flashcards
What is menopause?
cessation of periods
Explain premenopause, perimenopause and postmenopause?
premenopause= regular periods perimenopause= irregular period postmenopause= no periods > 12 months
What is the average age of UK menopause?
51 yo
Define premature ovarian insufficiency?
menopause < 40
Define early menopause? What percentage of women have early menopause?
age 40-44
5%
Percentage of women who experience severe menopause symptoms is ______
On average women experience ____ symptoms
ON average they last ______
85%
7
7.4 years
When are menopause symptoms most severe?
in late peri and early post menopause
Most menopause symptoms improve with time except _______
GUM problems e.g. dry vagina, painful sex and urinary problems
What are the symptoms of menopause? What are the top three?
Top 3:
hot flushes, night sweats, mood swings
Others:
brain fog, period problems, anxiety, dizziness, memory loss, dry skin and hair, aches and pains, weight gain, tiredness, lack of energy, palpitations, recurrent UTI symptoms, pins and needles, insomnia, decreased libido, headaches, painful sex, irritability
Explain what is meant by perimenopause?
the period before menopause- many women develop symptoms years before their last period
What testing is needed in those presenting with symptoms of perimenopause?
no routine FSH need in those 45 or over as FSH fluctuates at this point anyway
FSH x 2 (6 weeks apart) is indicated in women > 45 with atypical symptoms or in women between 40-45 with menopausal symptoms and/ or iatrogenic amenorrhoea (endometrial ablation or hysterectomy)
FSH, E2, glucose, prolactin and FAI should be checked in women < 40, in women less than 35 should also check chromosomes and exclude autoimmune causes
Overview of management of menopause?
lifestyle changes CBT for hot flushes environment changes non hormonal treatment: herbal medicine, SSRIs/ SNRIs, complementary medicine (e.g. acupuncture, homeopathy, hypnotherapy) HRT
Benefits of HRT?
increased quality of life, improved symptoms increased mental health increased sexual health decreased osteoporosis decreased CVD disease until age 60
Negatives of HRT?
increased breast cancer risk
increased VTE risk if taken PO
Increased CVD risk > 60
Contraindications of HRT?
history of breast cancer coronary heart disease TIA or previous stroke unexplained vaginal bleeding active liver disease
Explain what HRT you give to people?
If hysterectomy or mirena in situ only need oestrogen
If have uterus and no mirena then need oestrogen and progesterone, if perimenopausal then give sequential therapy, if postmenopausal give continuous combined therapy, need the progesterone to stop endometrial hyperplasia which could progress to cancer
How long can you give HRT for?
There is no time limit on HRT, can either gradually reduce or immediately stop
in those with early menopause or POI strongly advise giving HRT until at least 51
Perimenopausal contraception in someone under 40?
POI may be transitional, continue contraception
Perimenopausal contraception in those age 40-49?
stopped 2yrs after last natural period or if on contraception that is hormonal 2 years after 2 results of FSH > or equal to 30 taken 4-6 weeks apart
Perimenopausal contraception in those age 50-54?
stopped 1yr after last natural period or if on contraception that is hormonal 1 year after 2 results of FSH > or equal to 40 taken 4-6 weeks apart
Perimenopausal contraception in those 55 or over?
can stop even if still having periods
What is vulvo-vaginal atrophy?
thinning, drying and inflammation of the vaginal walls due to less oestrogen
Symptoms of vulvo vaginal atrophy?
can cause dryness, soreness, irritation, dyspareunia, urge incontinence
What is vulvo vaginal atrophy treated with?
topical oestrogen (v little risk) which can be used for as long as needed
