Menopause and Postmenopausal Bleeding Flashcards
How is menopause diagnosed?
-Only diagnosed in retrospect 12 months after LMP in women >50 / 24 months in women <50
-Average age is 51-54
What is the physiology of menopause?
-Termination of ovarian follicular recruitment, selection and development
-In the presence of elevated FSH+LH
-Symptoms are due to falling oestrogen levels
What happens during the perimenopause phase?
-This is the transition period from reproductive stage to postmenopausal years
-Symptoms = weight gain, menstrual irregularities (4-5y)
-Increased FSH, normal LH, normal oestrogen
What is the source of oestrogen after menopause?
-Ovary no longer produces oestrogen due to absence of follicular development
-Main source is therefore peripheral conversion from androgens
What happens to FSH and LH after menopause?
-FSH - 10-20x increase
-LH - 3x increase
-Try to stimulate ovary - fluctuate a lot
-Causes an increase in androgens
How do low oestrogen levels influence osteoporosis?
Oestrogen reduces bone resorption, so PM effects are as follows:
-Increased bone resorption and decreased bone formation –> increased fragility
-Reduced bone mineral density
-Manage with bisphosphonates
-Those who smoke, have a low BMI, are European / asian and have a FHx of osteoporosis are more at risk
How do low oestrogen levels influence the genitals?
-Causes genital atrophy (lower vagina, labia, urethra, trigone)
-Can cause symptoms such as dyspareunia, vaginismus, dysuria, urgency, urinary incontinence
-Managed with topical oestrogen creams and lubricants
What are some symptoms of menopause in the early stages?
-Vasomotor symptoms eg:
–Sweats, palpitations, flushes
–Insomnia
–Tiredness, irritability, poor concentration
–Mood swings
–Reduced cognitive functioning
-Connective tissue problems eg:
–Skin / hair thinning (loss of collagen)
–Joint / muscle aches
–Fat redistribution
What are some symptoms of menopause in the medium term?
-Genital tract
–Atrophic vaginitis - dryness, soreness, dyspareunia
-Bladder
–Increased frequency and urgency
–Dysuria
–UTIs
-Bleeding
–Usually caused by atrophic vaginitis
–NB ?endometrial cancer
What are the different forms of HRT?
-Oestrogen - tablet, gel, patch
–Oestrogen = treats symptoms of menopause
-Progesterone - tablet (+/- oestrogen), patch + oestrogen, Mirena coil
–Progesterone = stabilises and maintains a thin endometrium and counteracts potential proliferative effects of oestrogen
What are some benefits of HRT?
-Improves symptoms
-Reduces risk of osteoporosis, CVD and stroke
-Reduces risk of bowel cancer
-Improves muscle strength
What are some risks of HRT?
-Breast cancer (progesterone)
-Heart disease (if oral HRT started 10y after menopause / PMHx of cardiac event)
-Thrombosis (if oral HRT, due to metabolism occurring in the liver)
-Stroke (if oral HRT)
SEs
-Nausea
-Erratic PV bleeding
-Headaches
-Leg cramps
-Dyspepsia
-Fluid retention
-Bloating / breast tenderness
What are the contraindications to commencing HRT?
-Liver disease (metabolised by liver)
-Thromboembolic disorders
-Women with oestrogen-dependent breast / endometrial cancers
-Pregnancy / breastfeeding
What considerations are made to women with / without a uterus?
-If woman has a uterus = oestrogen and progesterone
-If woman no longer has a uterus = oestrogen only
What management options besides HRT are available for menopause?
-Diet and lifestyle advice
-Mirena coil to help with menorrhagia
-Contraception should be used until >1 year of amenorrhoea
-SSRIs can help vasomotor symptoms
-Calcium + vit D / bisphosphonates to treat osteoporosis
