Menopause Flashcards
What are the stages of menopause?
Premenopause = regular periods Perimenopause = irregular periods Postmenopause = no periods >12 months
What is the average age of menopause onset?
Age 51
What age would be defined as early menopause?
Between age 40-44 = occurs in 5% of women
What age would be defined as premature ovarian insufficiency (POI)?
Onset
What are some features of the symptoms of menopause?
85% of women have symptoms
Average symptom duration = 7.4 years
Average number of symptoms = 7
When are the symptoms of menopause most severe?
In late perimenopause and early postmenopause = have major effect on home, work, family, socialand sex life
Do the symptoms of menopause get better over time?
Largely yes = exception is GU problems (dry vagina, painful sex, urinary symptoms)
What are the major symptoms of menopause?
Mood swings, nights sweats and hot flushes
What are some of the associated symptoms of menopause?
Loss of sex drive, insomnia, lack of energy, headaches, pins & needles, recurrent UTI symptoms, painful sex, irritability, depression, palpitations, tiredness, weight gain, aches & pains, memory loss, dizziness, anxiety
What is perimenopause?
Menopausal symptoms occurring before last period
Should women >= age 45 be routinely tested for FSH?
No = exception is women >=50 on hormonal contraception who don’t want to continue until age 55
What can help diagnose perimenopause?
Menopause symptom chart = also useful for tracking symptoms
What medications should menopausal women <45 be on?
HRT or CHC for bone health
What women should have their FSH levels measured twice 6 weeks apart?
Women >45 with atypical symptoms
Women between 40-45 with symptoms and/or iatrogenic amenorrhoea
What should be checked in menopausal women aged <40?
FSH, E2, TFT, glucose, prolactin and FAI
Also check chromosomes
What should be excluded in menopausal women aged <35?
Autoimmune disorders
What are some lifestyle changes recommended to help menopausal symptoms?
Healthy diet (including phytoestrogens) and weight
Regular exercise and good sleep hygiene
No smoking and limited alcohol and caffeine
Reducing stress and CBT
What are some changes to the patient’s environment that may help menopausal symptoms?
Cooler ambient temperature, good ventilation, suitable clothing, neck cooling scarf, cooling spray
Are non-hormonal treatments for menopause effective?
Debatable = limited effectiveness and scope of symptom relief
What are some non-hormonal treatments for menopause?
Herbal medicine = St Johns wort, black kohosh
SRRIs/SNRIs and gabapentin = help in up to 66%
Acupuncture, homeopathy, aromatherapy, acupressure
What are the benefits of HRT?
Increased quality of life, improved mental and sexual health, reduces osteoporosis, reduces CVD (up until age 60)
What does HRT increase the risk of?
Breast cancer, VTE and CVD (if age >60)
What can be used to treat and prevent vulvovaginal atrophy?
HRT = can also be treated with topical oestrogen
What are the contraindications to using HRT?
History of breast cancer, coronary heart disease, TIA or previous stroke, unexplained vaginal bleeding, active liver disease
How is HRT used in women with premature ovarian insufficiency?
Give HRT until average age of menopause = continuous CHC could be used as alternative, continue use of contraception
How is HRT used in women with early menopause?
Strongly consider giving HRT until average age of menopause
What kind of HRT is used in women who have had a hysterectomy or mirena in situ?
Oestrogen only
Oral = oestradiol or conjugated equine oestrogens
Transdermal = gel, patch, spray
What kind of HRT is used in women who haven’t had a hysterectomy or mirena in situ?
Oestrogen + progestogen
Sequential therapy if perimenopausal
Continuous therapy if postmenopausal
What is the first line treatment for vasomotor symptoms and low mood/anxiety related to menopause?
HRT
What are the benefits of transdermal HRT?
Low/no increased risk of VTE
Better for symptom control
Associated with less CVD risk
What are the indications for transdermal HRT?
Individual preference
Poor symptom control with oral HRT
GI disorder affecting oral absorption or migraine
Increased VTE risk or variable blood pressure control
Current use of hepatic enzyme-inducer
Gallbladder disease
What are the side effects of oestrogenic hormones?
Bloating, breast enlargement and tenderness, fluid retention, headaches, leg cramps, mood swings, nausea
What are the side effects of progestogenic hormones?
Acne, anxiety, bloating, breast tenderness, depression, headaches, hirsutism, lower abdo/pelvic/back pain, mood swings
Should contraception be stopped in perimenopausal women age <40?
No = PIO may be transitional
When should contraception be stopped in a perimenopausal woman aged 40-49?
2 years after last natural menstrual period
2 years after two FSH results >=30 UI/l (taken at least 4-6 weeks apart)
When should contraception be stopped in a perimenopausal woman aged >=50?
1 year after last natural menstrual period
1 year after one FSH result >=30 IU/l
Should contraception be stopped in a perimenopausal woman aged >=55?
Yes = even if still having periods (due to poor oocyte quality)
When would you continue giving contraception to a perimenopausal woman aged >=55?
May continue for a year or two if periods are troublesome
What is used to treat vulvovaginal atrophy?
Vaginal oestrogen (includes women on systemic HRT) Moisturisers and lubricants may also be used
Can vulvovaginal atrophy relapse after treatment is stopped?
Yes = symptoms may return after treatment stops
Should women with vulvovaginal atrophy have their endometrial thickness routinely monitored?
No
What should be used to treat vulvovaginal atrophy in women in whom systemic HRT is contraindicated?
Vaginal oestrogen = exception is when there is a history of breast cancer
