Menopause and HRT Flashcards
What are the 5 main stages of menopause?
- Pre menopause
- Premature menopause -> Now called Primary Ovary Failure (POF)
- Perimenopause
- Menopause
- Post menopause
What are the endocrine changes of menopause
- Declining oocyte numbers to critically low level
- Rising FSH and declining oestrogen characterises the menopausal transition
- Upper centres can keep working but the ovary cannot respond (due to low number of oocytes)
- Low oestrogen and declining follicles, upper centres are relased from negative feedback
- As the number of follicles diminishes inhibin declines which stimulates a rise in FSH via the negative feedback loop.
What is the menopause?
Over what ages does it occur? Average age?
What are the most important hormonal changes?
Menopause = cessation of menses
Age range from 45- 60
Mean age 51 yrs
Decline in ovarian oestrogen production (which accounts for 90% of total oestrogen)
How long can the perimenopausal phase last?
Up to 5 years
Describe the change in follicle number as a woman progresses throughout life
Number of follicles at birth
Number at menopause
Cause of the change of follicle number?
Age at which this causal factor begins?
1.2 million follicles at birth.
Only 1000 left by menopause, mostly lost by ATRESIA NOT ovulation.
Atresia = the degeneration of ovarian follicles which do not ovulate during the menstrual cycle.
Atresia will increase from the age of 35 ish
Describe the change in fertility as women progress throughout life
What risks increase?
- Fertility wanes from around 35-47 yrs
- Risks of miscarriage increase
- Meiotic non- disjunction –> failure of sister chromatids to separate during cell division
- Down syndrome/ Trisomy 21
What are the Sx of menopause related to?
What are the main sx?
- Note the menopause can have a wide variation in experience due to FALLING levels of oestrogen rather than low levels
- Periods space out –> Oligomenorrhea (infrequent menstrual periods > 35 days between each cycle).
- Then then cease –> menopause
-
Sx triad: SH Vagina
- Sweats
- Hot flushes (vasomotor instability)
- Vaginal dryness (urogenital tissues are oestrogen sensitive)
What are the non specific Sx of menopause?
Dont Have My Period Joy
Disturbed sleep
Headaches
Migraines
Palpitations
Joint and muscle aches
What are the urogenital Sx of menopause?
Vaginal dryness
Cystitis
Urinary frequency
Urinary incontinence
What are the psychological sx of menopause?
Psychotic PILL
Panic attack
Poor memory
Irritability
Loss of concentration
Loss of libido
What are the wider consequences of menopause on connective tissue?
Atrophy of connective tissue:
Skin thinning
Hair loss
Brittle nails
Aches and pains
Osteoporosis
What is a common condition that can develop post menopause?
How does it present?
What is the cost?
Osteoporosis commonly develops post menopausal (decline in oestrogen leads to loss of bone density).
Loss of bone matrix, loss of height and deformity.
Increased risks of fractures
High economic cost
How is menopause diagnosed?
How is premature menopause/ Premature ovarian failure (POF) diagnosed?
Diagnosis made based on age, symptoms and clinical signs.
Normally tests are not required but if under 40 consider FSH as a marker.
For Premature menopause/ Premature ovarian failure (POF) there needs to be the abscence of menses for 12 months
FSH > 30 mlU/mL
Define premature menopause
What % of women does it affect?
Premature menopause is defined as premature ovarian failure (POF) before the age of 40 years
Affects 1% of women under the age of 40 yrs.
What are the risks associated with premature menopause?
Premature death
neurological disease
psychosexual function
mood disorders
osteoporosis
IHD and infertility
Premature ovarian failure (POF)
How does it develop?
POF develops overtime due to a “disconnect” between hormones and ovarian function, or an autoimmune problem. Causes may be genetic, iatrogenic (e.g. chemotherapy tx.), autoimmune, often idiopathic.
It doesnt necessarily mean a lack of viable follicles –> this is menopause.
What changes in the menstrual cycle are seen with premature ovarian failure?
Oligomenorrhea (skipped period)
Polymennorrhoea (too frequent periods)
Metrorrhagia (bleeding in between periods)
What are the causes of POF?
Idiopathic
Familial tendency (inherited) (5%)
Autoimmune/ thyroiditis
Genetic –> fragile X syndrome or Turner’s syndrome (partly missing or completely missing an X chromosome)
(two healthy X chromosome’s required for full and normal ovarian function.)
Radiation/ chemotherapy/ tamoxifen (oestrogen receptor blocker).
Infections / viral
Oophrectomy (ovary removal) and total hysterectomy (surgical menopause)
What is hormone replacement therapy?
What does the preparation use?
What is it combined with and why?
HRT is the Administration of oestrogen to relieve menopausal Sx.
Preparation tend to use natural oestrogen and at lower doses than the oral contraceptive pill
Combination with progesterone also available and avoids cystic endometrial hyperplasia -> oestrogen powerful and promoting growth of the endometrium, progesterone suppresses this development.
What are the routes of administration of HRT?
How long does each route last?
Orally via daily tablets
Transdermal patches -> oestrogen alone or oestrogen and progestogen – >lasts 2 weeks
Subcutaneous oestrogen implants -> pellets implanted surgically lasting up to 6 months. Progestogen is taken orally at specific times to avoid uterine Sx., except in the cases of hysterectomy.
Topical oestrogen creams used to treat urogenital sx. such as vaginal atrophy and dyspareunia (painful sexual intercourse)
What are the benefits of HRT?
- improves the vasomotor sx. such as hot flushes and night sweats
- improves urogenital sx. such as vaginal atrophy, vulvovaginitis, dyspanedysuria
- Reduces fracture risk and osteoporosis. Oestrogen R function in bone, increases mineral density reduces osteoclast proliferation.
What are the adverse effects and risks of HRT?
- Thromboembolism and stroke
- Breakthrough bleeding, breast tenderness
- Increased risk of breast CA
- increased risk of dementia in > 65 yrs
What other drug (encountered in block 4) can be used to treat menopausal sx?
Raloxifene –> a SERM (selective oestrogen receptor modulator)
Used to treat osteoporosis via activating positive oestrogen like effects via ER function in bone but NOT in breast or uterus
