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Menopause Flashcards

1
Q

What are the stages of menopause?

A 
Premenopause = regular periods
Perimenopause = irregular periods
Postmenopause = no periods >12 months
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2
Q

What is the average age of menopause onset?

A

Age 51

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3
Q

What age would be defined as early menopause?

A

Between age 40-44 = occurs in 5% of women

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4
Q

What age would be defined as premature ovarian insufficiency (POI)?

A

Onset

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5
Q

What are some features of the symptoms of menopause?

A

85% of women have symptoms
Average symptom duration = 7.4 years
Average number of symptoms = 7

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6
Q

When are the symptoms of menopause most severe?

A

In late perimenopause and early postmenopause = have major effect on home, work, family, socialand sex life

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7
Q

Do the symptoms of menopause get better over time?

A

Largely yes = exception is GU problems (dry vagina, painful sex, urinary symptoms)

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8
Q

What are the major symptoms of menopause?

A

Mood swings, nights sweats and hot flushes

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9
Q

What are some of the associated symptoms of menopause?

A

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

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10
Q

What is perimenopause?

A

Menopausal symptoms occurring before last period

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11
Q

Should women >= age 45 be routinely tested for FSH?

A

No = exception is women >=50 on hormonal contraception who don’t want to continue until age 55

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12
Q

What can help diagnose perimenopause?

A

Menopause symptom chart = also useful for tracking symptoms

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13
Q

What medications should menopausal women <45 be on?

A

HRT or CHC for bone health

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14
Q

What women should have their FSH levels measured twice 6 weeks apart?

A

Women >45 with atypical symptoms

Women between 40-45 with symptoms and/or iatrogenic amenorrhoea

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15
Q

What should be checked in menopausal women aged <40?

A

FSH, E2, TFT, glucose, prolactin and FAI

Also check chromosomes

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16
Q

What should be excluded in menopausal women aged <35?

A

Autoimmune disorders

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17
Q

What are some lifestyle changes recommended to help menopausal symptoms?

A

Healthy diet (including phytoestrogens) and weight
Regular exercise and good sleep hygiene
No smoking and limited alcohol and caffeine
Reducing stress and CBT

18
Q

What are some changes to the patient’s environment that may help menopausal symptoms?

A

Cooler ambient temperature, good ventilation, suitable clothing, neck cooling scarf, cooling spray

19
Q

Are non-hormonal treatments for menopause effective?

A

Debatable = limited effectiveness and scope of symptom relief

20
Q

What are some non-hormonal treatments for menopause?

A

Herbal medicine = St Johns wort, black kohosh
SRRIs/SNRIs and gabapentin = help in up to 66%
Acupuncture, homeopathy, aromatherapy, acupressure

21
Q

What are the benefits of HRT?

A

Increased quality of life, improved mental and sexual health, reduces osteoporosis, reduces CVD (up until age 60)

22
Q

What does HRT increase the risk of?

A

Breast cancer, VTE and CVD (if age >60)

23
Q

What can be used to treat and prevent vulvovaginal atrophy?

A

HRT = can also be treated with topical oestrogen

24
Q

What are the contraindications to using HRT?

A

History of breast cancer, coronary heart disease, TIA or previous stroke, unexplained vaginal bleeding, active liver disease

25
Q

How is HRT used in women with premature ovarian insufficiency?

A

Give HRT until average age of menopause = continuous CHC could be used as alternative, continue use of contraception

26
Q

How is HRT used in women with early menopause?

A

Strongly consider giving HRT until average age of menopause

27
Q

What kind of HRT is used in women who have had a hysterectomy or mirena in situ?

A

Oestrogen only
Oral = oestradiol or conjugated equine oestrogens
Transdermal = gel, patch, spray

28
Q

What kind of HRT is used in women who haven’t had a hysterectomy or mirena in situ?

A

Oestrogen + progestogen
Sequential therapy if perimenopausal
Continuous therapy if postmenopausal

29
Q

What is the first line treatment for vasomotor symptoms and low mood/anxiety related to menopause?

A

HRT

30
Q

What are the benefits of transdermal HRT?

A

Low/no increased risk of VTE
Better for symptom control
Associated with less CVD risk

31
Q

What are the indications for transdermal HRT?

A

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

32
Q

What are the side effects of oestrogenic hormones?

A

Bloating, breast enlargement and tenderness, fluid retention, headaches, leg cramps, mood swings, nausea

33
Q

What are the side effects of progestogenic hormones?

A

Acne, anxiety, bloating, breast tenderness, depression, headaches, hirsutism, lower abdo/pelvic/back pain, mood swings

34
Q

Should contraception be stopped in perimenopausal women age <40?

A

No = PIO may be transitional

35
Q

When should contraception be stopped in a perimenopausal woman aged 40-49?

A

2 years after last natural menstrual period

2 years after two FSH results >=30 UI/l (taken at least 4-6 weeks apart)

36
Q

When should contraception be stopped in a perimenopausal woman aged >=50?

A

1 year after last natural menstrual period

1 year after one FSH result >=30 IU/l

37
Q

Should contraception be stopped in a perimenopausal woman aged >=55?

A

Yes = even if still having periods (due to poor oocyte quality)

38
Q

When would you continue giving contraception to a perimenopausal woman aged >=55?

A

May continue for a year or two if periods are troublesome

39
Q

What is used to treat vulvovaginal atrophy?

A 
Vaginal oestrogen (includes women on systemic HRT)
Moisturisers and lubricants may also be used
40
Q

Can vulvovaginal atrophy relapse after treatment is stopped?

A

Yes = symptoms may return after treatment stops

41
Q

Should women with vulvovaginal atrophy have their endometrial thickness routinely monitored?

A

No

42
Q

What should be used to treat vulvovaginal atrophy in women in whom systemic HRT is contraindicated?

A

Vaginal oestrogen = exception is when there is a history of breast cancer

Reproduction (62 decks)

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