Menopause and HRT Flashcards
Menopause definition
Permanent cessation of menses
- Due to loss of ovarian function (loss of oestrogen effects)
Peri-menopause
- Definition
- Age
- Mean duration
Transition from reproductive cycle to post-menopause
Age
- Median is 47.5 (45-50)
Duration= 3.8 (4) years.
Mechanism + symptoms of peri-menopause
Very few ova remaining that can respond to hormones
- Causes irregular cycles
- Occasional heavy bleeding
- Hot flushes
- Mood changes
Primary symptoms of menopause
Menstrual cycle changes
Vasomotor
- Night sweats
- Hot flushes
- Can present early before menopause or or late after.
Vaginal dryness
Secondary symptoms of menopause [7]
Urinary stress/ urge incontinence
UTI/ cystitis risk
Mood changes
MSK pains (oesteoporosis)
Dry skin, hair thin, nail changes
Decreased concentration
Decreased libido.
Vasomotor symptoms
Includes
- Night sweats
- Hot flushes
Less severe in women of higher social class and better educational qualifications
Drugs for osteoporosis
Bisphosphonates
- Alendronate
- Risedronate
Drugs to reduce vasomotor symptoms [4]
Beta-blocks
Progesterone (not used commonly)
Selective oestrgen receptor modulators
- Raloxifene
Clonidine (alpha adrenergic stimulator)
Alternatives to HRT
No evidence suggested that they are particularly beneficial
Includes
- Phyto-oestrogens (soya beans)
- Herbalism
- Progesterone cream
- Homeopathy
- Acupunture
- Reflexology
Route of HRT [6]
Oral
Patches
Implants
Vaginal rings
Transdermal gel
Nasal
HRT regemines
Continuous
- Oestrogen only
- Indicated for those without uterus
- No bleeding or tablet break
Continuous sequential
- Oestrogen then progestogen at day 14
- Regular bleeding end of cycle
- No tablet break
Continuous combined HRT
- Oestrogen and progestogen given without tablet break
- No bleeding at the end of cycle
Unopposed oestrogen
Usually indicated in those without uterus
Low dose of oestradiol= cannot be contraception
Has to be taken continuously unless symptoms would return
HRT regime for females with uterus
Either
- Oestradiol everyday
Or
Norgestrol (oestrogen + progesterone) for 11 days
- Withdrawal bleeding
Absolute HRT contraindications [6]
Pregnancy
Active venous thromboembolism
Severe active liver disease
Endometrial carcinoma with recurrence
Breast carcinoma with recurrence
Relative contraindications HRT
Abnormal bleeding
Investigation that reveals breast lump
Previous breast cancer/ Strong family history of breast cancer
Family history of thromboembolism
