Menopause Flashcards
What is menopause?
permanent cessation of the menstrual cycle for 12 months (diagnosed retrospectively)
What is perimenopause?
The time from the onset of ovarian dysfunction to diagnosis of menopause
(the time around menopause)
What is the average age for menopause in UK?
51
What is the age interval for menopause?
45-55
What occurs to GnRH during menopause?
First increases in perimenopause
Then decreases > overall reduction long term
What occurs to LH and FSH during menopause?
Increases
Progressive decline as person becomes elderly
What occurs to oestrogen and progesterone during menopause?
DECLINE
What are oestrogen levels like in the elderly?
Very low
What are progesterone levels like in the elderly=?
Undetectable
What occurs to inhibit during menopause?
Declines to an undetectable level
What is premature ovarian insufficiency?
Menopause before the age of 40
What is the option for conception in premature ovarian insufficiency=
Egg donation
What are causes of premature ovarian insufficiency?
Primary:
- chromosomal abnormalities (Turner’s, fragile X)
- Autoimmune disease (hypothyroid, Addisons, myasthenia graves)
- Enzyme deficiency
Secondary:
- Chemotherapy/radiotherapy
Infections
What is the main cause of POI?
UNKNOWN in 90% of patients = IDIOPATHIC
How is POI diagnosed?
2 FSH readings 4-6 weeks apart
FSH will be high in both
What is treatment for POI?
Supportive care and counselling
- HRT/COCP for bone health and CVD protection
- ART(egg donation + IVF) for infertility
What are immediate symptoms of menopause?
vasomotor - hot flushes, night sweats
psychological - labile mood, anxiety, tearfulness
neuro - poor memory, loss of concentration
MSK - joint aches and pains
derm - dry and itchy skin
decreased libido
Whatare intermediate symptoms of menopause=
vaginal dryness, dysparaeunia
urgency of urine
Recurrent UTI
urogenital prolapse
What are long term symptoms of menopause?
osteoporosis
CVD
dementia
Why do vasomotor symptoms occur in menopause?
due to exaggerated peripheral vasodilation to slight changes in external temperature
What are triggers for vasomotor symptoms?
alcohol, caffeine, sweating
How does fat distribution change in menopause?
from gyanecoid (breast and hip fat) to android (abdominal fat)
How do CVD risk factors change in menopause?
reduction in HDL
Increase in triglycerides, cholesterol, LDL
What is conservative management of menopause?
normal BMI
stop smoking
reduce alcohol consuptption
What are non hormonal treatments for menopause?
alpha agonist e.g. clonidine beta-blocker e.g. propanolol SSRI (for vasomotor symptoms) vaginal moisturiser /lubricant osteoporosis treatment (buphosphonate, raloxifene)
What kind of hormones are used in HRT, and in what combination?
OESTROGEN ONLY if no longer has a uterus
OESTROGEN + PROGESTERONE otherwise (can be CYCLICAL or CONTINOUS COMBINED)
What is the function of progesterone in HRT?
Protects the endometrium from cancer
What are routes of hormone therapy administration?
Oral / transdermal / coil / gel
What is the benefit of transdermal route?
It bypasses the liver
What are absolute contraindications for HRT?
Suspected pregnancy Breast cancer Endometrial cancer Active liver disease Uncontrolled HTN LVTE Thrombophilia Otosclerosis
How does HRT affect cancer?
It does not drastically increase breast cancer
It just promotes growth of the cancer cells
What is the hormone that increases risk of breast cancer?
Progesterone
What is the hormone that increases risk of endometrial cancer?
Oestrogen
Why do you need to give progesterone in HRT ?For which women is this necessary?
In women who have a uterus / with endometriosis tissue
It protects against endometrial cancer
What is cyclical HRT composed of?
Oestrogen continuously
Progesterone only on day 0-12
What women is cyclical HRT appropriate for’
LMP <1 yr prior / still having periods
Good for POI to preserve fertility
What women is continuous combined HRT appropriate for
Women with LMP >2 yrs prior
What is the benefit of continuous combined HRT compared to cyclical?
Continuous progesterone reduces risk of endometrial cancer
BUT
It increases risk of breast cancer
What is the impact of HRT on CVD?
Depends on women’s age
- younger;: protective
- older: increases risk
What women can HRT be prescribed to ?
Women in the WINDOW OF OPPORTUNITY
- <60 years old
- within 10 years of menopause onset
How. do you follow up a woman after her first HRT dose?
Recall 3 months after starting - to see if trial works
Every 12 months review (BP; breast exam, vaginal exam, mammograpy)
How long do you leave a woman on HRT for?
The least duration of time possible
What kind of HRT does not have increased VTE risk?
TRANSDERMAL
what is the effect of adding a progesterone to HRT on VTE?
Adding a Progesterone will INCREASE VTE risk
What kind of progesterone in HRT will reduce risk of endometrial cancer
CONTINUOUS combined (so continuous progesterone)
What kinds of cancer does estrogen cause
Endometrial
Ovarian
What kinds of cancer does progesterone cause
Breast, cervical
What cancer is progesterone protective for
Endometrial
