Menopause Flashcards
When does menopause usually occur?
Average is 51
Premature menopause is considered <40
Is menopause instant?
No it takes ~5yrs prior to the actual date of menopause for the body to change. This is known as perimenopause and is when you get the symptoms of menopause
What is happening during menopause?
Ovarian insufficiency. Oestradiol starts to fall and FSH rises
What are the symptoms of menopause?
Altered periods (perimenopause) Vasomotor (Hot flushes) Vaginal dryness & soreness Low Libido Muscle & joint aches Mood change & forgetfulness
Menoapuse also causes osteoporosis due to the lack of oestrogen, what are the risk factors for this?
- Thin women
- Caucasians
- Smokers
- Alcohol
- FH
- Amenorrhoea
- Malabsorption
- Steroids
- Hyperthyroid
How can we prevent and treat osteoporosis in menopausal women?
- Exercise
- Ca2+ & Vit D
- HRT
- Bisphosphonates
- Denosumab
- Teriparatide
What is denosumab?
A monoclonal antibody to osteoclasts
Mechanism - RANKL inhibition
What is the normal 1st line treatment for osteoporosis?
Bisphosphonates (if its not due to menopause) - eg Zoledronic acid
HRT is common treatment for peri-menopausal symptoms, how long is it used for?
For roughly 5 yrs, only used to treat peri-menopausal symptoms not forever
How can we deliver HRT?
Local - Vaginal oestrogen pessary, ring or cream
Systemic - Transdermal patch or oral
Why would you choose transdermal vs oral HRT?
Transdermal carries less risk of VTE
HRT also comes in various formulations and regimens, what are these?
1) Oestrogen only
2) Oestrogen/Progestogen (aka combined)
- (2a) Cyclical - 14 days E –> 14 days of E&P
- (2b) Continuous - 28 days E & P
When would we use Oestrogen only HRT?
If the women had no uterus, e.g. her menopause was after a TAH & BSO
if a woman still has a uterus - use combined HRT
When would we use Cyclical combined HRT vs continuous?
Cyclical is used if theres still some ovarian function i.e. still perimenopausal
Continuous is used if there’s no ovarian function i.e. its >1yr since menopause or they’re >54
There is another option for HRT delivery that can be used at any age, whats that?
Mirena Levonorgestrel Intra-uterine system (LNG IUS)
Along with daily E either oral or transdermal
What are the contraindications to HRT?
- Current hormone dependant breast/endometrial cancer
- Current liver disease
- Uninvestigated abnormal bleed
You should also seek advice you’ve had previous:
- VTE
- Thrombophilia & Fh/o
- Breast Ca
- Or carry BRCA genes
How do different types of HRT affect bleeding?
Cyclical combined has a withdrawal bleed
Continuous combined HRT is bleed free after 3 months
What are the pros & cons of HRT?
Pros = Works for vasomotor, local genital & osteoporosis symptoms
Cons = Increases risk of breast/ovarian cancer as well as VTE & stroke if taken orally
Heres some common misconceptions about HRT which patients may believe or ask about?
- It helps alzheimers
- It increases risk of CVD (doesn’t if started <60)
- High risk of breast cancer (goes from 1/100000 to 2/100000, actually less than if you were obese or drank a lot)
Whne should we give HRT?
- If they have severe vasomotor symptoms, and it should be reviewed annually
- For premature ovarian insufficiency (up to age 50)
- Vaginal oestrogen if they have vaginal symptoms
Don’t give it for someone just cos they have osteoporosis, treat that with bisphosphonates
Name some other non-HRT treatments for menopause?
- Selective Oestrogen Receptor Modulators (SERMS)
- SSRI & SNRI antidepressants e.g. venlafaxine
- Natural methods e.g. red clover & hypnotherapy
- Non-hormonal lubricants e.g. Sylk
How effective are antidepressants for menopause?
Pretty crap and they have lots of side effects
How effective are natural methods of treating menopause?
They have a high placebo effect and can be very costly. Some work some don’t its not really worth it.
Men have their own form of menopause called “andropause” how does this work?
Testosterone falls by about 1%/yr after 30, DHEAS also falls.
Unlike menopause fertility remains and the changes are more gradual
